Navigating adulthood with juvenile-onset type 1 diabetes: a scoping review on education, employment and quality of life
Scientific publications by JACARDI
In this post series we share the scientific publications directly linked to the JACARDI project. All publications featured in this series are authored or co-authored by JACARDI partners and reflect research and findings developed within the project framework.
We aim to showcase how evidence supports our joint mission to tackle cardiovascular diseases and diabetes across Europe.
Stay informed on how JACARDI turns evidence into action.
Authors: Eleonora Maurel, Arianna Fornari, Alessandra Knowles, Erika Guastafierro, Martina Lanza, Alessia Marcassoli, Matilde Leonardi, Luca Ronfani and Lorenzo Monasta
Abstract:
Background: Juvenile type 1 diabetes can present lifelong challenges that may affect educational, employment, and health-related quality of life (HRQoL) outcomes in adulthood. This scoping review aims at exploring the long-term impact of juvenile-onset type 1 diabetes on education and career achievements and well-being in adulthood.
Methods: A scoping review conducted using PubMed and PsycInfo (2005– 2025) identified studies comparing adults diagnosed with type 1 diabetes during childhood and adolescence to controls without type 1 diabetes. Three studies focusing on educational attainment, employment, income, and HRQoL, met the inclusion criteria.
Results: The studies included in the review show that university attendance is significantly lower among individuals with juvenile-onset type 1 diabetes, and this affects both men and women. Access to the labor market and earnings are similarly affected, especially in the case of women who experience both lower employment rates and income, compared to controls without diabetes. Men with type 1 diabetes have equal opportunities for workforce entry, but this does not translate into long-term income parity. Compared to healthy controls, HRQoL is lower among adults with type 1 diabetes, particularly in the school/work and emotional domains. Common challenges include low energy, forgetfulness, and concentration difficulties.
Conclusion: While it is a matter of debate how juvenile-onset type 1 diabetes affects academic achievements, there is general agreement that it leads to persistent disadvantages in employment and HRQoL in adulthood. Targeted support from diagnosis and during transition to adulthood is essential to mitigate the long-term impact of juvenile-onset type 1 diabetes on educational, employment and psychosocial outcomes for this population.
Source: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1707581/full
A defining CVH moment in Europe: The Commission announced the Safe Hearts Plan
“When Europe acts together, we do not simply improve systems, we improve lives,” points out Benedetta Armocida, Coordinator of JACARDI, as the European Union’s Cardiovascular Health Plan is launched. At a time when cardiovascular disease remains Europe’s leading cause of death, this moment marks a collective step toward strengthening heart health across the continent.
Cardiovascular diseases (CVDs) remain the leading cause of death and disability in Europe, as confirmed by the newly released OECD report “The State of Cardiovascular Health in the European Union“. CVD claims 1.7 million lives each year, more than cancer and diabetes combined, and affects an estimated 62 million people. CVDs also contribute significantly to disability, early retirement, and absenteeism, lower the quality of life and reduce life expectancy, according to data from the European Commission [1], [2], [3].
The total economic burden of CVD in the EU is estimated at EUR 282 billion annually, around 2% of GDP, and significantly higher than that of cancer. The OECD report highlights stark geographic, gender and socio-economic disparities in cardiovascular outcomes and access to care, reinforcing the need for coordinated EU-level action. It also acknowledges JACARDI’s input to the report, and references JACARDI’s 4C Framework and pilot actions in France and Spain.
Bearing that in mind, the European Commission’s launch of the Cardiovascular Health Plan, under the name Safe Hearts Plan, marks a decisive moment for public health in the region. JACARDI strongly welcomes this Plan, as coordinated European action is essential to reduce the number of people falling ill with cardiovascular diseases, and to prevent premature deaths for those with existing conditions or risk factors, such as obesity, diabetes and high blood pressure.
“The launch of the Cardiovascular Health Plan marks a pivotal moment for Europe’s public health. JACARDI welcomes this initiative, recognizing the crucial role of Joint Actions in fostering collaboration among countries, experts, and stakeholders. By working together, sharing knowledge, and aligning efforts, we can ensure that advances in prevention, care, and innovation in cardiovascular health truly reach all communities, leaving no one behind,” notes Prof Graziano Onder, Scientific Coordinator of JACARDI.
The Plan arrives at a critical time. For too long, CVD and diabetes have lacked the political visibility their burden demands. The CVH Plan opens the door to a new European approach that puts prevention first, strengthens early detection and screening, and promotes equity and integrated, patient-centred care across health systems. For JACARDI, this initiative is an essential step towards making the healthy choice the easy and default choice for citizens across Europe.
“The CVH Plan is a decisive step forward, and JACARDI is proud to contribute with its experience and technical expertise. Our work shows that no cardiovascular strategy can be effective without putting equity at the centre, addressing the gaps linked to income, geography, education and gender that still shape health outcomes across Europe. We look forward to supporting the implementation of a Plan that has the potential to change lives across the region”, explains Dr Benedetta Armocida, coordinator of JACARDI.
The CVH Plan is needed as fragmented efforts can no longer address challenges that are inherently interconnected. “Prevention, early detection, treatment, rehabilitation, digital innovation, community engagement, these elements only create real impact when they are aligned and mutually reinforcing”, adds Dr Armocida.
Equally important is the improvement of data collection and use, ensuring that high-quality, reliable information drives policy decisions, guides clinical practice and allows progress to be measured transparently across countries, as highlighted in a recent policy paper published in The Lancet Regional Health – Europe, developed jointly by the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI), the Joint Action Prevent Non-Communicable Diseases (JA PreventNCD), and the WHO Regional Office for Europe (WHO/Europe), [4].
