A large study throughout sub-Saharan Africa shows that diabetes has not been recognized in children and young people – a common marker of type 1 diabetes and therefore may be treated incorrectly due to wrong treatment.
Posted in Lancet Diabetes and EndocrinologyThe study comes from nearly 900 cases in Cameroon, Uganda and South Africa. It found that 65% of young people diagnosed with type 1 diabetes have no immune system markers or genetic risk factors that are often associated with the disease. Despite severe insulin deficiency, these patients do not appear to have autoimmune diabetes, a unique form of disease, which is a unique form of disease.
“These findings are a wake-up call,” said Professor Moffat Nyirenda of MRC/UVRI and the London School of Health and Tropical Medicine Uganda Research Department. “They challenged our hypothesis about type 1 diabetes and suggested that the disease may differ among African children and adolescents.”
Missing diagnosis, hidden in flat sight
Classic type 1 diabetes is an autoimmune disease in which the body destroys its own insulin-producing cells. However, many children in Africa who have been diagnosed with type 1 diabetes seem to ignore the model. Some people manage to survive without insulin treatment, which is an abnormality under the usual meaning.
To investigate, the young diabetes study in Sub-Saharan Africa (YODA) screened participants for three islet autoantibodies and the genetic risk score of type 1 diabetes (GRS). While one-third of the cohort matches the typical autoimmune spectrum, most lack antibodies and genetic markers.
- Median diagnosis age: 15 years old
- 71.6% of insulin deficiency (C peptide) severe
- 65.1% of all autoantibodies tested were negative
- Genetic risk scores in autoantibodies are significantly reduced
“We have been wondering why many young people diagnosed with type 1 diabetes survived without insulin, at least for some time,” said Dr. Jean Claude Katte, chief author at the University of Exeter. “This study confirms our long-standing suspicion.”
Beyond Africa: A glimpse of American youth data
To test whether the finding is unique to sub-Saharan Africa, the team examined more than 3,000 young people in the U.S. study to find diabetes in youth studies. Non-automatic immunity patterns appear in a small percentage of black children, but white participants are absent, suggesting a link to ancestry or environmental exposure.
The novel subtype does not conform to known forms such as type 2 or diabetes associated with malnutrition. Participants were usually lean, lacked insulin resistance associated with obesity, and showed no signs of stunting or malnutrition.
Need for customized diagnosis and treatment
The current global diabetes classification may not capture the true range of diabetes manifestations in African populations. This may have life-changing effects on treatment: many may be receiving unnecessary or ineffective treatments.
“We have to invest in environmentally specific research,” said Professor Eugene Sobngwi of the Public Health Ministry of Cameroon. “If we don’t do that, we risk misdiagnosis and abuse of millions of people.”
Now, researchers aim to identify environmental, nutritional or infectious drivers of this non-automatic immunity, defective insulin subtype, a step that can open new doors for prevention and care.
Magazine: Lancet Diabetes and Endocrinology
doi: 10.1016/S2213-8587 (24) 00143-1
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