Miller RG, Orchard TJ, Costacou T, et al. - A hypothesis was tested that there exists heterogeneity in long-term patterns of glycemic control with respect to cardiovascular disease (CVD) development in type 1 diabetes and that risk factors for CVD vary by glycemic control pattern. The observed risk factor differences indicate that pathways to CVD could vary by glycemic control, potentially leading to crucial implications for prognosis in type 1 diabetes.

• In the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years old) type 1 diabetes, the links between data-derived latent HbA _1c trajectories and 30-year CVD risk were estimated.

• A total of 536 participants with mean age 27, who were CVD-free at baseline (with two or more HbA _1c measurements [median 6] and diabetes duration 18 years), were observed from 1986 to 1988 to 2016 to 2018.

• Experts discovered two HbA _1c trajectories with respect to differential CVD risk: low (HbA _1c ∼8% [64 mmol/mol] and improving over follow-up, 76% of cohort) and high (HbA _1c ∼10% [86 mmol/mol] and stable, 24%).

• The estimated 30-year CVD incidence and major adverse cardiovascular event incidence was 47.4% (n = 253) and 31.0% (n = 176), respectively.

• Threefold elevated CVD risk was noted with high HbA _1c vs low HbA _1c .

• Link of non-HDL cholesterol and estimated glomerular filtration rate with CVD risk was identified only in low HbA _1c ; albumin excretion rate was related to CVD risk only in high HbA _1c .