“Robust and accessible data are essential to understand where inequalities arise, to identify people at risk earlier and to ensure timely, high-quality care across Europe. Strengthening data systems, from availability and quality to interoperability and sharing, is key to improving early detection, screening programmes and continuity of care”, says Dr Héctor Bueno, co-leader of the working group on data availability, quality, accessibility and sharing from JACARDI.
Through its multidisciplinary network, technical expertise and strong partnerships, JACARDI stands ready to support the successful rollout of the Safe Hearts Plan. The Joint Action will continue to contribute practical knowledge on prevention, governance, data systems and quality of care, building on lessons learned from other European health initiatives and aligning closely with the shared vision set out by the European cardiovascular community.
Joint Actions are more than projects, they are engines of collaboration. JACARDI can serve as a bridge between countries, stakeholders, and other EU initiatives, helping to translate the CVH Plan into coordinated, coherent, and sustainable action across Europe.
JACARDI is generating concrete insights on equity, early detection, integrated care, digital tools, data systems, and workforce capacity. These lessons, grounded in practice and validated across diverse health systems, can inform the plan’s priorities, standards, and operational frameworks. JACARDI remains fully committed to supporting the European Commission in prioritizing the Cardiovascular Health Plan and promoting its effective implementation across Member States, ensuring that every step forward translates into meaningful impact for people’s health.
The Safe Hearts Plan at a glance:
• Prioritises prevention as one of its main pillars
• Sets clear targets, including reducing mortality related to cardiovascular disease by 25% by 2035
• Encourages Member States to develop or implement national cardiovascular health plans by 2027
• Emphasises reducing health inequalities and improving access to healthcare
• Supports an EU protocol on health checks to shift the focus from treatment to prevention
• Addresses lifestyle risks, including unhealthy diets, ultra-processed foods, and smoking
Read the full European Commission Safe Hearts Plan here.
References:
[1] OECD (2025), The State of Cardiovascular Health in the European Union, OECD Publishing, Paris,
[2] Cardiovascular health; European Commission
[3] Fighting cardiovascular disease – a blueprint for EU action, June 2020. European Heart Network and the European Society of Cardiology.
[4] Benedetta Armocida, Hanna Tolonen, Ivo Rakovac, Beatrice Formenti, Jill Farrington, Allison Ekberg, Hector Bueno, Giovanni Capelli, Silvia Francisci, Morten S. Frydensberg, Ane Fullaondo, Linda Granlund, Yhasmine Hamu Azcarate, Torben F. Hansen, Emil Høstrup, Tomi Mäki-Opas, Luigi Palmieri, Markku Peltonen, Valentina Possenti, Marco Silano, Gundo Weiler, Kremlin Wickramasinghe, Edwin Wouters, Knut-Inge Klepp, Graziano Onder, Gauden Galea, Strengthening non-communicable diseases monitoring systems in Europe through a multistakeholder collaborative approach: a key priority for advancing data-driven policymaking, The Lancet Regional Health – Europe, Volume 61, 2026, 101553, ISSN 2666-7762,
A historic step for global health: UN adopts declaration on NCDs and mental health
The Eightieth United Nations General Assembly (UNGA) has adopted a landmark global political declaration to tackle noncommunicable diseases (NCDs) and mental health in an integrated way, recognising that conditions like cardiovascular disease, diabetes, cancer, chronic respiratory illnesses and mental health disorders are now the leading causes of death, disability and lost opportunity worldwide.
This declaration marks a pivotal shift in global health policy, setting concrete, measurable targets for 2030 and calling on governments to act with urgency, equity and accountability.
The first-ever global outcome targets set out by the declaration to be achieved by 2030 include:
• 150 million fewer tobacco users;
• 150 million more people with hypertension under control;
• 150 million more people with access to mental health care.
The declaration goes beyond health systems, addressing the wider determinants of health – such as air pollution, unhealthy diets, harmful marketing practices, and digital harms – and emphasises that NCDs and mental health must be tackled together, through whole-of-government and whole-of-society collaboration.
This is a huge opportunity to reset global efforts and accelerate progress on the Sustainable Development Goals, especially on reducing premature deaths and promoting well-being for all.
Where JACARDI fits in
JACARDI’s mission aligns directly with this global vision. By advancing evidence-based, integrated prevention and care models for cardiovascular disease and diabetes – key components of the NCD burden – JACARDI helps translate these high-level political commitments into action on the ground.
Our work in harmonising data, strengthening health pathways, supporting policy implementation, and fostering cross-country learning directly contributes to the declaration’s ambitions of measurable impact and equity. With its emphasis on collaboration, scalability, prevention and inclusion, JACARDI is uniquely positioned to support Member States in meeting these targets, bridging research, policy and practice for lasting change.
Croí’s Healthy Hearts Club: empowering patients in heart disease self-management
Croí, the heart and stroke charity based in the west of Ireland, is leading one of Ireland’s pilot projects as part of JACARDI. This pilot, called the Healthy Hearts Club, focuses on patient self-management for those recovering from heart events, such as heart attacks. It aims to help individuals manage long-term health risks like high blood pressure and low physical activity. This project builds on Croí’s experience in heart disease prevention and rehabilitation and provides a crucial support system to patients after their initial cardiac rehabilitation.
A Sustainable Model for Long-Term Health
Cardiovascular disease remains the leading cause of death worldwide, and many patients face challenges in maintaining the positive changes achieved during rehabilitation. The Healthy Hearts Club offers a community-based model to help patients continue managing their heart health after formal rehabilitation ends.
“Cardiac rehabilitation is life-saving, but sustaining those changes is key to long-term health,” says Dr. Susan Connolly, Consultant Cardiologist at University Hospital Galway, who is a co-investigator on the project. “The Healthy Hearts Club provides ongoing support and helps patients stay on track with their health goals.”
