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The current work aimed to identify the predominant correlates of prediabetes and T2DM among a variety of socio-demographic, anthropometric and lifestyle indices, in a large sample of adults from families at high risk for T2DM.In this cross-sectional study, 2816 adults were recruited from low-socioeconomic areas in high-income countries (HICs) (Belgium-Finland), HICs under austerity measures (Greece-Spain), and low/middle-income countries (LMICs) (Bulgaria-Hungary). A positive association between the male sex (OR, 95% C.I.2.77 (1.69-4.54)) and prediabetes was revealed compared to females, while there was a negative association between younger age (45 years) (OR, 95% C.I. 0.58 (0.37-0.92)), and low/medium levels of waist circumference (OR, 95% C.I. 0.44 (0.22-0.89)) with prediabetes compared to older age and high levels of waist circumference, respectively. Concerning T2DM, 0-0.5 cups/day of fruits and berries (OR, 95% C.I.2. 13 (1.16-3.91)) and 150-300 g fish/week (OR, 95% C.I. 2.55 (1.01-6.41)) have a positive association compared to higher consumptions, respectively. Conversely,1 cup/week legumes (OR, 95% C.I. 0.55 (0.31-0.99) as well as 0-0.5 servings (OR, 95% C.I. 0.34 (0.12-0.95) and 0.5-1 servings (OR, 95% C.I. 0.37 (0.19-0.71) of full-fat dairy/day have a negative association compared to higher consumptions, respectively.These findings indicate the need for diabetes prevention measures targeting young adults and especially men, above 45 years of age, with central obesity and poor dietary habits and prioritize vulnerable groups and populations living in LMICs.NCT02393872.

Background: Individuals from families at high-risk for type 2 diabetes mellitus (T2DM) are also at high risk for hypertension (HTN) and cardiovascular disease. Studies identifying lifestyle patterns (LPs) combining dietary, physical activity or sedentary variables and examining their possible role with respect to developing blood pressure (BP) are limited. The present study aimed to examine the association of different LPs with BP levels in families at high risk for T2DM in Europe. Methods: In total, 1844 adults (31.6% males) at high-risk for T2DM across six European countries were included in this cross-sectional study using data from the baseline assessment of the Feel4Diabetes Study. BP measurements and dietary and physical activity assessments were conducted, and screen times were surveyed. LPs were revealed with principal component analysis of various data regarding diet, physical activity, screen time and smoking. Results: Three LPs were identified. LP3 (high consumption of sweet and salty snacks, sugar sweetened soft drinks and juices, and high amount of screen time) was positively associated with diastolic BP (B, 0.52; 95% confidence interval = 0.05–0.99) and the existence of HTN (odds ratio = 1.12; 95% confidence interval = 1.00–1.25). Participants in the highest tertile of LP3 spent mean 3 h of screen time, consumed 1.5 portions of sweet and/or salty snacks and 1 L of soft drinks on a daily basis, were associated with 12% higher risk of HTN. Conclusions: Focusing on the combination of eating and lifestyle behaviours may more accurately identify, and therefore guide preventive measures tailored to the specific needs of high-risk populations.

Objective:This study aimed to investigate the mediating role of food parenting practices (FPP), including home availability of different types of foods and drinks, parental modelling of fruit intake, permissiveness and the use of food as a reward in the relationship between parental education and dietary intake in European children.Design:Single mediation analyses were conducted to explore whether FPP explain associations between parents’ educational level and children’s dietary intake measured by a parent-reported FFQ.Setting:Six European countries.Participants:Parent–child dyads (n 6705, 50·7 % girls, 88·8 % mothers) from the Feel4Diabetes-study.Results:Children aged 8·15 ± 0·96 years were included. Parental education was associated with children’s higher intake of water, fruits and vegetables and lower intake of sugar-rich foods and savoury snacks. All FPP explained the associations between parental education and dietary intake to a greater or lesser extent. Specifically, home availability of soft drinks explained 59·3 % of the association between parental education and sugar-rich food intake. Home availability of fruits and vegetables was the strongest mediators in the association between parental education and fruit and vegetable consumption (77·3 % and 51·5 %, respectively). Regarding savoury snacks, home availability of salty snacks and soft drinks was the strongest mediators (27·6 % and 20·8 %, respectively).Conclusions:FPP mediate the associations between parental education and children’s dietary intake. This study highlights the importance of addressing FPP in future interventions targeting low-educated populations.

