Cardiometabolic & kidney

Adult-onset type 1 diabetes: predictors of major cardiovascular events and mortality

Eur Heart JPublished Registry-based cohort study

Authors' conclusion

Adult-onset T1D carries excess risk of death and MACE compared with population controls but less MACE risk than T2D. Individuals diagnosed after age 40 had similar excess risk and poorer glycaemic control than those diagnosed earlier

Study context

Population
People diagnosed with adult-onset T1D or T2D in 2001–20, Swedish National Diabetes Register, and population controls, followed until 2022
Participants
10,184 / 375,523 / 509,172
Exposure
Adult-onset T1D vs population controls and vs T2D
  • T1Dn = 10,184
  • T2Dn = 375,523
  • Population controlsn = 509,172reference
Outcome
Mortality, MACE and prognostic factors
Methodological detailsnationwide registers
  • Nationwide registers

Main finding

As reported in the abstract

Hazard ratio (95% CI)
T1Dvs Population controlsMACE
1.30(1.17–1.45)
T1Dvs Population controlsall-cause mortality
1.71(1.60–1.84)
T1Dvs T2DMACE
0.67(0.60–0.75)

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
Mortality from diabetic coma or ketoacidosisT1Dvs T2D7.04 (4.54–10.9)

Prognostic factors for death in T1D (PAR%)

Smoking
10.7%
HbA1c ≥ 53 mmol/mol
10.4%

Prognostic factors for major adverse cardiovascular events (MACE) in T1D (PAR%)

Overweight/obesity
19.8%
Smoking
8.4%
High HbA1c
8.8%

T1D diagnosed at age ≥40 (subgroup)

Results similar; lower insulin pump use and higher HbA1c than those diagnosed earlier

Original publication

Adult-onset type 1 diabetes: predictors of major cardiovascular events and mortality. Eur Heart J. Published 14 May 2025. doi:10.1093/eurheartj/ehaf304

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