The programme involves up to 160 patients, all of whom have completed cardiac rehabilitation through the through the Irish health service in Galway. Participants engage in six months of support, including regular nurse check-ins and group workshops on exercise, nutrition, emotional wellbeing, and heart disease risk factors. This ongoing support aims to help participants integrate these healthy habits into their daily lives.
Supporting Long-Term Change through Personalised Care
The Healthy Hearts Club emphasizes peer support, personalized care, and group activities tailored to the participants’ needs. By joining the programme soon after rehabilitation, patients are given the tools to continue the progress they’ve made, ensuring sustainable change over the long term.
“We believe that empowering people with the knowledge and tools to manage their health is essential for sustainable, person-centered care,” says Dr. Lisa Hynes, Head of Health Programmes at Croí. “This initiative aligns perfectly with our commitment to delivering innovative prevention and self-management programmes.”
In addition to in-person support, Croí will explore the use of digital health tools to further enhance the programme. Building on the success of Croí’s previous online self-management programme, the Healthy Hearts Club will assess how digital solutions can support long-term heart health.
A European Approach to Heart Disease Prevention
One of JACARDI’s goals is to integrate best practices across the entire patient journey—from screening and self-management to integrated care and workforce reintegration. The Healthy Hearts Club is a key component of this effort, with the programme’s evaluation aiming to develop scalable models for improving heart disease management across Europe.
“We’re excited to see how this project evolves and contributes to the broader European conversation on heart health,” says Dr. Connolly. “The insights we gain will help improve the long-term care and outcomes for patients.”
A Collaborative Effort for a Healthier Future
Croí’s leadership in the Healthy Hearts Club is part of the wider JACARDI programme, which connects Irish experts with a pan-European network of professionals working to reduce the burden of cardiovascular disease and diabetes. Dr. Hynes adds, “This collaboration with the HSE and European partners is a unique opportunity to learn from each other and translate research into real-world improvements in care.”
Sarah Cuschieri: Transforming small-state initiatives into the strength of Europe
Dr. Sarah Cuschieri, a leading voice in chronic disease epidemiology and small-state health systems, shares her insights on how JACARDI can accelerate Europe’s fight against cardiovascular disease and diabetes. “When every country speaks the same practical language of prevention, collaboration becomes scalable”, she explains. She also reflects on the importance of data, inclusion, and mentoring the next generation, reminding us that effective prevention is both a scientific and a human endeavour.
Drawing on your work in chronic disease epidemiology and the realities of small states, where do you see JACARDI’s greatest leverage in slowing the rise of cardiovascular disease and diabetes across Europe?
Drawing on my experience in chronic disease epidemiology and the realities of small states, JACARDI’s greatest leverage lies in transforming small-state initiatives into the strength of Europe.
First, small states can act as test beds for integrated prevention and care pathways, where whole-population coverage, centralized health systems, and close primary–secondary linkages allow rapid piloting and evaluation of cardiovascular and diabetes interventions. Evidence generated in these compact settings can be rapidly refined and transferred to larger Member States.
Second, small states excel at policy agility. With short governance chains, multidisciplinary teams, and accessible data infrastructures, they can translate guidelines into everyday practice faster than larger systems. Embedding JACARDI’s harmonized tools and care pathway templates in these contexts demonstrates how evidence can move from paper to patient in real time.
Third, small states provide a unique lens on equity and resilience. Their populations often mirror Europe’s diversity within a manageable scale, making them ideal for testing community-level engagement, health-literacy interventions, and cross-sector collaboration for risk-factor reduction.
By harnessing these advantages—rapid implementation, whole-system evaluation, and equitable design—JACARDI can convert its evidence base into practical, scalable prevention and care models that slow the rise of cardiovascular disease and diabetes across Europe.
How does participating in JACARDI advance your organisation’s goals on cardiovascular disease (CVD) and diabetes – whether through data, capacity-building, or policy impact?
From our vantage point at the University of Malta and through our broader collaboration within the Small States Health Platform, participation in JACARDI directly advances our institutional goals in CVD and diabetes prevention by strengthening the bridge between evidence, policy, and practice.
As a small island state with a centralized health system and accessible national datasets, Malta offers a unique setting to pilot integrated chronic disease pathways, risk factor surveillance tools, and community-based prevention models. Through JACARDI, we can both contribute real-world evidence from a small-population context and adapt proven interventions to local realities such as limited specialist capacity and high multimorbidity.
Moreover, JACARDI aligns with the University’s commitment to capacity building and implementation science, empowering clinicians, public health professionals, and researchers to translate data into sustainable prevention and care strategies. By embedding our work within this pan-European network, we ensure that Malta’s experience informs regional learning, while also benefitting from shared innovation to accelerate progress on CVD and diabetes management across small states and beyond.
You’ve often bridged research, policy, and practice. How do you think JACARDI can set a new standard for collaboration – across countries, disciplines, and data systems – so prevention becomes easier to implement and harder to ignore?
JACARDI has the potential to redefine how Europe collaborates on chronic disease prevention by turning fragmentation into function. Its strength lies in uniting researchers, policymakers, and practitioners around a shared implementation framework rather than isolated projects.
From a small-state perspective, success depends on breaking silos through simplicity and shared value. JACARDI can set a new standard by creating common, adaptable prevention “building blocks”, standardized care pathways, minimal data dashboards, and training modules that can be easily embedded into national systems, regardless of size or resources. When every country speaks the same practical language of prevention, collaboration becomes scalable.
Equally important is data solidarity, linking health information systems through harmonized indicators rather than complex infrastructures. This enables meaningful cross-country learning while respecting local capacities and governance.
Finally, JACARDI’s cross-disciplinary model, bringing together clinicians, epidemiologists, behavioural scientists, and community actors makes prevention not only evidence-based but implementable. By focusing on what works in real settings, it can make prevention easier to deliver and harder to ignore, setting a benchmark for how Europe acts collectively against cardiovascular disease and diabetes.
