Key result
High-risk metabolic and renal trajectories over decades linked to substantially elevated CVD and mortality in T1D.
Why the study?
Complications in type 1 diabetes evolve progressively over decades, affecting quality of life and longevity, but the long-term trajectories of glycemic and non-glycemic risk factors and their links to cardiovascular disease and mortality needed characterization.
Are specific trajectories of glycemic and non-glycemic risk factors associated with cardiovascular disease and mortality in patients with long-duration type 1 diabetes?
Cohort (n=1,441)
Are specific trajectories of glycemic and non-glycemic risk factors associated with cardiovascular disease and mortality in patients with long-duration type 1 diabetes?
In patients with long-duration type 1 diabetes, stable trajectories and slower worsening of risk factors (HbA1c, eGFR, AER, BMI, triglycerides) are associated with lower cardiovascular disease and mortality risk.
Answers are grounded in this paper and cite their sources.
May inform risk stratification via longitudinal monitoring; leaves open whether targeting trajectories improves outcomes in type 1 diabetes.
Introduction and Objective: Complications in type 1 diabetes (T1D) evolve progressively over decades, with consequences for quality of life and longevity. Using DCCT/EDIC data, we characterized trajectories of glycemic and non-glycemic risk factors, assessed their overlap, and examined links with cardiovascular disease (CVD) and mortality. Methods: Among 1,441 T1D participants (baseline age 28 years), latent growth mixture models identified trajectories for HbA1c, eGFR, AER, BMI, and triglycerides from EDIC visits. CVD events were adjudicated by a review committee. Results: Four HbA1c trajectories, two eGFR trajectories, and three each for AER, BMI, and triglycerides were identified (Figure 1). High-risk trajectories (HbA1c: Very High-Declining or Low-Rising, eGFR: Rapid Decline, AER: Early or Late Rise, BMI: Accelerated Rise-Decline, or triglycerides: Rapid Rise-Decline) consistently clustered with adolescent enrollment, conventional therapy, higher insulin requirements, lower insulin sensitivity, and substantially elevated CVD and mortality risk. Unfavorable glycemic trajectories co-occurred with higher-risk kidney injury and dyslipidemia trajectories. Conclusion: Glycemic control and complications evolved over decades in interrelated, clinically interpretable patterns. Stable trajectories and slower, rather than rapid, worsening in HbA1c, eGFR, AER, BMI, and triglycerides were associated with lower CVD and mortality risk. Disclosure B. Braffett: None. T. Costacou: None. L.K. El Ghormli: None. H. Karanchi: None. C. Limonte: None. J. Sherr: Other - research support, consultant, advisory board member; Current; Abbott Diabetes. Other - advisory board member, consultant; Current; Vertex Pharmaceuticals Incorporated. Consultant; Current; Ypsomed AG. Research Support; Current; Dexcom, Inc., JDRF, Provention Bio, Inc., National Institutes of Health. Other - research support, consultant, advisory board member; Current; Insulet Corporation, Medtronic. Research Support; Current; Sanofi. Advisory Panel; Current; sequel med tech. A.B. Karger: Research Support; Ended; Medtronic. I. de Boer: Consultant; Current; Boehringer Ingelheim International GmbH, Novo Nordisk, GlaxoSmithKline plc., Lilly. Consultant; Ended; Dexcom, Inc. Research Support; Current; Novo Nordisk, Dexcom, Inc. Consultant; Ended; AstraZeneca. Consultant; Current; Roche Diabetes Care. Consultant; Ended; Lexicon Pharmaceuticals, Inc. I. Bebu: None.
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BRAFFETT et al. (2026) conducted a cohort in Type 1 diabetes (n=1,441). High-risk trajectories of glycemic and non-glycemic risk factors vs. Stable trajectories and slower worsening was evaluated on Cardiovascular disease (CVD) and mortality. High-risk trajectories of HbA1c, eGFR, AER, BMI, and triglycerides over decades were associated with substantially elevated cardiovascular disease and mortality risk in type 1 diabetes.
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