Multi-omics profiling of human pancreatic islet dysregulation from normoglycemia to type 2 diabetes

Type-2 diabetes (T2D) mellitus results from a complex interplay of genetic and environmental factors leading to deficient insulin secretion from pancreatic islet beta cells. Here, we provide a the first comprehensive study of the human islet state of metabolically profiled pancreatectomized living human donors in relationship to glycemic control integrating clinical traits with multiple in situ islet and pre-operative blood omics datasets across the glycemia continuum from non diabetic healthy to overt T2D levels. Our transcriptomics and proteomics data suggest that progressive dysregulation of islet gene expression associated with increasing glucose intolerance is a disharmonic process resembling a non-linear trajectory of mature beta cell states towards trans-differentiation. Furthermore, we identify a unique islet gene set altered already in early-onset glucose intolerance and that, which correlates well across HbA1c levels - the gold-standard in clinical monitoring. Our findings reach beyond conventional clinical thresholds and can serve as direct or indirect prognostic markers for beta cell failure.