As a female leader in epidemiology who mentors the next generation, what were your key take-aways from the JACARDI General Assembly in Madrid, from a scientific and cultural point of view?
As a female leader in epidemiology, and someone deeply committed to mentoring the next generation, I left the JACARDI General Assembly in Madrid with a renewed sense of both scientific purpose and shared humanity. Scientifically, I want us to consolidate how JACARDI’s pilots are not just generating data, but truly changing practice, showing that prevention of cardiovascular disease and diabetes can be embedded into everyday care, across every health system, large or small.
Culturally, the moment JACARDI turned pink carries special meaning for me. It symbolises equity, voice, and visibility, giving women in science, medicine, and policy the space to lead and shape health agendas. It reminds us that public health is not only about outcomes but about inclusion and compassion.
I left Madrid knowing that we are building a network where collaboration transcends borders and disciplines, and where every young researcher – especially women – can see themselves reflected in leadership, discovery, and change. That, to me, would be the true legacy of JACARDI.
You made it to the top 2% of the most cited scientists in the world for five consecutive years, and you’ve written the book “To Do or Not to Do a PhD?” offering guidance to early-career researchers. What message would you send to young researchers, especially women just starting their careers in public health, particularly when facing various challenges?
I would tell young researchers – especially women – that they belong in this space, even when they have doubts. Every scientist, at every stage, faces moments of uncertainty; what matters is not the absence of doubt, but the courage to keep contributing despite it.
From my own journey, and through mentoring many early-career researchers, I’ve learned that success in public health is rarely a straight line. Structural barriers exist, but so do strong networks, mentors, and communities like JACARDI that value inclusion and collaboration. Seek those spaces that lift you up, and don’t be afraid to take your place at the table.
When I wrote To Do or Not to Do a PhD?, it was to remind researchers that impact isn’t defined by titles or citations—it’s defined by curiosity, persistence, and integrity. Imposter syndrome fades when you realize that public health needs diverse voices, perspectives, and lived experiences.
So my message is simple: be bold, be kind, and keep going. Science is richer, and societies are healthier, when you do.
Dr. Sarah Cuschieri is a Senior Lecturer at the University of Malta, Adjunct Professor at Western University, Canada, and a member of JACARDI’s Scientific Advisory Board. A medical doctor turned epidemiologist, she leads pioneering research into obesity, diabetes and chronic disease across small‑state contexts, heads the Chronic Disease Epidemiology Research Network and serves as Vice‑President of the Chronic Diseases Section of European Public Health Association (EUPHA). Internationally recognized for her scholarship, she ranks among the top 2% of most‑cited scientists.
Learn more about Dr. Cuschieri and her work, or connect on LinkedIn.
Five decisive actions to transform Europe’s NCD monitoring systems: “What gets measured gets prioritised”
A new policy paper published in The Lancet Regional Health – Europe calls for decisive action to transform how Europe monitors noncommunicable diseases (NCDs). Developed jointly by Joint Action on Cardiovascular Diseases and Diabetes (JACARDI), Joint Action Prevent Non-Communicable Diseases (JA PreventNCD), and the WHO Regional Office for Europe (WHO/Europe), the paper sets out five priority actions to strengthen health monitoring systems across the region, an essential step to curb the rising burden of NCDs and mental health and ensure more effective, equitable healthcare.
The publication, titled “Strengthening non-communicable diseases monitoring systems in Europe through a multistakeholder collaborative approach: a key priority for advancing data-driven policymaking”, comes at a critical momentum after the Fourth United Nations High-Level Meeting on NCDs and Mental Health. “Europe has a unique opportunity, and responsibility, to recommit to data-driven health governance and sustained investment in resilient NCD monitoring systems”, the authors explain in the publication.
Five priorities for 2025 and beyond
The publication highlights five critical areas where action is needed to make monitoring systems stronger, fairer, and more effective. It calls for collecting data that is truly inclusive and disaggregated, so that inequalities become visible and can be addressed. It stresses the importance of solid governance, clear legal frameworks, and long-term investment to ensure that progress is sustained.
Monitoring, the authors argue, should also be embedded in real-time policymaking, so that information directly shapes decisions and drives accountability. Civil society, communities, people with lived experience, and marginalized groups should have a meaningful voice in this process, making sure that data reflects people’s lived realities. And finally, the paper points to the need for stronger collaboration across sectors, greater sharing of knowledge, and more capacity building to secure lasting impact.
“Tackling NCDs is one of five priorities of WHO/Europe’s Second European Programme of Work, co-created with 53 Member States and shaped through broad public consultations, including with health professionals, people living with NCDs and civil society. Effective action on NCDs hinges on good data. Europe can lead by example and showcase collaborative and inclusive approaches together with key stakeholders, including EU Joint Actions”, said Dr Gundo Weiler, Director of the Division of Prevention and Health Promotion at WHO Regional Office for Europe.
The challenge: gaps between commitments and reality
An estimated 80% of NCDs are considered preventable through effective public health policies and early detection strategies. These figures underscore the urgent need for a paradigm shift from a model centred on diagnostics and treatment to one rooted in prevention, health promotion, and evidence-based screening.
Despite great efforts in international commitments, progress at the national level has been inconsistent. Monitoring systems remain fragmented, overly reliant on short-term projects, or challenged by limited governance and insufficient investment. This has created a critical gap between ambitious global targets and their translation into actionable national policies.
The policy paper identifies persistent data gaps, structural weaknesses, and opportunities for innovation. It emphasizes that monitoring is not just about collecting data, it is about ensuring that information is used in real time to drive policy reform, accountability, and equity.