Background Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. Findings Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a –3·62 mm Hg (95% CI –5·22 to –2·02) greater reduction in systolic blood pressure, and a –2·45 mm Hg (–3·83 to –1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (–2·45 mm Hg [–4·15 to –0·74]); however, there were no statistically significant reductions for SMS interventions (–1·80 mm Hg [–4·60 to 1·00]) or website interventions (–3·43 mm Hg [–7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. Interpretation SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility.

Background: Food parenting practices, behaviours and food availability at home are associated with children's food choices; however, these associations have been mainly studied for each parenting practice separately and focused mostly on healthy populations. The aim of the study was to identify patterns of parenting practices (including data regarding food availability at home, food and physical activity-related behaviours and rewards) and to investigate their cross-sectional associations with children's food choices in families at high risk for type 2 diabetes (T2D). Methods: Data of parents and children (n = 2278), from the Feel4Diabetes study conducted in six European countries, were collected using validated questionnaires. The data analysed included children's food choices, food availability at home and food and physical activity-related parenting practices. Four patterns of parenting practices were identified using principal component analysis, and associations between those components and children's food choices were assessed using adjusted, individual linear regressions. Results: Parenting patterns focusing on unhealthy habits, such as allowing unhealthy snacks and unlimited screen time, providing higher availability of unhealthy foods at home, rewarding with snacks and screen time, were positively associated with children's unhealthy food choices (consumption of savoury/sweet snacks, fizzy drinks, etc.). The parenting patterns providing fruit/vegetables at home, consuming fruit, and being physically active with the child were positively associated with children's healthier food choices (consumption of fruit, vegetables, whole grain cereals, etc.). Conclusions: Public health initiatives should focus on high-risk families for T2D, assisting them to adopt appropriate parenting practices and behaviours to promote healthier food choices for children.

The prevention of children being overweight/obese is of utmost importance. Parental characteristics play a pivotal role in shaping offspring weight status. This study aimed to examine associations between parental obesity and children's overweight/obesity status, and whether other parental type 2 diabetes (T2D) risk factors can predict children's obesity status.Logistic regression and receiver operating characteristic (ROC) analyses were conducted, using cross-sectional data from a European cohort of 20 151 adults (10 967 mothers; 9184 fathers) and children (n = 10 967) participating in the Feel4Diabetes study. Anthropometric measurements were conducted in children, and overweight/obesity was defined according to the International Obesity Task Force criteria. Parents' T2D risk was assessed applying the Finnish Diabetes Risk Score (FINDRISC).After adjusting for all other FINDRISC variables, region and maternal/parental education, maternal (adjusted odds ratio [aOR]: 2.64; 95% confidence interval [CI], 2.18-3.20) and parental (aOR: 3.21; 95% CI, 2.65-3.91) obesity, maternal (aOR: 1.46; 95% CI, 1.23-1.74) and parental (aOR: 1.59; 95% CI, 1.32-1.92) high waist circumference, as well as maternal (aOR: 1.60; 95% CI, 1.27-2.01) and parental (aOR: 1.87; 95% CI, 1.58-2.21) high FINDRISC score, were associated with child overweight/obesity status. Maternal (area under the curve- ROC: 0.638; 95% CI, 0.628-0.647) and paternal body mass index (BMI; area under the curve-ROC: 0.632; 95% CI, 0.622-0.642) were the most accurate in predicting child overweight/obesity status.Among parental risk factors for T2D, maternal/parental overweight/obesity status, central obesity, and high FINDRISC score were the main predictors of childhood overweight/obesity status, with BMI the most accurate. Maternal or paternal BMI is simple to use, and might be useful for the early identification of children at risk of being overweight/obese rather than other T2D factors.

