Biomarkers for the disease, which provide a deeper understanding of the disease process, are therefore eagerly sought. Type 2 diabetes is a progressive multifactorial disease which presently affects >400 m worldwide, with numbers expected to increase to >700 m by 2045 1. This comprehensive, multi-disciplinary approach thus identifies biomarkers with potential prognostic utility, provides evidence for possible disease mechanisms, and identifies potential therapeutic avenues to slow diabetes progression. High NogoR levels led to islet cell apoptosis, and IL-18R antagonised inflammatory IL-18 signalling towards nuclear factor kappa-B in vitro. NogoR/RTN4R injection improved glucose tolerance in high fat-fed male mice but impaired it in male db/db mice. In an external replication, proteins and lipids are associated with diabetes incidence and prevalence. Of ~1,300 proteins examined in two cohorts, levels of GDF15/MIC-1, IL-18Ra, CRELD1, NogoR, FAS, and ENPP7 are associated with faster progression, whilst SMAC/DIABLO, SPOCK1 and HEMK2 predict lower progression rates. Homocitrulline, isoleucine and 2-aminoadipic acid, eight triacylglycerol species, and lowered sphingomyelin 42:2 2 levels are predictive of faster progression towards insulin requirement. We identify biomarkers for disease progression in three type 2 diabetes cohorts encompassing 2,973 individuals across three molecular classes, metabolites, lipids and proteins. Nature Communications volume 14, Article number: 2533 ( 2023) Identification of biomarkers for glycaemic deterioration in type 2 diabetes
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