Prospective Study of Non-autoimmune Insulin-Deficient Diabetes Subtype in Young individuals in sub-Saharan Africa.

Diabetes affects over 24 million people in Africa, with type 1 and type 2 diabetes being the most recognised forms. However, my research has demonstrated that most children and young adults diagnosed with type 1 diabetes (T1D) in sub-Saharan Africa (SSA) appear to have a novel form of non-autoimmune diabetes of unclear cause. Those with this condition develop severe insulin deficiency but lack the immune and genetic characteristics of T1D. The disease occurs in thin children without genetic susceptibility to type 2 diabetes (T2D), suggesting distinct aetiological pathways that are currently unclear, underscoring the need for targeted investigation. My fellowship aims to characterise the clinical features and pathophysiological mechanisms associated with this non-autoimmune insulin-deficient diabetes (NAID) subtype in SSA. For the first time, I will characterise the disease at diagnosis, compare to matched controls and patients with autoimmune T1D, and prospectively follow-up these participants from diagnosis to understand the progression of beta-cell loss and the clinical course. Using advanced imaging techniques (Magnetic Resonance Imaging) and mixed meal tests, I will examine the pancreatic structural and exocrine/endocrine dysfunction associated with NAID. Outcomes will inform clinical recognition and management and answer critical questions about the aetiology and pathogenesis of this novel condition.