Background: Although there are many interventions targeting childhood obesity prevention, only few have demonstrated positive results. The current review aimed to gather and evaluate available school-based intervention studies with family involvement targeting dietary, physical activity and sedentary behaviors among primary schoolchildren and their families, in order to identify the most effective strategies. Methods: Studies published between 2000 and January 2015 were retrieved from scientific electronic databases and grey literature. The databases used included MEDLINE/PubMed, Web-of-Science, CINAHL and Scopus. Included studies had to be experimental controlled studies and had duration over 1 school year, had family involvement, combined PA and dietary behaviors and were implemented in school setting. A complementary search was executed to update the review to cover the period from February 2015 to January 2019. Results: From the studies examined (n = 425), 27 intervention programs (33 publications) fulfilled the inclusion criteria. Among these, 15 presented significant effect on weight status and/ or overweight/ obesity or clinical indices, 3 presented significant effect on most energy balance-related behaviors (EBRBs) while 9 presented significant effect on some/few EBRBs or determinants. Strategies implemented in effective interventions were: teachers acting as role-models and being actively involved in the delivery of the intervention, school policies supporting the availability of healthy food and beverage choices and limiting unhealthy snacks, changes in the schoolyard, in the recess rules and in the physical education classes to increase physical activity, and involving parents in the intervention via assignments, meetings, informative material and encouraging them to improve the home environment. Use of incentives for children, social marketing techniques, collaboration with local stakeholders were found to increase effectiveness. Programs that focused only on educational sessions and material for parents, without promoting relevant environmental and policy changes, were found to be less effective. Cultural adaptations have been suggested to increase the intervention’s acceptance in specific or vulnerable population groups. Conclusions: Several effective strategies were identified in the reviewed programs. Outcomes of the current review were taken into account in developing the Feel4Diabetes-intervention and summed up as recommendations in the current work in order to facilitate other researchers designing similar childhood obesity prevention initiatives. Keywords: Obesity prevention, Type 2 diabetes prevention, Primary school children, Families, School based intervention., The Feel4Diabetes-study has received funding from the European Union's Horizon 2020 research and innovation programme [Grant Agreement: n degrees 643708]. The content of this article reflects only the authors' views and the European Community is not liable for any use that may be made of the information contained therein.

The aim of the present study was to investigate the association of diet quality with fasting glycemia, insulinemia, and insulin resistance in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM) from six European countries, taking into account their socioeconomic status (SES).Baseline data from non-diabetic adults from the Feel4 Diabetes study were used and diet was assessed by the Healthy Diet Score (HDS). Insulin resistance (IR) was determined by homeostasis model assessment of IR (HOMA-IR). Sociodemographic and lifestyle characteristics were assessed through standardized questionnaires. Multiple linear regressions were adjusted for many confounders, in the total sample and by SES category.In 1980 adults, the third tertile of diet quality was inversely associated with insulin levels (-1.48; 95% confidence interval [CI], -2.34 to 0.62), and HOMA-IR (-0.33; 95% CI, -0.57 to 0.09), yet with no statistically significant results for glucose levels. In the SES subgroup analysis, in the high SES group, both second and third diet score tertiles were inversely associated with insulin levels (-1.81; 95% CI, -2.66 to 0.95) and HOMA-IR values (-0.45; 95% CI -0.69 to 0.21), independent of age, sex, smoking and body mass index. No such associations were observed for glucose levels in the high SES group and for all indices in the low SES group.In adults from families at high risk for T2DM, higher diet quality was negatively associated with fasting insulin levels and IR, only in the high SES group and not in the low SES group. Future larger studies may be able to explore further this association, as well as the potential factors that mitigate its strength in the low SES groups.

Aim To assess the diagnostic accuracy of the FINDRISC for undiagnosed type 2 diabetes mellitus (T2DM) and dysglycaemia (i.e. the presence of prediabetes or T2DM) among early middle-aged adults from vulnerable groups in a large-scale European cohort. Methods Participants were recruited from low-socioeconomic areas in high-income countries (HICs) (Belgium-Finland) and in HICs under austerity measures (Greece-Spain) and from the overall population in low/middle-income countries (LMICs) (Bulgaria-Hungary). Study population comprised of 2116 parents of primary-school children from families identified at increased risk of T2DM, based on parental self-reported FINDRISC. Sensitivity (Se), specificity (Sp), area under the receiver operating characteristic curves (AUC-ROC) and the optimal cut-offs of FINDRISC that indicate an increased probability for undiagnosed T2DM or dysglycaemia were calculated. Results The AUC-ROC for undiagnosed T2DM was 0.824 with optimal cut-off ≥14 (Se = 68%, Sp = 81.7%) for the total sample, 0.839 with optimal cut-off ≥15 (Se = 83.3%, Sp = 86.9%) for HICs, 0.794 with optimal cut-off ≥12 (Se = 83.3%, Sp = 61.1%) for HICs under austerity measures and 0.882 with optimal cut-off ≥14 (Se = 71.4%, Sp = 87.8%) for LMICs. The AUC-ROC for dysglycaemia was 0.663 with optimal cut-off ≥12 (Se = 58.3%, Sp = 65.7%) for the total sample, 0.656 with optimal cut-off ≥12 (Se = 54.5%, Sp = 64.8%) for HICs, 0.631 with optimal cut-off ≥12 (Se = 59.7%, Sp = 62.0%) for HICs under austerity measures and 0.735 with optimal cut-off ≥11 (Se = 72.7%, Sp = 70.2%) for LMICs. Conclusion FINDRISC can be applied for screening primarily undiagnosed T2DM but also dysglycaemia among vulnerable groups across Europe, considering the use of different cut-offs for each subpopulation.

