The age at which type 2 diabetes is diagnosed influences cardiovascular risk and long-term mortality. 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, a journal of The Lancet group. The study includes data from 1,880,545 people who received primary care in Catalonia between 2010 and 2021. The findings could help healthcare professionals better tailor cardiovascular prevention to each individual, particularly at older ages.

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

The timing of diagnosis changes the prognosis

The research team compared several age groups to assess how the excess risk associated with diabetes varied in each case compared with that of a person without the disease.

The results show that, after ten years of follow-up, people diagnosed before the age of 65 had an 18% higher relative excess risk of heart failure than those diagnosed at age 65 or older. Among older people, the differences were also notable: compared with those diagnosed at age 75 or older, people diagnosed between the ages of 65 and 74 had a 14% higher relative excess risk of ischaemic heart disease, a 20% higher risk of heart failure and a 16% higher risk of all-cause mortality.

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

Multidisciplinary collaboration

The study is the result of collaboration between primary care, endocrinology, epidemiology and data analysis professionals from the DAP.cat research group at IDIAPJGol, together with researchers from the Sant Pau Research Institute, Sant Pau Hospital, the University of Barcelona, the University of Vic, Epsom and St Helier University Hospitals and King’s College London. Cooperation between institutions and disciplines was essential to ensure methodological quality, interpret the findings in the context of clinical practice, and translate them into messages applicable to 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 the time when diabetes was diagnosed, not necessarily to its actual biological onset.” Fernández Camins also points out that “the differences observed could be influenced by shorter exposure to hyperglycaemia in late diagnoses, competing mortality, survivor selection or later detection in some older people.” Despite these limitations, the researcher highlights that the sensitivity analyses performed maintained the overall pattern of the results.

The study coordinators, Dídac Mauricio, a researcher at IR Sant Pau, the Centre for Biomedical Research Network on Diabetes and Associated Metabolic Diseases (CIBERDEM) and the University of Vic – Central University of Catalonia, and Josep Franch Nadal, a researcher with the Diabetes Epidemiology Research Group in Primary Care (DAP.cat) at IDIAPJGol, state that “the age at which diabetes is diagnosed matters, but it must be interpreted as part of an individualised assessment of each patient, never as an automatic reason to treat an older person less intensively.”

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

World Heart Day

World Heart Day is observed on 29 September to raise awareness of the impact of cardiovascular diseases, which are the leading cause of death worldwide. The event is promoted by the World Heart Federation, which this year is focusing on recognising the warning signs and symptoms of cardiovascular disease. In this context, type 2 diabetes mellitus is one of the main cardiovascular risk factors.

Article reference

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