Lessons from Europe
The authors underline that too often, NCD monitoring efforts have been ad hoc, reliant on external funding or driven by individual champions. This has led to uneven coverage, lack of comparability between countries, and persistent blind spots when it comes to the health of groups living in vulnerable situations, such as migrants, minorities, and people with disabilities.
Without data that is disaggregated and reflects disparities, inequalities remain invisible and policies risk reinforcing exclusion. The authors argue that equity must be at the center of all future monitoring efforts.
“It is a moral and ethical imperative to advocate for and generate more inclusive data. Data should be systematically disaggregated by age, sex, gender, geography, socioeconomic status, disability, ethnic and migration background to reveal territorial disparities and enable place-based interventions”, unfolds Dr Benedetta Armocida, from the Department of Cardiovascular, Endocrine-metabolic Diseases and Aging at Istituto Superiore di Sanità-ISS, Rome (Italy) and Coordinator of JACARDI.
“We should begin to view data not merely as numbers, but as reflections of human lives and rights: each data point tells a story, and data becomes truly powerful when it shifts narratives, amplifies the voices of those too often overlooked, and holds systems accountable. Data must be observed critically and translated into policies that strengthen health systems. Without inclusive monitoring, structural inequities remain concealed, and the most vulnerable remain invisible—one data point, one life, one missed opportunity at a time”, adds Dr Armocida.
At the same time, the authors highlight successful innovations and good practices emerging from European Joint Actions, such as JACARDI and JA PreventNCD, demonstrating that progress is possible when commitments are matched by clear governance, adequate investment, and cross-sector collaboration.
“Across Europe we already see solutions that work. Joint Actions like JA PreventNCD and JACARDI help countries align methods, share tools and learn faster from each other. That is how we improve comparability between countries and make monitoring more useful for prevention and health promotion, including by showing more clearly where inequalities persist,” says Professor Knut-Inge Klepp, from the Norwegian Institute of Public Health, Oslo and Scientific Coordinator of JA PreventNCD.
“But we have to treat monitoring as core infrastructure, not an extra task. It needs stable funding, clear governance and the ability to produce data that is timely and inclusive. If monitoring depends on short-term projects or individual champions, it will remain uneven. If it is institutionalized, it can guide priorities, strengthen accountability and help sustain progress over time,” adds Klepp.
Europe has both a responsibility and an opportunity to lead the way in building stronger, more inclusive health information systems that can serve as a global benchmark. Doing so will be critical not only to reducing premature mortality from NCDs by one-third by 2030, but also to ensuring health equity and resilience in the face of future challenges. “Because what gets measured gets prioritised. What gets disaggregated gets addressed. And what gets institutionalised can be sustained”, conclude the authors.
Disclaimers
JACARDI (Grant Agreement 101126953) and JA PreventNCD (Grant Agreement 101128023) projects have received funding from the EU4Health Programme 2021-2027. Views and opinions expressed are however those of the authors only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them.
WHO disclaimer: The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.
Benedetta Armocida, Hanna Tolonen, Ivo Rakovac, Beatrice Formenti, Jill Farrington, Allison Ekberg, Hector Bueno, Giovanni Capelli, Silvia Francisci, Morten S. Frydensberg, Ane Fullaondo, Linda Granlund, Yhasmine Hamu Azcarate, Torben F. Hansen, Emil Høstrup, Tomi Mäki-Opas, Luigi Palmieri, Markku Peltonen, Valentina Possenti, Marco Silano, Gundo Weiler, Kremlin Wickramasinghe, Edwin Wouters, Knut-Inge Klepp, Graziano Onder, Gauden Galea, Strengthening non-communicable diseases monitoring systems in Europe through a multistakeholder collaborative approach: a key priority for advancing data-driven policymaking, The Lancet Regional Health – Europe, Volume 61, 2026, 101553, ISSN 2666-7762, https://doi.org/10.1016/j.lanepe.2025.101553
JACARDI at the ESC Congress 2025: Advancing the integration of mental and cardiovascular health
During the ESC Congress 2025, Professor Héctor Bueno unveiled a new statement from the European Society of Cardiology on mental health and cardiovascular disease, calling for closer collaboration between cardiologists and mental health professionals. The message was clear, mental and cardiovascular health are tightly interconnected, shaping one another from onset through progression to outcomes.
The ESC Congress 2025, held in Madrid at the end of August and organized by the European Society of Cardiology, brought together global leaders in cardiovascular medicine to present the latest advances shaping the future of heart health. Among the standout contributions was the presentation of the 2025 ESC Clinical Consensus Statement on Mental Health and Cardiovascular Disease[1], delivered by Professor Héctor Bueno, co-leader of JACARDI’s working group on data; senior researcher at the Spanish National Center for Cardiovascular Research (CNIC) and cardiologist at Hospital Universitario 12 de Octubre in Madrid (Spain).
Professor Bueno, together with Professor Christi Deaton, from the University of Cambridge (UK), introduced the new ESC Clinical Consensus Statement, which calls for a fundamental change in how mental health and cardiovascular disease are understood, assessed, and addressed in clinical practice. Their message was clear: mental health and cardiovascular health are not isolated domains but deeply interconnected, with each influencing the onset, progression, and outcomes of the other.
The Consensus Statement urges healthcare systems to systematically screen for mental health symptoms during cardiovascular care, and conversely, to routinely evaluate cardiovascular risk in individuals being treated for mental health conditions. This bidirectional approach is grounded in strong evidence: poor mental health contributes to the development of cardiovascular disease, while patients with cardiovascular disease face a significantly higher risk of anxiety, depression, and other mental health challenges. When both conditions coexist, outcomes tend to worsen, underscoring the need for integrated care.