Background Multisystem Inflammatory Syndrome in children related to COVID-19 (MIS-C) is a new condition the aftermath of which is yet to be studied both in Bulgaria and globally. Up to mid December 2020, world COVID-19 fatalities are put at 1 582 674, according WHO statistics. Case Presentation Summary We present a 15 years old patient with MIS-C, diagnosed with acute abdomen, operated andtreated for septic shock syndrome. The current situation represents a major clinical challenge in part due to the complex differential diagnosis involved: acute abdomen, septic shock, autoimmune diseases (Lupus erythematosus, Juvenile idiopathic arthritis, Kawasaki disease, Acquired immune deficiency, Crohn`s disease, Ulcer colitis), acute myocarditis. At the same time, other symptoms observed in children with COVID-19 such as skin rashes, lymphadenopathy, conjunctivitis are not presented inour patient. We did not observe any myocardial injury, however she went into an acute vasodilatory shock with tachycardia, reduced kidney perfusion pressure and oliguria. Learning Points/Discussion Effects of SARS-CoV-2 infection on patients will be a subject of analysis and clinical research. Differential diagnosis of the multisystem inflammation syndrome in children, clinical experience and new therapeutic strategies are the key to reducing mortality and long-term complications in the affected patients.

The Feel4Diabetes program was comprised of a community-based screening and a two-year intervention phase aiming to prevent type 2 diabetes (T2D) in families at risk for diabetes across Europe. The current work aimed to identify the socio-demographic characteristics and body weight perceptions of participants who benefitted the most, achieving at least a 5% reduction in body weight, waist circumference and glycaemic indices (fasting plasma glucose, insulin, glycosylated haemoglobin levels), over two-year period. Following a two-stage screening procedure, 2294 high-risk parents were randomly allocated to standard care or more intensive intervention. The participants who benefitted most were living in Southern (OR 2.39&ndash, 3.67, p &lt, 0.001) and Eastern Europe (OR 1.55&ndash, 2.47, p &lt, 0.05), received more intensive intervention (OR 1.53&ndash, 1.90, p = 0.002) and were younger (&lt, 40 years old) adults (OR 1.48&ndash, 1.51, p &lt, 0.05). Furthermore, individuals with tertiary education (OR 2.06, p &lt, 0.001), who were unemployed (OR 1.62&ndash, 1.68, p &lt, 0.05) and perceived their body weight to be higher than normal (OR 1.58&ndash, 3.00, p &lt, 0.05) were more likely to benefit from the program. Lastly, males were more likely to show improvements in their glycaemic profiles compared to females (OR 1.40, p = 0.024). These findings point out the regions in Europe and the sociodemographic profile of individuals that benefitted the most in the current study, highlighting the need to prioritise regions in greater need for such interventions and also tailor future interventions to the characteristics and perceptions of the target populations.

Identification of participants’ characteristics who benefited most from large community-based intervention studies may guide future prevention initiatives in order to maximize their effectiveness. The current study aimed to examine the socio-demographic, anthropometric, and behavioral characteristics, as well as the health and eating perceptions of those who improved their lipidemic profile, in the Feel4Diabetes early screening and prevention program. In the present analyses, 1773 adults from families at high risk for developing type 2 diabetes mellitus (T2DM) were enrolled, receiving either the standard care or the more intensive intervention, and 33.3–55.2% of them improved one or more of their lipidemic indices by &gt, 5%. Women, people living in Southeastern Europe, coming from two-parent families, having higher financial security, educational level and better diet quality were associated with a 27–64% higher likelihood for benefiting from the program regarding one or more of their lipidemic profile indices. Participants who were overweight or obese (especially with central obesity), employed, with prolonged sedentary behavior, prone to emotional eating and perceiving their weight status as lower than their actual weight were 24–43% less likely to have benefited. These findings should guide future interventions, prioritizing regions in greater need, and being tailor-made to specific population characteristics in order to further improve their effectiveness.

Background: The clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus. Methods: The aim of this paper is to describe the detailed methodology of the intervention’s cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention’s value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only. Conclusions: The optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources., Publication of this supplement was funded by the European Union’s Horizon 2020 research and innovation programme under grant agreement n° 643708.

