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Type 1 diabetes in Africa: an immunogenetic study in the Amhara of North-West Ethiopia – published online 23/07/2020

Shitaye A. Balcha, Abayneh G. Demisse, Rajashree Mishra, Tanwi Vartak, Diana L. Cousminer, Kenyaita M. Hodge, Benjamin F. Voight, Kim Lorenz, Stanley Schwartz, Samuel T. Jerram, Arla Gamper, Alice Holmes, Hannah F. Wilson, Alistair J. K. Williams, Struan F. A. Grant, R. David Leslie, David I. W. Phillips, Elisabeth R. Trimble

From sub-Saharan Africa, a region of enormous genetic diversity, reports of insulin-dependent diabetes associated with both a low autoantibody prevalence and a low incidence in childhood have raised questions about its relationship to classic type 1 diabetes. In this issue, Balcha et al (https://doi.org/10.1007/s00125-020-05229-x) performed an immunogenetic study of insulin-dependent diabetes in individuals from the Amhara, the second-largest ethnic group in Ethiopia. The authors found that, although the genomes of the Amhara were distinct from European and other African genomes, individuals with insulin-dependent diabetes (89.4% born in rural areas) had the same principal HLA-DRB1 allele associations as cases of European-background type 1 diabetes. In contrast to previous reports, at diagnosis, the age-related total autoantibody prevalence was similar to that in many industrialised countries. However, the autoantibody profile was different; this was most marked in childhood cases, where the majority had a single autoantibody (to GAD), and the prevalence of autoantibodies to ZnT8 and IA-2 was very low. The authors conclude that these Ethiopian cases have the immunogenetic characteristics of autoimmune type 1 diabetes associated with an autoantibody profile that differs somewhat from cases of European background.

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