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June 7, 2026Diabetes

High-risk metabolic and renal trajectories over decades linked to substantially elevated CVD and mortality in T1D.

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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?

Population

1,441 T1D participants (baseline age 28 years)

Comparison

Trajectories of HbA1c, eGFR, AER, BMI, and triglycerides

Design

Cohort study (DCCT/EDIC data analysis using latent growth mixture models)

Follow-up

Over decades

Key result

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.

Authors

BBBARB BRAFFETTTCTINA COSTACOULGLaure K. El ghormli

Discussion

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Member takes

Overview

May inform risk stratification via longitudinal monitoring; leaves open whether targeting trajectories improves outcomes in type 1 diabetes.

Key Points

  • This study aims to characterize the long-term trajectories of risk factors in individuals with type 1 diabetes and assess their impact on cardiovascular disease and mortality.
  • Analyzed data from 1,441 type 1 diabetes participants using latent growth mixture models to identify trajectories of HbA1c, eGFR, AER, BMI, and triglycerides.
  • CVD events were reviewed and adjudicated by a committee.
  • Examined the correlation between glycemic and non-glycemic risk factors and their association with cardiovascular outcomes.
  • Identified four distinct HbA1c trajectories, two for eGFR, and three each for AER, BMI, and triglycerides.
  • High-risk trajectories were linked to earlier enrollment, conventional therapy, and increased CVD and mortality risk.
  • Stable trajectories showed a correlation with lower risks of CVD and mortality compared to rapid worsening patterns.

Study Design

Type

Cohort (n=1,441)

Structured PICO

Are specific trajectories of glycemic and non-glycemic risk factors associated with cardiovascular disease and mortality in patients with long-duration type 1 diabetes?

P
Population
1,441 participants with type 1 diabetes (baseline age 28 years) followed over decades to characterize risk factor trajectories.
O
Outcome
Cardiovascular disease (CVD) and mortalityhard clinical

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.

Cite This Study

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.

synapsesocial.com/papers/6a250d2a7def13d035e1d37chttps://doi.org/10.2337/db26-2983-lb
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 12173-P: Twenty-Year Glycemia Trajectories and Risk for Cognitive Impairment (CI) in Adults with Prediabetes or Type 2 Diabetes (T2D) in the Diabetes Prevention Program Outcomes Study (DPPOS)2026
  2. 21864-P: What Makes the Difference? Predicting Glycemic Trajectory following AID Initiation in Youth with Type 1 Diabetes2026
  3. 32965-LB: Cardiovascular Disease Risk Prediction in Type 1 Diabetes over 30 Years2026
  4. 474-OR: ADA Presidents' Select Abstract: CGM Metrics from Five Studies Identify Participants at High Risk of Imminent Type 1 Diabetes (T1D) Development2024 · 1 citations
  5. 546-PUB: Trajectory of Kidney Function in Type 1 Diabetes over Time: A Scoping Review2026