Cardiovascular disease remains a major burden for people with type 1 diabetes

Cardiovascular disease remains a major cause of illness and death among the estimated 9.5 million people worldwide living with type 1 diabetes, according to a new review published in Cardiovascular Diabetology – Endocrinology Reports. Despite substantial advances in diabetes care, the review concludes that the burden of cardiovascular disease and its personal and socioeconomic consequences remain high in this population.

The review, written by a multidisciplinary team of authors, highlights that atherosclerosis occurs earlier in people with type 1 diabetes than in the general population. Those whose diabetes begins in early childhood face a particularly high lifetime risk of cardiovascular disease, underscoring the importance of prevention starting early in life.

According to the authors, both traditional and novel risk factors contribute to cardiovascular disease in type 1 diabetes. Traditional factors include glycaemia, blood lipids, blood pressure, obesity and smoking. Novel factors include social determinants of health, inflammation and genetics. The review argues that these multiple influences call for a life-course approach to managing overall cardiovascular risk, with the aim of preventing or mitigating end-stage complications such as atherosclerotic events, cardiac autonomic neuropathy and heart failure.

A central concern raised in the review is that most people with type 1 diabetes do not meet all recommended risk factor targets. This gap between guideline recommendations and real-world achievement of targets persists even as guidelines advocate increasingly intensive goals for risk factor management.

Risk prediction is another focus of the review. Type 1 diabetes-specific risk calculators for cardiovascular disease are available and can guide shared decision-making and risk factor management. However, the authors note that greater awareness of these tools and further data are needed to inform their use across different type 1 diabetes populations.

The review identifies a relative paucity of type 1 diabetes-specific clinical trial data to inform the management of cardiovascular risk factors such as dyslipidaemia, hypertension and chronic kidney disease, as well as the treatment of clinically evident cardiovascular disease.

One area of growing interest is the use of adjunct glucose-lowering drugs that were initially developed for type 2 diabetes, including sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 agonists. The review reports that some benefits have been shown for weight, glycaemia, blood pressure and albuminuria. However, cardiovascular outcome trials specifically conducted in people with type 1 diabetes are currently lacking, and the authors describe this absence of dedicated trials as a critical gap.

Technologies also feature in the review’s assessment of current care. Optimising risk factors alongside technologies such as insulin pumps and continuous glucose monitoring not only improves glycaemic control but also helps mitigate chronic complications, according to the authors. Continuous ketone monitoring is described as an emerging option offering promise, although regulatory approvals for its use remain limited.

The review concludes that type 1 diabetes-specific or validated cardiovascular risk tools now inform primary prevention, with guidelines advocating more intensive targets. It calls for dedicated cardiovascular outcome trials in type 1 diabetes and for robust real-world data to guide clinical practice, framing these as essential steps to close the evidence gap and improve cardiovascular outcomes for the millions of people living with the condition.

Subject of Research: Cardiovascular risk, prediction and management in people with type 1 diabetes

Article Title: Type 1 diabetes and cardiovascular medicine

Article References: Jenkins, A. J., Huang, M., Hemphill, M., Chen, D., Ha, J. T., Sata, Y., Sindone, A., Gnanenthiran, S. R., & Lan, N. S. R. (2026). Type 1 diabetes and cardiovascular medicine. Cardiovascular Diabetology – Endocrinology Reports, 12(1), Article 63. https://doi.org/10.1186/s40842-026-00338-9

Image Credits: AI Generated

DOI: 10.1186/s40842-026-00338-9

Keywords: type 1 diabetes, cardiovascular disease, atherosclerosis, risk factors, risk prediction, heart failure, SGLT2 inhibitors, GLP-1 agonists, cardiovascular outcome trials, continuous glucose monitoring, chronic kidney disease, hypertension