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A major international study has identified a previously unknown form of type 1 diabetes in children and young people in sub-Saharan Africa. This discovery challenges long-held beliefs about the disease and raises urgent questions about the potential formisdiagnosis and improper treatment of young patients across the continent.

Published in The Lancet Diabetes & Endocrinology, the study is the largest of its kind ever conducted in Africa and was funded by the UK’s National Institute for Health and Care Research (NIHR). Researchers found that approximately 65% of young people diagnosed with type 1 diabetes in the study lacked both autoimmune markers and genetic risk factors typically associated with the disease. Instead, they appear to have a novel, non-autoimmune subtype, one not captured by current global classifications.

“I was diagnosed at 16 and put on medication for type 2 diabetes, which worsened my condition. It wasn’t until years later that I learned I had type 1 diabetes,” said Edith Mukantwari, a Ugandan youth advocate and co-founder of the Africa Diabetes Alliance.“Before I was diagnosed with type 1 diabetes at 16, nobody in my family or community had ever heard of it, much less knew it could affect children and adolescents.” Edith served as the Public Patient Involvement and Engagement (PPIE) patient advisor on the study

Her story not only highlights the consequences of diagnostic gaps but also reinforces the study’s core finding that a different form of diabetes may be going unrecognised in African children and young people.

The findings emerged from the Young-Onset Diabetes in Sub-Saharan Africa (YODA) study, involving nearly 900 participants under the age of 25 across Cameroon, Uganda, and South Africa. The research was conducted by scientists from the University of Exeter, University of Yaoundé I, the Medical Research Council/Uganda Virus Institute/ ������app of Hygiene & Tropical Medicine Uganda Research Unit (MRC/UVRI & LSHTM) and the University of the Witwatersrand.

To explore whether the subtype exists beyond Africa, the researchers also examined more than 3,000 young people in the US-based SEARCH for Diabetes in Youth study. While a small number of Black American children exhibited similar characteristics, the subtype was absent in white participants, pointing to possible environmental or ancestral influences.

Clinicians participating in the study are already observing important differences in how type 1 diabetes presents among African children, insights that are helping shape the research questions.

“We have seen that children in Africa who have type 1 diabetes often don’t show some of the serious signs doctors usually expect, like having other related diseases such as thyroid or coeliac disease or developing dangerous complications like Diabetic Ketoacidosis when they skip insulin doses. This makes us think the type of diabetes they have might be milder or different from what’s seen in other parts of the world.” Said Dr. Catherine Nyangabyaki Twesigye, Paediatrician at St Francis Hospital Nsambya, one of the clinical research sites in Uganda.

The team is now expanding its work to investigate what causes this unique diabetes subtype, ranging from infections and nutritional factors to environmental exposures. They also hope to determine whether some young, slim individuals diagnosed with type 2 diabetes in Africa may in fact have a milder form of this newly discovered subtype.

The findings highlight a critical gap in global diabetes research, which has often focused on white Western populations. The team is calling for greater investment in region-specific studies, noting that sub-Saharan Africa may be home to distinct forms of diabetes with different causes, trajectories, and treatment needs.

Dr Jean Claude Katte, Principal Investigator (PI) of the Young-Onset Diabetes in Sub-Saharan Africa (YODA) study said: “These new research findings confirm our long-standing suspicion. We have always wondered why many young people diagnosed with type 1 diabetes manage to survive without insulin, at least for some time, which would be unusual in typical type 1 diabetes.”

Professor Moffat Nyirenda, Co-PI and Director of the MRC/UVRI and LSHTM Uganda Research Unit said, “These findings are a wake-up call. They challenge our assumptions about type 1 diabetes and show that the disease may present differently in African children and adolescents. We urgently need to deepen our investigations into the biological and environmental factors driving this form of diabetes and ensure our diagnostic and treatment approaches are fit for purpose in African settings.”

Professor Eugene Sobngwi, Director of Health Care Organisation and Technology at the Ministry of Public Health of Cameroon and Senior Diabetes Researcher, said “We must invest in context-specific research. If we don’t, we risk misdiagnosing and mistreating millions of people.”

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ABOUT THE KEY SCIENTISTS

Dr Jean Claude Katte is a Translational Fellow with the Exeter NIHR Biomedical Research Centre. His research is focused on understanding the pathogenesis of young-onset diabetes in African populations. Katte is a Cameroonian-trained medical doctor, public health medicine specialist passionate about global health diabetes care and research in sub-Saharan Africa. His area of focus is mainly around the phenotype and pathogenesis of young-onset diabetes (especially type 1 diabetes) in African populations, NCD prevention and control, and access to insulin in LMICs. His research was nominated for the Diabetes UK Early Career Investigator & Paediatric Diabetes Award at the 2023 Diabetes UK Professional Conference. He has received several awards such as the JC Mbanya Fellowship Award of the Africa Diabetes Congress and the Merck Diabetes Award of the Merck Foundation.

He is an alumnus of the Young Physician Leaders (YPL) programme of the InterAcademy Partnership (IAP), an initiative hosted by The World Academy of Sciences (TWAS), Trieste, Italy. He is also a pioneer member of the Cameroon Academy of Young Scientists (CAYS).

