Age at Type 2 Diabetes Diagnosis Helps Predict Cardiovascular and Mortality Risk

Age at type 2 diabetes diagnosis influences long-term cardiovascular and mortality risk. This is the conclusion of a study conducted by a team from the Jordi Gol Primary Care Research Institute (IDIAPJGol) and the Sant Pau Research Institute (IR Sant Pau), recently published in eClinicalMedicine, part of The Lancet group. The study draws on data from 1,880,545 people receiving primary care in Catalonia between 2010 and 2021. Its findings may help healthcare professionals better tailor cardiovascular prevention to each individual, particularly in older age.

The study included data from 481,709 people newly diagnosed with type 2 diabetes and compared them with 1,398,836 people without diabetes, matched by sex and year of birth. The data came from the Information System for Research in Primary Care (SIDIAP), which collects pseudonymized clinical information on more than 75 % of Catalonia’s population. Participants were followed for up to ten years.

Timing of Diagnosis Changes the Prognosis

The research team compared several age groups to analyze how the excess risk associated with diabetes varies relative to the risk in people without the disease.

The results show that, after ten years of follow-up, people diagnosed before age 65 have an 18% greater relative excess risk of heart failure than those diagnosed at age 65 or older. Among older adults, the differences are also substantial: compared with those diagnosed at age 75 or older, people diagnosed between ages 65 and 74 have a 14% greater relative excess risk of ischemic heart disease, a 20 % greater relative excess risk of heart failure, and a 16% greater relative excess risk of death from any cause.

The researchers clarify that these percentages reflect differences in the relative risk attributable to diabetes and should not be interpreted as meaning that people diagnosed at very advanced ages have a low absolute risk. In fact, their burden of cardiovascular disease, mortality, other coexisting conditions, and frailty remains high.

Multidisciplinary Collaboration

The study is the result of collaboration among professionals in primary care, endocrinology, epidemiology, and data analysis from IDIAPJGol’s DAP.cat group, together with researchers from the Sant Pau Research Institute, Hospital de Sant Pau, the University of Barcelona, the University of Vic – Central University of Catalonia, Epsom, and St. Helier University Hospitals, and King’s College London. Cooperation across institutions and disciplines was essential to ensuring methodological quality, interpreting the findings in the context of clinical practice, and translating them into practical messages for cardiovascular prevention and shared decision-making with patients.

The study’s first author, Berta Fernández Camins, a researcher at IDIAPJGol and IR Sant Pau, explains that “this is an observational study based on clinical records, and the date recorded corresponds to when diabetes was diagnosed, not necessarily its actual biological onset.” Fernández Camins also notes that “the differences observed could be influenced by shorter exposure to hyperglycemia in people diagnosed later in life, competing mortality, survivor selection, or delayed detection in some older adults.” Despite these limitations, she emphasizes that the sensitivity analyses performed support the overall pattern of the findings.

The study coordinators, Dídac Mauricio, a researcher at IR Sant Pau, the Biomedical Research Network Center for Diabetes and Associated Metabolic Diseases (CIBERDEM), and the University of Vic – Central University of Catalonia, and Josep Franch Nadal, a researcher in IDIAPJGol’s Primary Care Diabetes Epidemiological Research Group (DAP.cat), state that “age at diabetes diagnosis matters, but it must be interpreted within an individualized assessment of each patient, never as an automatic reason to provide less treatment to an older person.”

This study was funded by the Carlos III Health Institute and the Government of Catalonia’s Agency for Management of University and Research Grants (AGAUR), with support from the European Regional Development Fund.

World Heart Day

World Heart Day is observed on September 29 to raise awareness of the impact of cardiovascular diseases, the leading cause of death worldwide. The event is led by the World Heart Federation, which this year is focusing on recognizing the warning signs and symptoms of cardiovascular diseases. Type 2 diabetes mellitus is one of the major cardiovascular risk factors.

Reference Article

Fernandez-Camins B, Navas E, Vlacho B, Franch-Nadal J, Maltese G, Mauricio D. Cardiovascular outcomes and mortality risk at diagnosis of type 2 diabetes in older adults: a retrospective population-based study using health records from Spain. eClinicalMedicine. 2026;98:104118. doi:10.1016/j.eclinm.2026.104118