The goal of this observational study is to better understand how diabetes develops in adults at the time of diagnosis. The study focuses on adults with newly diagnosed diabetes in the Kazakh population.

The main questions it aims to answer are:

• How do insulin resistance and beta-cell function differ between participants?
• How is the immune system involved at the early stage of diabetes?
• How are inflammation markers related to metabolic changes?

Participants undergo clinical and laboratory assessments at diagnosis. These include:

• Measurement of body mass index (BMI) and blood glucose control (HbA1c)
• Assessment of insulin resistance and beta-cell function using HOMA2 indices
• Measurement of C-peptide levels
• Testing for islet autoantibodies (GADA, IA-2A, ZnT8A, ICA)
• Measurement of inflammatory markers, including interleukin-1 beta (IL-1β) and interleukin-1 receptor antagonist (IL-1Ra) This study aims to improve understanding of different forms of adult-onset diabetes and support more personalized approaches to diagnosis and treatment.

Adult-onset diabetes is increasingly recognized as a heterogeneous condition with diverse underlying pathophysiological mechanisms. At the time of diagnosis, individuals may present with varying degrees of insulin resistance, impaired beta-cell function, and immune activation. However, traditional classifications based mainly on glycemic parameters do not fully capture this complexity.

This study aims to provide an integrated assessment of metabolic and immunoinflammatory features in adults with newly diagnosed diabetes. Particular attention is given to the interplay between insulin resistance, beta-cell function, and immune-mediated processes, including islet autoimmunity and inflammatory signaling pathways.

The study focuses on key metabolic indicators such as body mass index, glycemic control, C-peptide levels, and indices derived from the HOMA2 model, as well as immunological markers including islet autoantibodies and cytokines involved in the interleukin-1 pathway. The balance between pro-inflammatory and anti-inflammatory activity is assessed through the IL-1β/IL-1Ra ratio.

By integrating metabolic and immunological data, this study seeks to better characterize early-stage heterogeneity of adult-onset diabetes and to contribute to improved phenotypic classification. A more comprehensive understanding of these mechanisms may support the development of more personalized approaches to diagnosis and disease management in diverse populations.

Inclusion Criteria:

• Adults aged 25 years and older
• Kazakh population with newly diagnosed diabetes mellitus
• Diagnosis established in routine clinical practice
• No prior insulin therapy at the time of enrollment
• No prior use of glucose-lowering therapy beyond initial management
• Ability and willingness to provide informed consent

Exclusion Criteria:

• Clinical features suggestive of classical type 1 diabetes at presentation
• History of long-term insulin therapy prior to enrollment
• Severe acute illness or infection at the time of assessment
• Pregnancy
• Incomplete clinical or laboratory data

Adults with newly diagnosed diabetes recruited from primary health care settings in the Kazakh population. Participants were assessed at the time of diagnosis using clinical, metabolic, and immunological parameters.

Individual participant data (IPD) are not currently planned to be shared due to ethical considerations and restrictions related to informed consent. Data may be made available upon reasonable request and subject to approval by the institutional ethics committee.