Analysis of 10,587 Taiwanese patients with type 2 diabetes revealed NT-proBNP thresholds of 179 pg/mL (outpatient) and 728 pg/mL (emergency) best predicted heart failure hospitalization over 3.5 years. Age-stratified cutoffs ranged from 85 pg/mL in patients under 50 to 290 pg/mL in those over 75. These thresholds are substantially lower than current Western guidelines, suggesting Asian populations may develop detectable cardiac stress at lower biomarker levels. The finding addresses a critical gap in precision medicine, as heart failure remains a leading cause of death in diabetes patients worldwide. Lower diagnostic thresholds could enable earlier intervention with ACE inhibitors, beta-blockers, or SGLT2 inhibitors before irreversible cardiac damage occurs. However, this remains a preprint awaiting peer review, and the retrospective design cannot establish whether earlier detection translates to improved outcomes. The study's strength lies in its large sample size and real-world hospital setting, but validation across other Asian populations is needed. If confirmed, these ethnicity-specific thresholds could reshape cardiovascular screening protocols for millions of diabetic patients across Asia, potentially preventing thousands of preventable heart failure hospitalizations through earlier detection and treatment.