Diabetes complications cohort study

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Project leader: Professor Jonathan Shaw

Type 2 diabetes affects millions of Australians, but the disease itself isn't what causes the greatest burden, it's the complications. Eye damage leading to blindness, kidney disease requiring dialysis, nerve damage causing pain and disability, heart attacks and strokes — these complications dramatically reduce quality of life and life expectancy.

Yet we still don't fully understand why some people with diabetes develop severe complications whilst others don't, even with similar blood glucose control. The PREDICT study (Preventing Complications of Diabetes) is designed to answer this question.

A comprehensive investigation

PREDICT is recruiting 2000–3000 people with type 2 diabetes from across Australia to better understand what causes diabetes complications. Unlike previous studies that focus on single complications in isolation, PREDICT takes a comprehensive approach, examining:

Classic complications:

  • Eye disease (diabetic retinopathy).
  • Kidney disease (diabetic nephropathy).
  • Nerve damage (diabetic neuropathy).
  • Cardiovascular disease (heart attack and stroke).

Emerging complications:

  • Cognitive decline and dementia.
  • Frailty and physical disability.
  • Depression and mental health.

By studying the full spectrum of complications together, we can understand how they're interconnected and identify common underlying causes.

Beyond blood sugar

Traditional diabetes research has focused primarily on blood glucose levels and standard risk factors. PREDICT goes further, investigating:

  • Psychological factors
    How stress, depression and mental health affect complication development.
  • Behavioural factors
    How lifestyle, self-management and medication adherence influence outcomes.
  • Pathophysiological factors
    The biological mechanisms driving tissue damage.
  • Novel biomarkers
    New biological indicators that might predict who's at highest risk.

This holistic approach recognises that diabetes complications develop through complex interactions between biology, behaviour and psychology — not through glucose levels alone.

A living biobank

Central to PREDICT is establishing a comprehensive biobank of blood, urine and tissue samples that can be analysed for novel candidate causes of complications. As new testing technologies emerge and scientific understanding advances, these samples can be re-examined to uncover mechanisms invisible with today's techniques.

This biobank represents a crucial resource for the diabetes research community, enabling investigations into:

  • Genetic factors that increase complication risk.
  • Inflammatory markers that predict disease progression.
  • Metabolic signatures associated with specific complications.
  • Novel therapeutic targets for preventing or slowing complications.

Following people over time

PREDICT is a longitudinal study, following participants over years to track who develops complications and why. This population-based cohort approach is the gold standard for understanding disease development because it captures:

  • Risk factors measured before complications develop.
  • How risk changes over time.
  • Individual trajectories from health to disease.
  • Why some high-risk individuals remain complication-free.

A powerful collaboration

This research is being undertaken in collaboration with world-leading researchers at:

  • Monash University
  • Centre for Eye Research Australia
  • Deakin University's Australian Centre for Behavioural Research in Diabetes.

These partnerships bring together expertise in endocrinology, ophthalmology, nephrology, cardiology, neurology, psychology and behavioural science — the multidisciplinary approach essential for understanding complex chronic disease.

Real-world impact

PREDICT findings will inform:

  • Screening guidelines
    Identifying who needs intensive monitoring for complications.
  • Prevention strategies
    Interventions to stop complications before they start.
  • Treatment approaches
    Targeting newly discovered mechanisms with existing or novel therapies.
  • Risk prediction tools
    Helping clinicians and patients understand individual complication risk.
  • Public health policy
    Evidence-based approaches to reducing diabetes complications at the population level. 

Publications and findings

PREDICT has already generated important insights into diabetes complications:

Student research opportunities

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