A major innovation introduced in the Statement is the creation of Psycho-Cardio Teams, multidisciplinary units in which mental health professionals, such as psychologists and psychiatrists, work alongside with cardiologists and other cardiovascular specialists. These teams aim to ensure early identification of mental health conditions, better coordination of care, and more comprehensive support for both patients and caregivers.
As Professor Bueno emphasized during his presentation: “Clinical cardiovascular practice often overlooks the impact of mental health. We need to see cardiovascular health professionals developing collaborations with mental health professionals in Psycho-Cardio Teams to help identify early mental health conditions in our patients and improve care and support for patients and their caregivers.”
Empowering patients
The proposal represents more than a structural change, it calls for a cultural shift within cardiovascular medicine. By integrating mental health into routine cardiovascular assessments, empowering patients to discuss psychological concerns openly, and acknowledging the complex interplay between emotional and physical well-being, this initiative moves toward a more person-centred model of care.
Such progress represents a significant cultural shift towards a more integrated and responsive healthcare system, with the ultimate goal of empowering patients and enhancing their quality of life. This vision aligns strongly with JACARDI’s mission to promote person-centred, prevention-oriented, and patient-empowerment models of care.
JACARDI and its growing impact on cardiovascular health in Europe
Building on this shared vision, JACARDI is actively contributing to this transformation through initiatives such as working groups focused on patients’ self-management [2] and integrated care pathways [3]. The goals of the Consensus Statement resonate strongly with JACARDI’s commitment to empowering individuals in taking an active role in managing their cardiovascular and mental health.
Professor Bueno’s leadership in this landmark ESC initiative reinforces the consortium’s dedication to advancing cardiovascular health through innovative, holistic, and patient-centred approaches. His contribution at the ESC Congress 2025 marks an important milestone in Europe’s ongoing effort to bridge the gap between mental and cardiovascular health, an effort that promises meaningful benefits for patients across the region, empowering them to openly discuss their mental health with cardiovascular professionals and increasing the likelihood that their concerns will be taken seriously.
During the ESC Congress, the European Alliance for Cardiovascular Health (EACH) also highlighted JACARDI’s role during its annual meeting held in Madrid [4]. EACH partners reviewed progress in their 2025 workplan, celebrated key advocacy achievements, and reaffirmed the importance of coordinated action to improve cardiovascular health across Europe. At the meeting, JACARDI was recognised as a strong example of effective communication and successful synergy-building among partners, illustrating how collaborative approaches can strengthen cardiovascular health initiatives at the European level.
The visible engagement of JACARDI at the ESC Congress 2025 further highlights its increasing impact on the evolution of cardiovascular care in Europe. By championing mental–cardiovascular integration, strengthening patient empowerment, and fostering collaborative care pathways, JACARDI is helping to pave the way for a more holistic, equitable and person-centred cardiovascular health ecosystem across the region.
References:
[1] Héctor Bueno, Christi Deaton, Marta Farrero, Faye Forsyth, Frieder Braunschweig, Sergio Buccheri, Simona Dragan, Sofie Gevaert, Claes Held, Donata Kurpas, Karl-Heinz Ladwig, Christos D Lionis, Angela H E M Maas, Caius Ovidiu Merșa, Richard Mindham, Susanne S Pedersen, Martina Rojnic Kuzman, Sebastian Szmit, Rod S Taylor, Izabella Uchmanowicz, Noa Vilchinsky, ESC Scientific Document Group , 2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease: developed under the auspices of the ESC Clinical Practice Guidelines Committee: Developed by the task force on mental health and cardiovascular disease of the European Society of Cardiology (ESC).
Endorsed by the European Federation of Psychologists’ Associations AISBL (EFPA), the European Psychiatric Association (EPA), and the International Society of Behavioral Medicine (ISBM), European Heart Journal, Volume 46, Issue 41, 1 November 2025, Pages 4156–4225, https://doi.org/10.1093/eurheartj/ehaf191
[2] Work Package 10: Patients’ Self-management, ‘Be the master of your health’
[3] Work Package 09: Integrated care pathways, ‘Elevating pathways, enhancing Care’
A major step forward: Basque country rolls out integrated heart failure care model
A new pilot project has recently been launched in the Basque country as part of JACARDI, featuring an integrated, value-based care pathway for people with heart failure. This pilot is aligned with JACARDI’s broader mission to reduce the burden of cardiovascular disease and diabetes across Europe by strengthening coordinated care, enhancing health literacy, and scaling best practices.
Within JACARDI, Biosistemak represents the Basque country as an affiliated entity, co-leading communication and dissemination activities, supporting methodological frameworks for European pilots, contributing to health literacy initiatives, and leading the deployment of the heart failure pathway. This includes conducting a comprehensive needs assessment on the European level.
On 27 November, at the launch event organized at Cruces University Hospital in Barakaldo, Osakidetza – the public health care service of the Basque country – presented the new value-based integrated care pathway for heart failure, after two years of joint development with Biosistemak and Osakidetza’s Care Integration and Chronicity Service (SIAC). Throughout the entire development process, Biosistemak provided methodological support on pathway design, including the adaptation of care pathways and resources, the development of evaluation frameworks, the integration of technological requirements, and the preparation of awareness raising actions and training plans for professionals. The result is a comprehensive and coordinated care model that improves outcomes and quality of life for people living with heart failure while ensuring long-term sustainability.
During the event, Biosistemak researcher Yhasmine Hamu highlighted the importance of the extensive multidisciplinary collaboration behind the initiative. Over two years, professionals from family and community medicine, hospital care, nursing, pharmacy, and management collaborated to create a model that responds to real patient needs and incorporates sex- and gender-based perspectives. Presentations also highlighted innovative solutions, new corporate tools, and lessons learned on improving communication, standardising care, and defining indicators for continuous improvement.
