Non-autoimmune, insulin-deficient diabetes in children and young adults in Africa: evidence from the Young-Onset Diabetes in sub-Saharan Africa (YODA) cross-sectional study
Authors' conclusion
In sub-Saharan Africa, clinically diagnosed type 1 diabetes is heterogeneous, comprising classic autoimmune type 1 diabetes and a novel, non-autoimmune, insulin-deficient diabetes subtype. There is evidence of this subtype in Black but not White individuals in the USA. Therefore, alternative causes must be considered in this group of individuals, and understanding the drivers of this subtype might offer new insights into prevention and treatment.
Study context
- Population
- Black African individuals without obesity with young-onset (age <30 years), insulin-treated, clinically diagnosed T1D, outpatient clinics in Cameroon, Uganda and South Africa; median age at diagnosis 15 years (IQR 11–19), median diabetes duration 5 years (2–10), BMI 21.7 kg/m² (19.5–24.1)1,072 identified
- Participants
- 894 individuals
- Exposure
- Islet autoantibody-negative vs autoantibody-positive young-onset clinically diagnosed T1D
- Autoantibody negativen = 582
- Autoantibody positiven = 312reference
- Outcome
- Autoimmune origin of clinically diagnosed T1D: islet autoantibody positivity (GADA, IA-2A, ZnT8A), T1D genetic risk score and C-peptide
Methodological detailsobservational, multinational (Cameroon, Uganda, South Africa), comparison with SEARCH study (USA)
- Observational
- Multinational (Cameroon, Uganda, South Africa)
- Comparison with SEARCH study (USA)
Main finding
As reported in the abstract
Positive for islet autoantibodies
312 (34.9%) of 894
Without islet autoantibodies
582 [65.1%] of 894
Median T1D genetic risk score (GRS), without vs with autoantibodies (significantly lower without)
9.66 [IQR 7.77-11.33] vs 11.76 [10.49-12.91]
p<0.0001
Autoantibody-positive participants with plasma C-peptide <200 pmol/L
225 (82.7%) of 272
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Autoantibody-negative diabetes, diagnosed <20 years: SEARCH Black ancestry vs sub-Saharan Africa | SEARCH Black 15.1% · median T1D GRS (autoantibody negative) 10.41 [IQR 8.65-12.22] · Sub-Saharan Africa 55.1% |
| Autoantibody negativity and T1D GRS in SEARCH White participants | SEARCH White 9.3% · median T1D GRS autoantibody negative 13.42 [IQR 11.80-14.61] · median T1D GRS autoantibody positive 13.49 [12.29-14.58] |
Autoantibody negativity and T1D GRS in SEARCH White participants
- Median GRS similar in autoantibody-negative and autoantibody-positive White participants
Original publication
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