Highly Uncontrolled Cardiovascular Risk in Emerging Adults With Paediatric-Onset Type 1 Diabetes-A Cross-Sectional Analysis From the Diabetes Prospective Follow-Up Registry DPV.

Aims Cardiovascular disease (CVD) is a major contributor to premature morbidity and mortality in individuals with type 1 diabetes (T1DM). Glycaemic control often deteriorates during the transition from paediatric to adult care, and thus we assessed the prevalence and pharmacological management of overt and actionable modifiable cardiovascular risk factors in adolescents and young adults with paediatric-onset T1DM. We examined factors associated with risk burden and early microvascular complications.Methods We analysed data from 7298 individuals aged 17-26 years with paediatric-onset T1DM and ≥ 2 years diabetes duration in the DPV registry between 2020 and 2023. Five predefined CVD risk factors were assessed (HbA1c > 9%, obesity, elevated blood pressure, LDL > 130 mg/dL, smoking), using median values over a 3-year observation period. Factors associated with cumulative risk burden and associations with retinopathy and microalbuminuria were evaluated using multivariable linear and logistic regression models.Results At least one CVD risk factor was present in 49.2% of individuals; 19.1% had ≥ 2 and 5.2% ≥ 3 risk factors. Poor glycaemic control, defined as HbA1c > 9% (21.8%) and elevated blood pressure (17.6%) was most frequent. CVD risk factor burden was associated with diabetes duration > 10 years and migration background. The likelihood of microalbuminuria increased progressively with the number of CVD risk factors, with an odds ratio of 2.68 (95% CI: 1.34-5.36) among individuals with four risk factors. Within this high-risk cohort, significant indication-treatment gaps remained: only 9.9% with overtly elevated LDL cholesterol > 130 mg/dL and 19.8% with hypertension > 140/90 mmHg received medication.Conclusions Young adults with paediatric-onset T1DM show a high burden of modifiable CVD risk factors with substantial treatment gaps, and clustering is associated with microvascular complications. Early identification and targeted intervention are critical to mitigating long-term vascular damage.