The jointly developed pathway covers the entire care cycle for people with heart failure, from initial suspicion of the condition to hospitalisation, discharge, and ongoing follow-up in both primary and specialised settings. It is designed to align the perspectives of patients, professionals, and the general population. For patients, the model organises interventions and responsibilities in one integrated system to reduce morbidity and mortality and strengthen self-care. For professionals, it offers a clear overview of actions to be taken, decision-support tools, and a framework that promotes coordination and reduces variability. On a societal level, the model improves population health by enhancing scientific knowledge and reinforcing the sustainability of health systems.
The success of this pilot is a perfect example of how JACARDI supports Member States in adopting evidence-based and scalable care models for chronic disease management. Through its leadership in this initiative, Biosistemak contributes to strengthening integrated care and advancing cardiovascular health both within the Basque country and across Europe.
Can artificial intelligence help shape smarter cardiovascular policies across Europe?
What if policymakers across Europe had faster, clearer and more reliable data to guide decisions in cardiovascular health? Addressing that challenge, one of JACARDI’s pilot teams from CNIC presented their work at the ESC Digital & AI Summit 2025, showcasing AI innovations designed to turn evidence into actionable policy.
At the European Society of Cardiology Digital & AI Summit 2025, researchers Fatima Sanchez-Cabo, Juan Ignacio Alvarez Arenas, Daniel Jiménez Carretero, from the Computational Systems Biomedicine group at CNIC (Spanish Cardiovascular Research Center), and active members of JACARDI’s Working Group on Data Availability, Quality, Accessibility and Sharing, presented their poster: CARMINA: Optimizing low-parameter language models for high-quality cardiovascular research assistance. The work was featured in the session From bench to bedside: the potential roles of large language models in cardiovascular medicine, moderated by Professor Lis Neubeck, from Edinburgh Napier University; and Associate Professor Johan Verjans MD PhD FESC FRACP, from the University of Adelaide.
Why does this matter?
Within JACARDI’s Pilot 57, CNIC is developing EUROCARDIAB, a pioneering federated data platform integrating cardiovascular health indicators from across Europe. One of its key features is a CVD impact simulator that models how changes in risk factors could reduce event prevalence, providing policy makers with reliable, data-driven scenarios for national planning.
A dedicated web front-end will share these insights and will also host CARMINA (Cardiovascular And Research-driven Molecular Insight with Novel Assistant), an AI-powered research assistant designed to support specialized cardiovascular research. CARMINA will orchestrate the Intelligent Policy Agent (IPA), enabling autonomous trend analysis, computational modeling of interventions, and the creation of clear, actionable policy briefings for decision-makers in cardiology and diabetology.
This year’s ESC Digital & AI Summit motto, “Prepare for the next frontier in cardiovascular care”, aligns strongly with JACARDI’s overarching mission: accelerating patient outcomes and transforming clinical workflows across Europe through better data, smarter tools and more equitable care pathways.
Today, accurate, comparable and timely data on cardiovascular disease and diabetes remain limited, yet this information is essential for developing targeted policies that reduce disease burden, improve healthcare for all citizens and help close persistent inequalities.
The ESC Digital & AI Summit remains a key meeting point for global leaders, innovators and technology experts shaping the digital transformation of cardiovascular care, and pilots like this one from CNIC demonstrate how JACARDI is already turning that vision into meaningful, data-driven progress across Europe.
Slovenia’s breakthroughs in the fight against diabetes
This year’s National Diabetes Conference in Slovenia placed a strong spotlight on JACARDI and the country’s three national pilot projects addressing diabetes. These initiatives are designed to:
- Identify individuals with undiagnosed type 2 diabetes or intermediate hyperglycemia, especially among vulnerable groups who rarely access preventive services.
- Increase participation in primary-care education programs among people already diagnosed with type 2 diabetes or intermediate hyperglycemia.
- Boost attendance in the national diabetic retinopathy screening program, a crucial step in preventing diabetes-related blindness.
Slovenia is well aware of its key challenges in diabetes care and is actively addressing them through the nearly complete CARE4DIABETES project and its ongoing work within JACARDI. Both efforts are fully aligned with the country’s National Diabetes Plan, ensuring that strategic intent is translated into concrete action.
Why JACARDI matters for Slovenia
In an interview conducted during the conference, Dr Jelka Zaletel (NIJZ Slovenia) explained why JACARDI is uniquely important for the country. Slovenia knows its main barriers in managing the diabetes burden: many individuals with type 2 diabetes remain undiagnosed; those who would benefit most from preventive visits or early detection often do not enter the healthcare system; and attendance in primary-care education programs remains lower than expected.
The JACARDI pilot projects help tackle these issues head-on:
- Pilot 1: Developing new, community-based approaches to reach people unlikely to attend preventive check-ups.
- Pilot 2: Understanding and addressing why individuals with type 2 diabetes do not participate in primary-care education programs—and redesigning these programs accordingly.
- Pilot 3: Improving uptake of the national diabetic retinopathy screening program. Although 30,000 people currently attend screenings, an estimated 150,000 Slovenians live with diabetes. JACARDI helps uncover where the gaps lie and how to close them.
A fourth pilot: Strengthening cardiovascular care
These efforts are embedded in Slovenia’s National Diabetes Plan, supported by clear action plans. The National Diabetes Conference, held every November, is one such action, providing an annual moment to share progress and results from JACARDI.
Slovenia is also implementing a fourth JACARDI pilot project focused on cardiovascular health. It aims to harmonize approaches across rehabilitation centers treating patients after acute coronary events—an area where attendance is also suboptimal. This work aligns with the Ministry of Health’s decision to develop a National Strategy for Cardiovascular Health, reinforcing how JACARDI can support strategic planning beyond diabetes.
Relive the Conference
A mood video from the event captures the atmosphere at the venue. Although only speakers and roundtable participants were physically present, the online turnout was impressive, with more than 170 remote attendees.