Professor Moffat Nyirenda is a Professor of Medicine (Global Non-Communicable Diseases) at the ������app of Hygiene & Tropical Medicine (LSHTM) and is the Director of the MRC/UVRI and LSHTM Uganda Research Unit. Professor Nyirenda holds a BSc in Immunology from the University of London, a Bachelor of Medicine and Bachelor of Surgery (MBChB) through a hybrid training program between the University of London and the University of Malawi, and a PhD in Molecular Medicine from the University of Edinburgh.

His research focuses on the mechanistic clinical and laboratory phenotyping of non-communicable diseases (NCDs), with a particular interest in the risks of obesity, diabetes, and hypertension in adulthood. His contributions to genomics studies of NCDs in sub-Saharan Africa have been widely published. He is also deeply committed to strengthening research capacity in Africa, mentoring early-career scientists and leading initiatives that support local research development.

Professor Eugene Sobngwi is the Director of Health Care Organisation and Health Technology at the Cameroon Ministry of Public Health. He is also Professor of Medicine and Chair of Endocrinology and Diabetes at the University of Yaoundé I, where he heads the Laboratory of Molecular Medicine and Metabolism at the Biotechnology Centre. In addition, Professor Sobngwi leads non-communicable diseases research at the MRC Unit in Uganda and is a Senior Diabetes Researcher and co-founder of the RSD Institute for Health Research and Interventions.

He is a Fellow of the Cameroon Academy of Sciences, and a fellow of the African Academy of Sciences. He has served in many national and international expert committees such as the American Diabetes Association International Committee for the Diagnosis of Diabetes (2008), the IDF Type 2 guidelines revision committee and several WHO expert committees including the expert committee for diagnosis and classification of diabetes, the committee on the diagnosis of diabetes in pregnancy, and the consultation for NCD comorbidities in HIV, and is the Vice-President of Cameroon Scientific Council for Public Health Emergencies since COVID-19 outbreak. 

Professor Angus Jones is an Associate Professor of Diabetes at the University of Exeter Medical School and a Consultant Physician at the Royal Devon University Healthcare NHS Trust. He also serves as Co-Director of the NIHR Global Health Group on diabetes in Sub-Saharan Africa. Professor Jones holds a BSc in Clinical and Biological Sciences from Imperial College London, a Bachelor of Medicine and Bachelor of Surgery (MBBS) from St. George’s, University of London, and a PhD in Diabetes Research from the Peninsula College of Medicine and Dentistry, a joint program between the Universities of Exeter and Plymouth.

His research focuses on the clinical and biomarker-based classification of diabetes, helping to differentiate between type 1 and type 2 diabetes using tools such as C-peptide and islet autoantibodies. He has contributed to revisions in national and international diabetes guidelines and works on optimising individualised treatments for patients with type 2 diabetes. His global health work involves improving diagnostic approaches and treatment strategies for diabetes in resource-limited settings in Africa. He is also committed to capacity-building in global health, collaborating across regions to advance diabetes care and mentoring emergingresearchers.

ABOUT THE COLLABORATING INSTITUTIONS

The Medical Research Council/Uganda Virus Institute/ ������app of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit.

The MRC/UVRI & LSHTM Uganda Research Unit is an internationally recognised centre of excellence for research and training established in 1988 to improve the understanding and control of the HIV epidemic in Uganda and globally, following a request from the Uganda Government to the United Kingdom (UK) Government. In response to the changing public health landscape, Unit work has broadened beyond HIV to include other infections, neglected, endemic, emerging and re-emerging infections and non-communicable diseases (NCDs). Its mission is to conduct high-quality research that adds knowledge and leads to improved control of infectious and non-communicable diseases in Uganda, Africa and globally, through translation of scientific findings into policy and practice, and rigorous research capacity building.

The University of Yaoundé I
The University of Yaoundé I is a leading public university in Cameroon, established in 1962 with a widely recognised for academic excellence and scientific research in Central Africa. It serves as a hub for higher education and innovation, offering programs in science, technology, health, and the humanities. Its mission is to provide high-quality academic training and conduct impactful research that contributes to the advancement of knowledge and the resolution of societal challenges in Cameroon, Africa, and globally, through innovation, ethical leadership, and inclusive education.

University of Witwatersrand
University of Witwatersrand founded in 1922 in Johannesburg, South Africa, is a leading research-intensive institution with a long-standing commitment to academic excellence and social justice. Initially established to support the mining industry, Wits has grown into a multidisciplinary university addressing Africa’s most pressing challenges through research, innovation, and public engagement. Its mission is to make a positive impact on society by creating and advancing global knowledge and fostering graduates to be leaders with integrity. It provides across 3,600 undergraduate and postgraduate courses in English within the following five departments- Health Sciences, Science, Commerce, Law and Management, Humanities and Engineering and the Built Environment.

University of Exeter  
The University of Exeter is a Russell Group university that combines world-class research with high levels of student satisfaction. Exeter has over 30,000 students and sits within the Top 15 universities in The Times and Sunday Times Good University Guide 2025 and the Complete University Guide 2025.  Exeter is also ranked in the top 200 globally in both the QS World Rankings 2025 and THE World University Rankings 2025. In the 2021 Research Excellence Framework (REF), more than 99% of our research was rated as being of international quality, and our world-leading research impact has grown by 72% since 2014, more than any other Russell Group university.