Cardiovascular risk in Type 1 Diabetes: An overlooked reality
Type 1 Diabetes (T1D) is an autoimmune, lifelong disease. Despite advances in diabetes care, cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in this population, accounting for 44% of deaths among people living with T1D. Compared with the general population, individuals with T1D develop CVD earlier in life and experience a reduced life expectancy of at least 11 years.
While the elevated cardiovascular risk in T1D is well recognised, the mechanisms linking T1D, cardiovascular risk factors, and cardiovascular events are not yet fully understood. A major challenge is the delayed identification and management of CVD risk in people with T1D, which limits opportunities for timely intervention.
Cardiovascular risk in T1D often remains high even when traditional indicators, such as blood pressure, cholesterol, and glycaemic control, are well managed. This suggests additional, disease-specific drivers of risk that are not fully addressed by standard cardiometabolic prevention frameworks. Emerging evidence indicates that immune system dysfunction, a hallmark of autoimmune T1D, may contribute to CVD through interlinked inflammatory pathways.
Without adequately reflecting these distinct disease characteristics, opportunities for earlier risk recognition and more targeted prevention for people living with T1D may be missed.
CVD risk awareness matters for people living with Type 1 Diabetes
At a recent policy dialogue co-hosted by Breakthrough T1D, the International Diabetes Federation (IDF) Europe and the International Society for Paediatric and Adolescent Diabetes (ISPAD), people living with T1D and clinicians highlighted the importance of earlier and more transparent communication about cardiovascular risk. Mikael, Sara and Adrianna, who live with T1D, shared the feeling of many affected individuals: “Discussions about cardiovascular risk take place late and are frequently framed as distant complications. Too often, heightened CVD risk is recognised only after a cardiovascular event has already occurred”. Participants also underscored the need for more integrated care pathways, stronger awareness among healthcare professionals, and meaningful inclusion of people with T1D in clinical research.
A shift from late-stage complication management to earlier prevention supports timely intervention, improved patient outcomes, and more resilient healthcare systems.
Now is the time to deliver an EU Safe Hearts Plan for all people with Type 1 Diabetes
The EU’s Cardiovascular Health (Safe Hearts) Plan, published in December 2025, presents a timely opportunity to address these gaps. With its strong emphasis on prevention, early detection, and care pathways, the Plan should offer a framework that can deliver meaningful progress for populations whose cardiovascular risk has historically been overlooked, including people living with T1D. As the European Parliament considers its position in early 2026, several areas warrant particular attention.
Early identification and prevention
The Safe Hearts Plan rightly recognises the need to identify populations at increased cardiovascular risk. People living with diabetes – including T1D, T2D and those with a history of gestational diabetes – belong in this category, and their needs should be explicitly addressed during the implementation of the Plan.
The proposed EU protocol on health checks and screening for conditions such as cardiovascular disease, diabetes, and obesity has the potential to support earlier identification of risk and accelerate the shift from costly treatment to actionable prevention. Ensuring that screening approaches are appropriately adapted across diabetes types, in particular T1D and T2D, will be key to harmonising early detection and strengthening long-term cardiovascular prevention. International consensus around the need for early detection of T1D, via autoantibody screening, is growing, with leading diabetes organisations calling for a coherent European strategy. The EU (IHI)-funded programme EDENT1FI is rapidly generating evidence on the feasibility, public awareness, and cost-effectiveness of T1D screening.
In addition to the importance of early detection of T1D, it is also crucial to focus on the prevention and management of cardiovascular disease in people with established T1D.
Initiatives in several Member States, alongside EU-funded programmes such as iCARE4CVD, are generating evidence on the feasibility, public awareness, and cost-effectiveness of targeted CVD risk assessment in people with diabetes. iCARE4CVD is a public-private research collaboration aiming to personalise prevention and treatment of CVD. The project focuses on four key areas: enhancing early diagnosis of patients at risk, assigning risk levels to prioritise urgent intervention, predicting individual responses to treatment using AI-based tools, and integrating patient-reported outcomes into care.
Research, innovation, and evidence
Crucially, iCARE4CVD will also lay the foundations for a prospective clinical trial in people with T1D, who remain underrepresented and often excluded from cardiovascular clinical trials. This limits the potential relevance of evidence coming out of the trials, slows progress toward tailored prevention strategies, and sustains care models that overlook population-specific needs. The Safe Hearts Plan’s focus on closing research and innovation gaps is particularly relevant in this context.
Registries and long-term monitoring
In its Safe Hearts Plan, the European Commission calls for a higher ambition in Member States’ registry infrastructure.
Establishing national diabetes registries in Europe that can drive quality improvements in diabetes care, with consequent improvements in outcomes for people with diabetes, is a work in progress. The number of dedicated initiatives is growing along with expanding awareness of the importance of monitoring diabetes care performance amongst all European clinical stakeholders.
As innovation in T1D advances, including the availability of disease-modifying therapies and cell-based treatments, robust registries and long-term follow-up frameworks are essential to assess their real-world impact on CVD outcomes.
The path ahead for Type 1 Diabetes and Cardiovascular Health
Recognising T1D as a distinct at-risk population – and embedding early detection, research, innovation, and data frameworks that reflect its specific cardiovascular risk drivers across the life course – will be critical to making sure the Safe Hearts Plan will be truly safe for all.
Doing so will require sustained investment in research that goes beyond traditional risk factors, meaningful inclusion of people with T1D in cardiovascular trials, and a regulatory and data environment that supports innovation while enabling timely, safe access to new therapies.
By closing the current prevention gap, Europe can ensure that ambition in cardiovascular policy translates into measurable improvements in outcomes for all at-risk populations, including people living with T1D.
Written by:
Chantal Mathieu, Chair, EUDF, Past President, European Association for the Study of Diabetes (EASD)
Carine de Beaufort, Past President, International Society for Paediatric and Adolescent Diabetes (ISPAD)
Carmen Hurtado del Pozo, Director of European Research, Breakthrough T1D
Sufyan Hussain, Board Member, International Diabetes Federation Europe (IDF-Europe)