First large-scale study identifies novel subtype of type 1 diabetes in Africa  

Why was this study conducted?

There have been theories surrounding why some people with T1D can survive without taking insulin for a long time after diagnosis. Typically, in T1D, the person diagnosed would have to inject insulin to replace the insulin producing cells destroyed by the body (known as an autoimmune attack). There are, however, cases where people require little to no insulin for longer than expected. This study was conducted to find out why this might happen, and if this is more common in different ethnic groups, such as African children or white, Western children.

What did the results show?

A way to identify if a person has T1D, alongside blood-glucose testing, is to test for autoantibodies. Autoantibodies are produced by the immune system and target the body’s own healthy cells and tissues. In T1D, these autoantibodies attack the insulin-producing cells (known as beta cells).

The findings showed that 65% of children tested across Cameroon, Uganda and South Africa did not have the autoantibodies present which would be typically associated with T1D. They also had no genetic pre-disposition to T1D and did not have features consistent with other known types of diabetes (such as type 2 diabetes or malnutrition-related diabetes). This led the researchers to believe that a new form of T1D has been identified which was not of autoimmune origin (low or no rates of autoantibodies were present).

These results were cross-referenced with 3,000 children from the USA, using a research study called SEARCH for Diabetes in Youth. It was confirmed that the subtype was found in a small number of black American children and was not present in the white children tested. This highly suggests either environmental or ancestral factors.

Why is this study important?

Results like this highlight the need for diversity and inclusion in T1D research, as most studies to date have focussed on white, Western populations. These findings demonstrate the need to broaden our investigations into the biological and environmental factors of this condition to ensure that we have the tools and treatments truly fit for all, regardless of ethnicity and gender. 

Breakthrough T1D is dedicated to supporting diversity and inclusion in research, and aided in the design and implementation of a policy in the UK called MESSAGE. This is a policy framework ensures researchers consider sex and gender in their research. 

How is Breakthrough T1D involved in this research?

Although not directly involved in this research, Breakthrough T1D funds the research labs at the university of Exeter, where Dr Katte is a Translational Fellow with the Exeter National Institute for Health and Care Research (NIHR). He led this research, alongside Professor Moffat Nyirenda, Director of the Medical Research Council / Uganda Virus Research Institute (MRC/UVRI) and the London School of Hygiene and Tropical Medicine Uganda Research Unit. Dr Katte has worked in labs funded by Breakthrough T1D for many years, conducting research and paving the way towards a deeper understanding of T1D.

In an interview regarding this new research, Dr Jean Claude Katte said: “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.”