To determine whether healthcare visits within one year after diabetes identification lower 10-year cardiovascular disease (CVD) risk compared with no visits. 

 We emulated a target trial in the nationwide JMDC Claims Database (>12 million Japanese beneficiaries). Adults aged 40–74 years with newly identified diabetes (HbA1c ≥ 6.5 % [48 mmol/mol] or fasting glucose ≥126 mg/dL) during annual health checkups between 1 January 2005 and 31 March 2021 and no prior history of CVD were assigned to an early-visit group (≥1 outpatient visit within one year) or a no-visit group. Weighted pooled logistic regression estimated 10-year risk differences and risk ratios for a composite CVD outcome.

Among 148,288 participants (mean age 53 years; 77 % men; 421,466 person-years), 1,741 CVD events occurred. Early visits were associated with a lower 10-year composite CVD risk compared to no visits (risk difference –3.4 percentage points [95 % CI –6.2 to –1.4]; risk ratio 0.73 [95 % CI 0.59 to 0.87]). Subgroup analyses confirmed consistent results across various characteristics. 

Early healthcare visits within one year of diabetes identification were associated with a lower 10-year CVD risk. Health systems should facilitate early follow-up after screening to translate early detection into cardiovascular benefit.