Pathophysiology of type 2 diabetes in sub-Saharan Africans – published online 27/09/2022

Julia H. Goedecke, Amy E. Mendham

Sub-Saharan Africa (SSA) is the region that is projected to have the greatest rate of increase in type 2 diabetes (129% by 2045). In this issue, Goedecke and Mendham (https://doi.org/10.1007/s00125-022-05795-2) summarise known mechanisms relating to the pathophysiology of type 2 diabetes in sub-Saharan Africans and highlight factors that may influence the pathogenesis of type 2 diabetes in SSA, such as social determinants, infectious diseases and genetic and epigenetic influences. They propose that, among Black Africans from SSA, hyperinsulinaemia due to a combination of both increased insulin secretion and reduced hepatic insulin clearance is the primary defect, which promotes obesity and insulin resistance, exacerbating the hyperinsulinaemia and eventually leading to beta cell failure and type 2 diabetes. The authors conclude that future research on dietary interventions that reduce hyperinsulinaemia and obesity is warranted to gain insights into the mechanistic underpinnings of type 2 diabetes in this population. The figures from this review are available as a downloadable slideset.

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