To investigate the potential progression rate of cerebral small vessel disease (CSVD) in brain MRI among neurologically asymptomatic middle-aged individuals with type 1 diabetes. A total of 172 individuals with type 1 diabetes were re-examined with brain MRI 7.5 years after their initial visit. Baseline predictors of changes in CSVD, particularly cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs) were analyzed. The proportion of individuals with type 1 diabetes with CSVD increased from 36% to 70% (P < 0.001), CMBs increased from 17% to 33% (P < 0.001), and WMHs from 23% to 63% (P < 0.001) at follow-up. The increase in CMBs was associated with baseline systolic blood pressure, HbA1c, and preexisting CMBs. The increases in CSVD and WMHs were associated only with age. The prevalence of CSVD doubled over a 7.5-year period in middle-aged individuals with type 1 diabetes.