Atypical diabetes subtypes in Black African populations

Area of Science:

• Endocrinology
• Metabolic Disorders
• Population Health

Background:

• Atypical diabetes mellitus (DM) subtypes are more prevalent in African and Asian populations.
• Classical type 1 and type 2 DM do not fully encompass the spectrum of diabetes presentations in these groups.

Purpose of the Study:

• To review the epidemiology, clinical presentation, aetiopathogenesis, and management of four atypical diabetes subtypes in Black African populations.
• To provide practical recommendations for precision diagnosis and management within the African region.

Main Methods:

• Literature review focusing on ketosis-prone diabetes (KPD), fibrocalculous pancreatic diabetes (FCPD), type 2 DM in non-obese individuals, and malnutrition-related diabetes (MRD).
• Synthesis of current insights and clinical evidence specific to African populations.

Main Results:

• KPD: Characterized by unprovoked ketoacidosis, often without autoimmunity, with potential for remission.
• FCPD: Presents in young, lean males with pancreatic calcifications and severe hyperglycemia.
• Type 2 DM in non-obese: Normal BMI, low visceral adiposity, insulin resistance, and beta-cell dysfunction.
• MRD: Associated with undernutrition, normal BMI, resistance to ketoacidosis, and severe beta-cell dysfunction.

Conclusions:

• These four atypical diabetes subtypes have distinct phenotypes differing from classical DM.
• High prevalence necessitates further research to improve epidemiology, diagnostic accuracy, and develop context-specific management strategies for diverse African populations.