Long-Term Major Adverse Cardiovascular and Cerebrovascular Event Risk in Adult-Onset Type 1 Versus Type 2 Diabetes: A...

Evidence characterizing major adverse cardiovascular and cerebrovascular (MACCE) risk in adult-onset type 1 diabetes (T1DM), particularly versus type 2 (T2DM), remains limited, inconsistent, and derived from non-U.S. cohorts. Leveraging a multi-center U.S. database, we compared long-term MACCE risk between adult-onset T1DM and T2DM.

Using TriNetX, adults diagnosed with T1DM or T2DM between 2005-2015 were followed through 2025. Cohorts were stratified by age, HbA1c, and non-insulin antihyperglycemic use. Patients were 1:1 propensity-score matched on demographics and comorbidities, yielding a covariate-balanced comparator subset of T2DM patients. Cumulative 10-year risks of MACCE (stroke, hemorrhage, cardiac arrest, heart failure, myocardial infarction, peripheral vascular events, and revascularization procedures), kidney complications, and all-cause mortality were reported for unmatched and matched cohorts, and strata.

At baseline, T1DM patients (n = 36 599) were younger with fewer comorbidities than T2DM patients (n = 1 740 748). 10-year MACCE incidence in T1DM was 5.2%. Upon matching (n = 33 364), risks of MACCE (5.5% vs. 11.3%; risk ratio [RR] 0.48; p < 0.001) and all-cause mortality (7.7% vs. 8.3%; RR 0.92; p = 0.003) were lower in T1DM. This held true upon stratification, except mortality which was similar between patients prescribed antihyperglycemics (7.0% vs. 6.5%; RR 1.07; p = 0.45).

Compared with a propensity-matched phenotypically selected T2DM comparator cohort, T1DM was associated with lower 10-year MACCE and modestly lower all-cause mortality risk, suggesting lower relative cardiovascular event burden in newly diagnosed adults. In T2DM, however, antihyperglycemic therapy mitigated mortality risk, yielding survival comparable to T1DM.