The study reveals that many young people in Africa, and some in the U.S., may have a non-autoimmune form of type 1 diabetes, suggesting the potential for more accurate diagnoses and targeted treatments.
A major international study has revealed that many children and young adults in Sub-Saharan Africa who are diagnosed with type 1 diabetes (T1D) may actually have a different, non-immune-based form of the condition. Unlike the traditional autoimmune version of T1D, this form appears to develop without the immune system attacking the insulin-producing cells. This finding could significantly reshape how diabetes is diagnosed and treated across the region, potentially leading to more precise care and better health outcomes.
The research was published in the journal Lancet Diabetes and Endocrinology.
“This is the first study across several Sub-Saharan African countries to use the same lab tests and genetic tools to learn more about type 1 diabetes. We’ve done similar research in the U.S. with different groups, but what’s exciting here is being able to compare results between Africa and the U.S.,” said the paper’s co-author Dana Dabelea, MD, PhD, Distinguished Professor and Associate Dean of Research at the Colorado School of Public Health on the University of Colorado Anschutz Medical Campus.
The research team examined 894 individuals who developed diabetes at a young age in three countries: Cameroon, Uganda, and South Africa. They then compared this data to findings from similar age groups in the United States.
A New Look at T1D Heterogeneity
“It’s a really unique and important opportunity to explore the heterogeneity of T1D across countries and racial groups living in vastly different environments,” adds Dabelea, who is also the director of the Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at CU Anschutz.
The researchers found that many young people in Sub-Saharan Africa diagnosed with T1D often don’t have the usual markers in their blood (called islet autoantibodies) typically seen in people with T1D in other parts of the world. Specifically, 65% of participants with T1D in this region did not have islet autoantibodies.
Islet autoantibodies help distinguish T1D from other forms of diabetes, like type 2 or monogenic diabetes, which have different causes and treatments.
“This suggests that many young people in this region have a different form of T1D altogether and is not autoimmune in origin,” said Dabelea.
When the researchers compared this data to studies in the U.S., they found a smaller but significant proportion (15%) of Black participants diagnosed with T1D had a similar form of diabetes found in Sub-Saharan Africa – characterized by negative autoantibodies and a low T1D genetic risk score.
However, white Americans with T1D showed the typical autoimmune pattern, even if they didn’t have detectable autoantibodies, their genetics still pointed to autoimmune diabetes.
“The identification of this T1D diabetes subtype in Sub-Saharan African populations and among individuals of African ancestry in the U.S. suggests a potential ancestral or genetic link,” Dabelea notes. “These findings highlight the need to consider alternative etiologies in this group and a deeper understanding of the underlying mechanisms may provide important insights for future prevention and treatment strategies.”
Reference: “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” by Jean Claude Katte, Steven Squires, Mesmin Y Dehayem, Priscilla A Balungi, Carolyn J Padoa, Dhriti Sengupta, Segun Fatumo, Thereza Piloya, Catherine Nyangabyaki-Twesigye, Silver Bahendeka, Edna Majaliwa, Kandi C Muze, Kaushik Ramaiya, Suzanne Sap, Ayesha A Motala, Fraser J Pirie, Paul Rheeder, Jacobus C Van Dyk, Jean Claude Mbanya, Beverley M Shields, Amy S Shah, Catherine Pihoker, Jasmin Divers, Kashyap A Patel, Richard A Oram, Dana Dabelea, Andrew T Hattersley, Timothy J McDonald, Nigel J Crowther, Moffat J Nyirenda, Eugene Sobngwi and Angus G Jones, 21 July 2025, The Lancet Diabetes & Endocrinology.
DOI: 10.1016/S2213-8587(25)00120-2
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