You can also watch the full interview with Dr Jelka Zaletel, where she explores in more depth how Slovenia leverages JACARDI to address long-standing gaps in diabetes and cardiovascular care.
Socioeconomic and health disparities in adults diagnosed with type 1 diabetes mellitus before age 18
Scientific publications by JACARDI
In this post series we share the scientific publications directly linked to the JACARDI project. All publications featured in this series are authored or co-authored by JACARDI partners and reflect research and findings developed within the project framework.
We aim to showcase how evidence supports our joint mission to tackle cardiovascular diseases and diabetes across Europe.
Stay informed on how JACARDI turns evidence into action.
Keywords: public health, socioeconomic inequalities, health inequalites, type 1 diabetes mellitus, quality of life
Giulia Zamagni, Valentina Minardi, Maria Masocco, Federica Asta, Riccardo Candido, Gianluca Tornese, Giulia Bresciani, Valentina Manfredini, Elena Frattolin, Claudia Veronica Carletti, Daniela Germano, Eleonora Maurel, Luca Ronfani, Lorenzo Monasta
Abstract:
Background: Type 1 diabetes mellitus is a lifelong condition with consequences that extend well beyond glycaemic control, often impacting individuals’ socioeconomic status and overall quality of life. In Italy, the broader effects of early-onset type 1 diabetes on social and health-related outcomes have been insufficiently investigated. Therefore, this study aimed to investigate the socioeconomic impacts of type 1 diabetes among adults diagnosed with the condition before age 18.
Methods: Using data from the Italian Behavioral Risk Factor Surveillance System (PASSI) collected between 2011 and 2018 and in 2023, we analyzed key outcomes in adults aged 18–50 who were diagnosed with type 1 diabetes before age 18 and were on insulin therapy. Each case was matched by age and sex to two non-diabetic controls. Descriptive statistics and multivariable logistic regression
were used to compare key indicators.
Results: Our sample included 993 participants (331 cases and 662 controls). Cases had significantly higher odds of being unemployed [OR = 1.57 (1.20–2.07)], experiencing severe financial difficulties [OR = 1.81 (1.05–3.13)], and reporting poor self-rated health [OR = 6.64 (2.53–17.43)]. Cases also had an increased likelihood of reporting physical impairment for 1–13 days [OR = 1.91 (1.30–2.81)] and ≥14 days [OR = 2.95 (1.54–5.65)], mental health impairment for 1–13 days [OR = 2.16 (1.46–3.19)], and daily activity limitations for 1–13 days [OR = 1.73 (1.06–2.82)].
Conclusions: These findings highlight the multifaceted burden of type 1 diabetes and the need for integrated approaches to care that address not only clinical but also socioeconomic and psychosocial dimensions of the disease.
Source: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1655035/full
Workplace Health Interventions Targeting Cardiovascular Diseases and Diabetes Mellitus for Blue-Collar Workers
Scientific publications by JACARDI
In this post series we share the scientific publications directly linked to the JACARDI project. All publications featured in this series are authored or co-authored by JACARDI partners and reflect research and findings developed within the project framework.
We aim to showcase how evidence supports our joint mission to tackle cardiovascular diseases and diabetes across Europe.
Stay informed on how JACARDI turns evidence into action.
Authors: Chiara Di Girolamo, MD, MSc, PhD; Agnieszka Lipiak, MA; Matteo Franco, MSc; Krzysztof Kaczmarek, PhD; Guillermo Barreres-Martín, MSc; Piotr Romaniuk, PhD; Carles Muñoz-Alfonso, MSc; Andrea Arroyo-Álvarez, MSc; Federica Turatto, MD; Daznia Bompart Berroterán, PhD; Ewelina Chawłowska, PhD
Abstract:
Background: Cardiometabolic diseases, such as cardiovascular diseases (CVD) and diabetes mellitus (DM), represent a global health issue, causing significant premature mortality and disability. Blue-collar workers, who often face a higher exposure to risk factors (eg, smoking, poor diet, and lack of physical activity), are particularly vulnerable to these diseases. Workplace health promotion plays a crucial role in mitigating this risk, yet the scope and the characteristics of interventions targeting this specific workforce remain unclear.
Objective: The objective of this scoping review will be to assess the extent and characteristics of workplace health promotion interventions aimed at preventing cardiometabolic diseases and their risk factors in blue-collar workers.
Methods: The review will follow the JBI methodology for scoping reviews. A search of MEDLINE, Scopus, Embase, and the Cochrane Database as well as grey literature will be conducted. The search strategy is designed to capture relevant studies published since 2014 in English, Spanish, Italian, and Polish. Eligible study designs include experimental design (eg, randomized controlled trials), observational studies (eg, longitudinal studies), qualitative research, and mixed-method approaches as well as other formats present in grey literature (eg, reports). This review will include studies focusing on health promotion interventions involving adult blue-collar workers (aged ≥18 years) currently employed, with at least 60% of participants being blue-collar employees. The interventions of interest are workplace health promotion strategies targeting CVD, DM, or their risk factors, such as hypertension, obesity, and smoking. Each paper retrieved will be screened for inclusion by at least 2 reviewers. Disagreements between the reviewers will be resolved through discussion with the other reviewers. Studies focusing on noninterventional contexts, mental health, or ergonomic safety will be excluded. Data will be extracted and analyzed using qualitative and quantitative methods, with a focus on intervention types, participant characteristics, and outcomes.
Results: The study began in March 2024 and the full scoping review report is expected to be ready in September 2025.
Conclusions: The scoping review presented in this protocol can contribute to filling the knowledge gap by mapping the current state of workplace health promotion interventions aimed at preventing CVD and DM and modifying relevant risk factors in the blue-collar workers’ group.