A study published on August 24 in Diabetologia indicates that type 2 diabetes can follow markedly different biological and clinical patterns in African adults depending on body weight. Researchers from Amsterdam UMC and the University of Ghana report that inadequate insulin production appears more important among lean patients, while insulin resistance remains the principal mechanism among patients with higher body mass index.
The researchers analyzed data from more than 3,300 African adults with type 2 diabetes in cohorts spanning Ghana, Nigeria, Kenya and Europe. They said nearly four in ten African adults living with the condition are lean, rising to as many as six in ten in some rural Ghanaian settings. The team estimates that about 10 million lean patients across Africa do not fit the common association between type 2 diabetes and excess weight.
The analysis also identified different complication patterns. Lean participants more often had diabetic retinopathy, which damages the eyes, and strokes, while participants with overweight more often had high blood pressure and elevated cardiovascular risk. Chronic kidney disease occurred at similar rates in both groups, and the amount of body fat accounted for much of the observed difference, according to the researchers.
The scientists linked the lean pattern more frequently to earlier malnutrition or low birth weight, factors that can impair pancreatic development. By contrast, excess weight is commonly associated with lifestyle-related insulin resistance. These findings describe associations in the available cohort data and do not by themselves prove that a particular treatment will produce better outcomes.
Current international guidance commonly leads clinicians in Africa to treat both profiles with the same oral medicines, including metformin and sulfonylureas. The researchers cautioned that therapies designed mainly to counter insulin resistance may not address inadequate insulin supply in lean patients. They called for targeted clinical trials rather than an immediate change in medication, stressing that treatment decisions remain a matter for qualified clinicians.
The potential relevance extends beyond Africa. Prior UK Biobank analysis found that people of African descent at a BMI of 26 had a diabetes risk comparable with Europeans at a BMI of 30, while migration studies show earlier onset and poorer glucose control among African populations in Europe. The research team said future trials should determine which therapies best serve this large, often overlooked group and whether guidelines should distinguish between the two disease profiles.
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