New type 1 diabetes discovered in sub-Saharan Africa, scientists sound a “wake up call”

Scientists have identified a new subtype of diabetes in children and young adults in sub-Saharan Africa, indicating that many patients are not receiving the best treatment for the condition. 

The discovery was made through the largest study of its kind in the region. It challenges the global understanding of diabetes in young people, raising concerns that many patients across the continent, and possibly beyond, may require updated diagnoses to access optimal treatment.

“These findings are a wake-up call. They challenge our assumptions about type 1 diabetes and show that the disease may present differently in African children and adolescents,” warns lead study author professor Moffat Nyirenda, director of the Medical Research Council/Uganda Virus Research Institute and the London School of Hygiene and Tropical Medicine Uganda Research Unit, UK.

“We urgently need to deepen our investigations into the biological and environmental factors driving this form of diabetes and ensure our diagnostic and treatment approaches are fit for purpose in African settings.”

Noticeable differences in symptoms

Clinicians in parts of Africa had long suspected that some children diagnosed with type 1 diabetes did not quite fit the standard profile.

The scientists found that nearly two-thirds (65%) of young people thought to have type 1 diabetes lacked the typical features of the disease, such as the immune system attacking the pancreas (autoimmunity) and genetic susceptibility.

The patients in the study expressed “novel, non-autoimmune” subtype of diabetes not captured by current global classifications.Conversely, the patients appeared to have a “novel, non-autoimmune subtype,” not captured by current global classifications.

“These new research findings confirm our long-standing suspicion. We have always wondered why many young people diagnosed with type 1 diabetes manage to survive without insulin, at least for some time, which would be unusual in typical type 1 diabetes,” says Dr. Jean Claude Katte of the University of Exeter, who is also a translational fellow with the Exeter National Institute for Health and Care Research (NIHR) Biomedical Research Centre in the UK.

The findings emerged from the Young-Onset Diabetes in Sub-Saharan Africa study, which involved nearly 900 participants across Cameroon, Uganda, and South Africa. The participants were all diagnosed with type 1 diabetes before their 30s.

Approximately 65% of participants did not have antibodies typically present in autoimmune diabetes, nor did they display evidence of genetic predisposition to type 1 diabetes.

Moreover, these patients lacked the features consistent with other known types of diabetes, such as type 2 and malnutrition-related diabetes.

The research was conducted in collaboration with scientists from the University of Yaoundé I (Cameroon) and the University of Witwatersrand (South Africa).

Looking outside of Africa

To find out whether this new subtype exists outside Africa, the team studied over 3,000 children in the US-based Search for Diabetes in Youth cohort.

The subtype was identified in a small number of Black American children and was absent in White participants, suggesting environmental or ancestral factors.

“Our next step is to investigate possible causes — ranging from infections and nutritional factors to environmental toxins. If we can find the cause, we may be able to prevent new cases and find new treatments,” says Katte.

Most diabetes studies to date have focused on White Western populations, overlooking regional and genetic diversity in disease presentation.The team’s discovery flags a major gap in global diabetes research. Most studies to date have focused on White Western populations, overlooking regional and genetic diversity in disease presentation.

“We must invest in context-specific research. If we don’t, we risk misdiagnosing and mistreating millions of people,” urges professor Eugene Sobngwi, director of Health Care Organisation and Technology at the Ministry of Public Health of Cameroon and senior diabetes researcher.

The paper was published in The Lancet Diabetes & Endocrinology and funded by the NIHR.

Latest scientific inquiries

In other diabetes research, a recent US study found that exposure to PFAS may increase the risk of type 2 diabetes. Mount Sinai researchers found that participants with higher “forever chemicals” levels had a greater risk (31%) of developing type 2 diabetes in the future.

For expectant mothers, an observational study of 67,701 mother-child pairs found that diets high in foods causing low-grade inflammation during pregnancy may boost the risk of the child developing type 1 diabetes. Moreover, raising a mother’s gluten intake by 10 g during pregnancy was linked to a 36% higher risk.

In more dietary research, food scientists found that optimizing the fermentation of pulses can increase their antidiabetic properties, as well as their antioxidant performance and soluble protein content. The fermented pulses’ antioxidant activity rose up to 83%, while their ability to regulate type 2 diabetes markers surged by up to 70%.