Researchers studied 518 people with type 1 diabetes to see if healthy lifestyle choices could protect their hearts. They looked at seven healthy habits: maintaining a healthy weight, not smoking, exercising regularly, eating a Mediterranean diet, controlling cholesterol and blood pressure, and managing blood sugar. People who followed more of these habits had less buildup of plaque in their arteries—a sign of early heart disease. The study suggests that for people with type 1 diabetes, focusing on overall healthy living, not just blood sugar control, may be one of the best ways to prevent heart problems.

The Quick Take

  • What they studied: Whether following seven healthy lifestyle habits helps prevent early signs of heart disease in people with type 1 diabetes
  • Who participated: 518 adults with type 1 diabetes (average age 48, mostly people who had diabetes for many years or had kidney problems from diabetes). About half were women.
  • Key finding: People who followed more healthy habits had significantly less plaque buildup in their neck arteries. Those with the best habits were about 70% less likely to have plaque and 70% less likely to have multiple plaques compared to those with poor habits.
  • What it means for you: If you have type 1 diabetes, paying attention to weight, exercise, diet, cholesterol, blood pressure, and blood sugar control—not just blood sugar alone—may help protect your heart. However, this study shows a connection, not proof that these habits prevent heart disease.

The Research Details

This was a cross-sectional study, which means researchers looked at a group of people at one point in time rather than following them over years. They included 518 adults with type 1 diabetes who didn’t already have heart disease. Participants had to be at least 40 years old, or have kidney problems from diabetes, or have had diabetes for 10+ years with another heart risk factor.

Researchers scored each person on seven healthy habits using a modified version of the American Heart Association’s ‘Life’s Simple Seven’ system. The habits were: healthy weight (BMI), not smoking, regular physical activity, eating a Mediterranean diet, good cholesterol levels, healthy blood pressure, and good blood sugar control. Each habit could earn points, with a total score ranging from 0 to 13 points (higher is better).

They then used ultrasound to look at the carotid arteries in the neck to see if plaque had started building up. They compared people with low scores (5 or less), medium scores (6-7), and high scores (8 or more) to see if better scores meant less plaque.

This approach is important because it looks at the ‘whole picture’ of health rather than just one factor. For people with type 1 diabetes, doctors usually focus heavily on blood sugar control, but this study shows that other factors matter too. By measuring multiple habits at once, researchers could see how overall lifestyle affects early heart disease signs.

This study has some strengths: it included a decent-sized group of 518 people, used a clear scoring system, and measured actual plaque in arteries (not just risk factors). However, because it’s cross-sectional, it shows a connection between habits and plaque but can’t prove that the habits actually prevent plaque from forming. The study was done in Mediterranean countries, so results might differ in other regions. The researchers did adjust their analysis for other heart risk factors not included in the score, which strengthens the findings.

What the Results Show

People with higher healthy lifestyle scores had significantly less plaque in their arteries. The relationship was clear and consistent: as the score went up, plaque presence went down. Even after accounting for other heart risk factors that weren’t part of the scoring system, the connection remained strong.

Specifically, people in the highest score group (8 or more points) were about 63% less likely to have any plaque compared to those with low scores. For people with multiple plaques (a sign of more advanced buildup), those with high scores were about 70% less likely to have this problem.

The study also found that each of the seven individual habits—weight, smoking, exercise, diet, cholesterol, blood pressure, and blood sugar—was independently connected to lower plaque levels. This suggests that all seven factors work together to protect the heart.

The study confirmed that each individual healthy habit was connected to lower heart disease risk factors. People with better scores had better cholesterol levels, blood pressure, weight, and blood sugar control. This makes sense because the score was partly based on these measurements. The findings suggest that a comprehensive approach addressing all these factors together may be more effective than focusing on just one or two.

Previous research in people without diabetes has shown that following healthy lifestyle guidelines reduces heart disease risk. This study extends those findings to people with type 1 diabetes, a group that hasn’t been studied as thoroughly. The results align with general heart health recommendations but emphasize that these guidelines are especially important for people with type 1 diabetes, who have higher baseline heart disease risk.

This study shows a connection between healthy habits and less plaque, but it can’t prove that the habits actually prevent plaque from forming—people with healthy habits might have other unmeasured advantages. The study was done in Mediterranean countries, so results might not apply equally to other regions or populations. The study looked at people at one moment in time, not following them over years to see who actually develops heart disease. Finally, the study relied on self-reported information for some habits like diet and exercise, which might not be completely accurate.

The Bottom Line

For people with type 1 diabetes: Focus on all seven healthy habits together—maintain a healthy weight, don’t smoke, exercise regularly, eat a Mediterranean-style diet, keep cholesterol and blood pressure controlled, and manage blood sugar well. These recommendations have moderate-to-strong evidence from this study. Talk with your doctor about which habits to prioritize for your specific situation. This study suggests that blood sugar control alone isn’t enough; the whole lifestyle picture matters.

This research is most relevant for people with type 1 diabetes, especially those over 40, those with diabetes-related kidney problems, or those who’ve had diabetes for many years. It’s also relevant for doctors treating type 1 diabetes patients. People without diabetes or with type 2 diabetes should note that while these habits are generally healthy, this specific study doesn’t directly apply to them.

Changes in plaque buildup happen slowly over years, so you wouldn’t expect to see dramatic improvements in weeks or months. However, improvements in individual factors like blood pressure, cholesterol, and blood sugar can happen within weeks to months. Meaningful reductions in plaque might take 1-2 years or longer of consistent healthy habits.

Want to Apply This Research?

  • Track a weekly ‘Healthy Habits Score’ by recording: (1) whether you exercised at least 150 minutes, (2) whether you followed a Mediterranean-style diet most days, (3) your average blood pressure reading, (4) your average blood sugar readings, (5) your weight, (6) smoking status, and (7) recent cholesterol levels. Rate each 0-2 points weekly for a total out of 14, aiming for 8+.
  • Use the app to set one specific goal from the seven habits each week. For example: Week 1 focus on adding 30 minutes of walking three times; Week 2 focus on adding more vegetables to meals; Week 3 focus on checking blood pressure daily. Rotate through all seven habits monthly, building sustainable changes rather than trying to change everything at once.
  • Track your seven-habit score monthly and look for trends over 3-6 months. Also monitor individual markers: weight weekly, blood pressure 2-3 times weekly, blood sugar daily (as usual), and cholesterol/kidney function through doctor visits. Create a simple dashboard showing your score trend and which habits need the most attention.

This research shows an association between healthy habits and lower early signs of heart disease in people with type 1 diabetes, but it does not prove that these habits prevent heart disease. This information is educational and should not replace medical advice from your doctor. Before making significant changes to your diet, exercise routine, or diabetes management, consult with your healthcare provider or diabetes care team. Individual results vary, and what works for one person may not work for another. If you have type 1 diabetes, work with your medical team to develop a personalized plan that addresses all aspects of your health.