A study led by Inserm, CNRS, and Université Paris-Cité has uncovered four distinct immune profiles in people with type 2 diabetes (T2D) that may help predict the risk of complications, according to a recent report. These profiles can be identified using a standard complete blood count, known as a nuclear formula (NFS), and are described as stable and predictive of health outcomes. The study examined the NFS of over 1,500 individuals who had recently been diagnosed with T2D from three European research groups. Four immune subtypes were identified: SIND (severe inflammatory diabetes), MIND (mild inflammatory diabetes), LYRD (lymphocyte-rich diabetes), and LYDD (lymphocyte-deficient diabetes). The SIND and LYDD profiles are associated with more serious health outcomes, including higher risks of heart-related issues, kidney problems, and mortality. In contrast, the MIND and LYRD profiles are linked to better clinical outcomes. Around 15% of people with T2D have the SIND profile, which is considered the most risky. Over a five-year period, the risk of death from any cause was about 15% for both SIND and LYDD profiles. Cardiovascular events occurred in 17% of SIND patients and 16% of LYDD patients. For kidney-related complications, the LYDD profile had the highest rate, at 13.5% over five years, followed by SIND (12%), MIND (9%), and LYRD (6%). The immune profiles appear to remain consistent over time. Data from three large studies over a period of 5 to 10 years involved nearly 8,500 participants, most of whom had T2D. These findings were confirmed in five national and international studies, including over 70,000 people. The immune profiles can predict complications up to five years before they occur. Multi-omics profiling, which involves analyzing various biological data, confirmed that each subtype has distinct and specific markers. Preliminary evidence suggests that the SIND profile might be reversible. In a study of 20 people with prediabetes, researchers found that highly inflammatory SIND states improved after treatment with anti-interleukin-1 drugs or bariatric surgery. However, these findings are still preliminary and require further confirmation. Questions remain about whether the separation of variables into distinct groups is appropriate, the impact of fluctuations in measured variables, and the long-term effects of such treatments. Clinical trials are currently underway with 300 SIND patients. The results suggest the potential for using simple tools in routine medical care to assess risk and move toward more personalized treatment for T2D.