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Article History

Received: 4 February 2026

Accepted: 1 June 2026

First Online: 3 August 2026

Ethics

Data availability: Individual-level data are not publicly available due to ethical and legal restrictions. De-identified data are available upon reasonable request after publication, with approval from the ANDIS steering committee.

Funding: The ANDIS study was financed by Swedish governmental funding for clinical research (ALF) from Region Skåne, Swedish Research Council project grant numbers 2020-02191 and 2015-2558, infrastructure grant numbers 2010-5983, 2012-5538 and 2014-6395, Linnaeus grant number 349-2006-237, strategic research grant number 2009-1039 (EXODIAB), and by the Swedish Foundation for Strategic Research IRC15-0067 (LUDC-IRC). JGS was supported by grants from the Swedish Heart–Lung Foundation (2023-03332 and 2025-0805), the Swedish Research Council (2021-02273 and 2024-03314), the European Research Council (ERC-STG-2015-679242), Gothenburg University and Skåne University Hospital, by governmental funding for clinical research within the Swedish National Health Service, and by a generous donation from the Knut and Alice Wallenberg Foundation to the Wallenberg Center for Molecular Medicine in Lund. CL was supported by grants from the Thelma Zoéga Foundation (2023-0068) and the Birger Segerfalk Foundation (87407). EA was supported by grants from the Swedish Research Council (2020-02191), Swedish governmental funding for clinical research, and the Swedish Heart and Lung Foundation (20241121). MFG received funding from the Swedish Heart–Lung Foundation (20190470), the Swedish Research Council (2018-02837) and the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement number 115974 (BEAt-DKD). This joint undertaking receives support from the European Union’s Horizon 2020 research and innovation programme, and from EFPIA with JDRF. Any dissemination of results reflects only the authors’ views; the joint undertaking is not responsible for any use that may be made of the information contained in this article. DEC is supported by the EFSD and Lilly European Diabetes Research Programme and by a grant from Novo Nordisk A/S within the LUDC-IRC framework.

Authors’ relationships and activities: MFG has received financial and non-financial (in-kind) support from Boehringer Ingelheim Pharma GmbH, JDRF International, Eli Lilly, AbbVie, Sanofi-Aventis, Astellas, Novo Nordisk A/S and Bayer AG, within EU grant H2020-JTI-lMl2-2015-05 (grant agreement number 115974 – BEAt-DKD). She has also received financial and in-kind support from Novo Nordisk, Pfizer, Follicum, Coegin Pharma, Abcentra, Probi and Johnson & Johnson within a project funded by the Swedish Foundation for Strategic Research on precision medicine in diabetes (LUDC-IRC 15-0067). MFG has also received personal consultancy fees from Lilly and Tribune Therapeutics AB. EA has received research funding from AstraZeneca. The remaining authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

Contribution statement: CL and JGS researched data, contributed to discussion, and wrote the first draft of the manuscript. TC and EA researched data and reviewed and edited the manuscript. LB, DEC, OOB, OM and MFG contributed to discussion and reviewed and edited the manuscript. All authors approved the final version of the manuscript. CL is the guarantor of this work, and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.