The FinnDiane Study

FinnDiane: Understanding and preventing diabetes complications

The FinnDiane Study is one of the world's leading research initiatives focused on understanding why some people with type 1 diabetes develop complications while others remain protected. Our overarching goal is to identify the biological, genetic, environmental, and lifestyle factors that influence the development and progression of diabetes-related complications, particularly diabetic kidney disease, cardiovascular disease, and diabetic eye disease.

Although advances in diabetes care have substantially improved outcomes, complications remain a major cause of reduced quality of life, disability, and premature mortality. By understanding the mechanisms underlying these complications, we aim to improve risk prediction, enable earlier prevention, and support the development of more personalized approaches to diabetes care.

Over the past decades, FinnDiane has identified numerous risk factors associated with diabetes complications, ranging from lifestyle and metabolic factors to genetic susceptibility. Our research spans clinical epidemiology, genetics, molecular biology, and translational medicine, combining long-term follow-up data with state-of-the-art laboratory and computational methods.

Current research areas

Epidemiological and clinical research

A major strength of the FinnDiane Study is its unique combination of long-term clinical follow-up and nationwide health register data. This enables us to monitor the burden of diabetes complications at the population level and identify factors that influence long-term health outcomes in people with type 1 diabetes.

Our research has revealed important trends in the incidence of cardiovascular disease and diabetic kidney disease over recent decades, helping to identify areas where diabetes care has improved and where challenges remain. We investigate both traditional and emerging risk factors for complications, including kidney disease, cardiovascular disease, frailty, fractures, and premature mortality. Recent studies have demonstrated the major impact of diabetic kidney disease on cardiovascular outcomes and survival, while also highlighting the importance of frailty as a predictor of future complications and death.

In addition, we study the heterogeneity of type 1 diabetes itself, including the persistence of residual insulin secretion many years after diagnosis. Understanding individual differences in disease progression and complication risk is an essential step toward more personalised diabetes care.

Genetics, epigenetics and multi-omics

FinnDiane is internationally recognised for its work in uncovering the molecular mechanisms underlying diabetes complications. By combining large-scale genetic studies with detailed clinical data, we aim to understand why some individuals are particularly susceptible to complications while others remain protected despite decades of living with diabetes.

Our discoveries include multiple genetic loci associated with diabetic kidney disease, diabetic retinopathy, cardiovascular disease, and other metabolic traits. More recently, whole-exome and whole-genome sequencing have enabled the identification of novel genes and rare genetic variants that contribute to the risk of diabetic complications.

Beyond DNA sequence variation, we investigate biological pathways through a broad range of omics technologies, epigenetics, proteomics, and metabolomics. We have identified urinary metabolites that predict cardiovascular outcomes and progression of diabetic kidney disease, and have characterised how kidney function influences the human metabolome. We have also discovered DNA methylation markers associated with both the presence and progression of diabetic kidney disease, providing important insights into disease mechanisms and potential future biomarkers for risk prediction and treatment monitoring. Furthermore we investigate how proteomics can inform disease mechanisms and be used for prediction of diabetic complications.

By integrating genomics, epigenomics, metabolomics, and clinical data, we aim to move towards precision medicine approaches that enable earlier identification of individuals at risk and more targeted preventive interventions.

Gut microbiome, inflammation and hypoxia

A key focus of our mechanistic research is understanding how chronic inflammation contributes to diabetes complications. We investigate how alterations in the gut microbiome, intestinal barrier function, and exposure to bacterial products may affect kidney health and cardiovascular risk through activation of inflammatory pathways.

Another important research area is tissue hypoxia, a condition in which organs receive insufficient oxygen. Growing evidence suggests that diabetes-induced hypoxia may contribute to irreversible damage in the kidneys, retina, cardiovascular system, and other tissues. We study the molecular and cellular mechanisms linking hypoxia, inflammation, and metabolic dysfunction to the development and progression of diabetes complications.

Together, these studies help identify novel biological pathways that could be targeted to prevent complications and improve long-term outcomes for people living with type 1 diabetes.

Looking ahead

By integrating genetic information with detailed clinical and lifestyle data collected over many years, we aim to identify new therapeutic targets and support the development of precision medicine approaches for people living with diabetes. Our success is built upon the long-term commitment of thousands of study participants, close collaboration between researchers and healthcare professionals, and extensive national and international partnerships. Together we share the goal of reducing the burden of diabetes complications and improving the lives of people with diabetes.