Chikowore says that there are many possible explanations, ranging from genetic variants still unknown to the physiological structure of the pancreas. This last theory comes from Research carried out in East AfricaThis found that some men develop type 2 diabetes despite a healthy weight. A study in progress Directed by the Uganda Medical Research Council, in partnership with British researchers, measures the size of the pancreas in these men and assesses its function.
“These cases do not seem to be linked to fat, so we want to try to understand what is going on,” explains Chikowore. “Is it genetics? Or because of how the pancreas developed? Some scientists think that it is linked to malnutrition at the start of life, which has an impact on the development of beta cells so that they do not produce so much insulin.”
In addition to revealing the path to new treatments, understanding these cases could lead to better screening tools. Currently, the methods of diagnosing and evaluation of the progression of type 2 diabetes are plasma glucose tests on an empty stomach, which measure blood sugar after fasting, and the blood test of HBA1C, which detects the levels of a chemical compound called HBA1C which indicates blood sugar over time. But such tests prove ineffective in certain populations.
Last year A major study underlined that a significant number of people of African ancestry are diagnosed with a type 2 diabetes much later than they are because they have deficiencies in an enzyme called G6PD. This genetic variation is relatively common In some parts of sub -Saharan Africa because it gives protection against serious malaria, but this also reduces HBA1C levels, which gives the impression that a person's blood sugar is healthier than they are. The study has shown that many of these patients eventually suffer avoidable complications such as diabetic retinopathy, which can cause blindness.
Meanwhile, researchers like Julia Goedecke, professor and chief scientist of the South African Medical Research Council, found that the use of plasma glucose on an empty stomach as a means of diagnosing type 2 diabetes in African women tends to be ineffective, as it assumes that the patient transports a significant amount of liver fat. “Jewish glucose is often used as a marker of the risk of diabetes, but it is because liver fat is a large driver of glucose levels on an empty stomach,” explains Goedecke. “In Africans, it is actually a bad marker, because most women who have diabetes have a weak liver fat, so you often miss diabetes if you only take a fasting glucose value.”
Instead of liver fat, Goedecke's search Said that many of these cases are drawn by an altered capacity to eliminate insulin from blood circulation, which makes people already have abnormally high levels of insulin.
Goedecke and others are now carrying out a study that includes men and women in the South African canton of Soweto, various communities in Ghana and Ghanaian immigrants in Germany and the Netherlands. They will regularly assess a range of biological characteristics over several years. “We hope that this data will also give us a better understanding of the mechanisms involved in the disease and the ideas of interventions to try to prevent it,” she said.
While research on diabetes across Africa should have direct impacts for patients in the region, Chikowore thinks that it could also benefit all diseases. Understand why sub -Saharan African women seem to be more resistant to gaining liver fats, for example, could lead to the development of drugs that can improve metabolic health in other ethnic groups. “With diversity, you have the two ends of the spectrum: people likely to protect,” he said. “And we have higher chances of finding these people in Africa than everywhere else.”
As an example of what could be possible, Chikowore quotes how genetic studies in African populations have led to the development of a new class of hypocholesterolers, a company even exploring genes to treat patients. “Imagine if we could one day do the same for diabetes,” he says. “A genetically informed drug that can make people in the test of diabetes. I think that's what the world is looking for.”
