Inflammation plays a central role in type 2 diabetes pathophysiology, yet most classification systems have overlooked this component. Findings from a multicenter study integrating circulating immune cell profiling were presented at the European Association for the Study of Diabetes Conference 2025, highlighting distinct inflammatory endotypes with implications for disease progression and complication risk.

The study recruited 1,500 newly-diagnosed type 2 diabetes participants from France, Italy, and Germany and applied unsupervised clustering on neutrophils, monocytes, and lymphocytes. Multi-omics analyses further characterized immune responses across endotypes. 

Four stable immune-based endotypes emerged, with two demonstrating higher susceptibility to cardiovascular events and nephropathy. Notably, one high-risk group exhibited classical monocyte enrichment, a SIGLEC signature, and interferon pathway activation, suggesting a distinct inflammatory mechanism driving complications.

These results demonstrate that incorporating immuno-inflammatory profiling into diabetes stratification refines risk prediction and identifies patients at high risk for adverse outcomes. Immune-based endotyping could guide personalized monitoring and targeted therapeutic interventions, addressing the heterogeneity of type 2 diabetes.