Unravelling the molecular mechanisms causal to type 2 diabetes across global populations and disease-relevant tissues.

Type 2 diabetes (T2D) is a prevalent disease that arises from complex molecular mechanisms. Here, we leverage T2D multi-ancestry genetic associations to identify causal molecular mechanisms in an ancestry- and tissue-aware manner. Using two-sample Mendelian Randomization corroborated by colocalization across four global ancestries, we analyze 20,307 gene and 1,630 protein expression levels using blood-derived -quantitative trait loci (QTLs). We detect causal effects of genetically predicted levels of 335 genes and 46 proteins on T2D risk, with 16.4% and 50% replication in independent cohorts, respectively. Using gene expression -QTLs derived from seven T2D-relevant tissues, we identify causal links between the expression of 676 genes and T2D risk, including novel associations such as and . Causal effects are mostly shared across ancestries, but highly heterogeneous across tissues. Our findings provide insights in cross-ancestry and tissue-informed multi-omics causal inference analysis approaches and demonstrate their power in uncovering molecular processes driving T2D.