Immune-Based Endotyping in Type 2 Diabetes Identifies High-Risk Patients 

A new study presented at EASD 2026 has identified four immune profiles in people with newly diagnosed type 2 diabetes, with some groups showing substantially higher risks of cardiovascular problems, kidney decline and death. 

The findings suggest that immune-based endotyping in type 2 diabetes could help doctors distinguish patients according to their underlying inflammatory patterns rather than relying only on conventional diabetes classifications. 

Researchers analysed routine blood counts from more than 1,500 people with newly diagnosed type 2 diabetes across cohorts in France, Italy and Germany. Neutrophil, lymphocyte and monocyte counts were used to group patients according to their immune characteristics. 

The analysis identified four type 2 diabetes immune endotypes: severe inflammatory diabetes (SIND), mild inflammatory diabetes, lymphocyte-rich diabetes and lymphocyte-deficient diabetes. 

The differences between the groups were linked to long-term health outcomes. Patients in the SIND and lymphocyte-deficient groups had higher rates of cardiovascular events, kidney deterioration and mortality, while the other two groups showed more favourable outcomes. 

The study also found signs that the inflammatory pattern may be changeable. Treatment with an IL-1β antagonist was associated with fewer pro-inflammatory monocytes and a reduction in the number of patients classified as SIND. 

Bariatric surgery was also linked to movement towards lower-risk immune profiles. The findings do not establish that either intervention should be selected based on immune endotype, but they provide clues for further research into personalized diabetes treatment. 

What’s Next 

The researchers validated the four type 2 diabetes immune endotypes across additional longitudinal cohorts involving up to 67,000 people. Cardiovascular, kidney and mortality outcomes were tracked over five to 12 years. 

The results put immune-based endotyping in type 2 diabetes among emerging approaches being studied for more personalised risk assessment. Further clinical research will be needed to determine whether routine blood counts can eventually be used to guide treatment decisions in everyday diabetes care.