A large study across sub-Saharan Africa has revealed a previously unrecognized subtype of diabetes in children and young adults—one that lacks the usual markers of type 1 diabetes and may be receiving the wrong treatment as a result.
Published in The Lancet Diabetes & Endocrinology, the research draws from nearly 900 cases across Cameroon, Uganda, and South Africa. It found that 65% of young people diagnosed with type 1 diabetes had no immune system markers or genetic risk factors typically associated with the disease. Despite severe insulin deficiency, these patients do not appear to have autoimmune diabetes—suggesting a distinct and largely unrecognized form of the illness.
“These findings are a wake-up call,” said Professor Moffat Nyirenda of the MRC/UVRI and London School of Hygiene and Tropical Medicine Uganda Research Unit. “They challenge our assumptions about type 1 diabetes and show that the disease may present differently in African children and adolescents.”
A Missing Diagnosis, Hidden in Plain Sight
Classic type 1 diabetes is an autoimmune condition in which the body destroys its own insulin-producing cells. Yet many children in Africa diagnosed with type 1 diabetes seemed to defy this model. Some managed to survive without insulin therapy—an anomaly under conventional definitions.
To investigate, the Young-Onset Diabetes in Sub-Saharan Africa (YODA) study screened participants for three islet autoantibodies and a type 1 diabetes genetic risk score (GRS). While one-third of the cohort matched the typical autoimmune profile, the majority did not, lacking both antibodies and genetic markers.
- Median age of diagnosis: 15 years
- 71.6% had severe insulin deficiency (C-peptide < 200 pmol/L)
- 65.1% were negative for all tested autoantibodies
- Genetic risk scores in autoantibody-negative patients were significantly lower
Dr. Jean Claude Katte, lead author from the University of Exeter, noted, “We have always wondered why many young people diagnosed with type 1 diabetes manage to survive without insulin, at least for some time. This research confirms our long-standing suspicion.”
Beyond Africa: A Glimpse Into U.S. Youth Data
To test whether the finding was unique to sub-Saharan Africa, the team examined over 3,000 young people in the U.S.-based SEARCH for Diabetes in Youth study. The non-autoimmune pattern appeared in a small subset of Black American children but was absent in white participants, suggesting a link to ancestry or environmental exposure.
The novel subtype did not fit known forms such as type 2 or malnutrition-related diabetes. Participants were typically lean, lacked obesity-related insulin resistance, and did not show signs of stunting or malnourishment.
Urgent Need for Tailored Diagnosis and Treatment
Current global diabetes classifications may not capture the true spectrum of diabetes presentations in African populations. That could have life-altering implications for treatment: many may be receiving unnecessary or ineffective therapies.
“We must invest in context-specific research,” said Professor Eugene Sobngwi of the Cameroonian Ministry of Public Health. “If we don’t, we risk misdiagnosing and mistreating millions of people.”
Researchers now aim to identify environmental, nutritional, or infectious drivers of this non-autoimmune, insulin-deficient subtype—a step that could open new doors for prevention and care.
Journal: The Lancet Diabetes & Endocrinology
DOI: 10.1016/S2213-8587(24)00143-1
ScienceBlog.com has no paywalls, no sponsored content, and no agenda beyond getting the science right. Every story here is written to inform, not to impress an advertiser or push a point of view.
Good science journalism takes time — reading the papers, checking the claims, finding researchers who can put findings in context. We do that work because we think it matters.
If you find this site useful, consider supporting it with a donation. Even a few dollars a month helps keep the coverage independent and free for everyone.