Background Feel4Diabetes was a school and community based intervention aiming to promote healthy lifestyle and tackle obesity for the prevention of type 2 diabetes among families in 6 European countries. We conducted this literature review in order to guide the development of evidence-based implementation of the Feel4Diabetes intervention. We focused on type 2 diabetes prevention strategies, including all the phases from risk identification to implementation and maintenance. Special focus was given to prevention among vulnerable groups and people under 45 years. Methods Scientific and grey literature published between January 2000 and January 2015 was searched for relevant studies using electronic databases. To present the literature review findings in a systematic way, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. A complementary literature search from February 2015 to December 2018 was also conducted. Results The initial review included 27 studies with a follow-up ≥12 months and 9 studies with a follow-up ≥6 months and with a participant mean age Conclusion This narrative review highlighted several important aspects that subsequently guided the development of the Feel4Diabetes high-risk intervention. Research on diabetes prevention interventions targeted at younger adults or vulnerable population groups is still relatively scarce. Feel4Diabetes is a good example of a project aiming to fill this research gap. Trial registration clinicaltrials.gov NCT02393872, registered 20th March 2015.

In recent years еpicardial adipose tissue has been reported to be an independent predictor of coronary risk, along with the already well established coronary calcium score. In our study we look for a corellation between these two markers in patients with long-term diabetes mellitus type 1 and healthy controls. Epicardial fat volume is quantified by semiautomatically and manually segmenting images acquired with computed tomography and magnetic resonance tomography. The two types of images demonstrate excellent correlation between them. A mild to moderate correlation between epicardial fat volume and coronary calcium score is found, regardless of which type of image the fat is calculated from.

Early identification of type 2 diabetes mellitus (T2DM) and hypertension (HTN) risk may improve prevention and promote public health. Implementation of self-reported scores for risk assessment provides an alternative cost-effective tool. The study aimed to develop and validate two easy-to-apply screening tools identifying high-risk individuals for insulin resistance (IR) and HTN in a European cohort. Sociodemographic, lifestyle, anthropometric and clinical data obtained from 1581 and 1350 adults (baseline data from the Feel4Diabetes-study) were used for the European IR and the European HTN risk assessment index respectively. Body mass index, waist circumference, sex, age, breakfast consumption, alcohol, legumes and sugary drinks intake, physical activity and sedentary behavior were significantly correlated with Homeostatic Model Assessment of IR (HOMA-IR) and/or HTN and incorporated in the two models. For the IR index, the Area Under the Curve (AUC), sensitivity and specificity for identifying individuals above the 75th and 95th of HOMA-IR percentiles were 0.768 (95%CI: 0.721&ndash, 0.815), 0.720 and 0.691 and 0.828 (95%CI: 0.766&ndash, 0.890), 0.696 and 0.778 respectively. For the HTN index, the AUC, sensitivity and specificity were 0.778 (95%CI: 0.680&ndash, 0.876), 0.667 and 0.797. The developed risk assessment tools are easy-to-apply, valid, and low-cost, identifying European adults at high risk for developing T2DM or having HTN.

It is well-recognized that diabetes-related complications are the leading cause of the still increased morbidity and mortality from diabetes and exert a heavy economic burden on society. The discovery of insulin led to a dramatic change in life expectancy of patients with type 1 diabetes (T1D). Furthermore, it caused a major shift in the distribution of causes of death - from diabetic coma in the pre-insulin era, to long-term complications being the predominant causes of death nowadays. The aim of the present review is to assess the trends in the absolute and the relative mortality rates as well as the leading causes of death among patients with childhood-onset (< 18 years) T1D in populations from different latitudes. It is also observed how disease duration, age at diagnosis, and year of diagnosis affect these mortality trends. Eight population-based studies published in English in the last 14 years, as well as another one, published in 2001, with different duration of follow-up, are included in the review. However, it is hard to compare different populations due to the dissimilarities in the study methods and the characteristics of the examined cohorts.

Among the traditional risk factors for cardiovascular diseases (CVD) in individuals with type 1 diabetes mellitus (T1DM), new ones are constantly being sought for timely prophylaxis and treatment. The increasing knowledge of the role of inflammation and visceral adipose tissue in the pathogenesis of T1DM complications is an integral part of the work of leading European centers. Obesity is a progressing risk factor and its role in the cardiovascular pathology of patients with T1DM is unclear. Lack of established practices and algorithms for management in these individuals has been poorly studied and presented to date. With prevalence of intensified insulin therapy in T1DM, leading sometimes to relatively high doses, and with the contemporary habits of eating, the patients’ risk of morbidity and mortality increases. Prioritization of cost-effective projects and specific timely commitment to protect disability in these patients is of utmost importance in scientific and healthcare aspects. The aim of this article is to present the design of the study of the cardiovascular and metabolic risk in patients with long-term T1DM.