Evidence map›Paper›PMID 32705316›Full record

ArticleDiabetologia2020

Type 1 diabetes in Africa: an immunogenetic study in the Amhara of North-West Ethiopia.

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 and 8 more

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In one paragraph

Article in Diabetologia, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  12. Phenotypic and Genetic Diversity in Diabetes Across Populations.The Journal of clinical endocrinology and metabolism · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Shitaye A BalchaDepartment of Internal Medicine, Gondar University Hospital, Gondar, Ethiopia.
Abayneh G DemisseDepartment of Pediatrics and Child Health, School of Medicine, University of Gondar, Gondar, Ethiopia.
Rajashree MishraDivision of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Tanwi VartakBlizard Institute, Queen Mary University of London, London, UK.
Diana L CousminerDivision of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Kenyaita M HodgeDivision of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Benjamin F VoightDepartment of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Kim LorenzDepartment of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Stanley SchwartzMain Line Health System, Wynnewood, PA, USA.
Samuel T JerramBlizard Institute, Queen Mary University of London, London, UK.
Arla GamperSevern Postgraduate School of Primary Care, Health Education England, Bristol, UK.
Alice HolmesAvon and Wiltshire Mental Health Partnership NHS Trust, Clevedon, UK.
Hannah F WilsonDiabetes and Metabolism, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
Alistair J K WilliamsDiabetes and Metabolism, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
Struan F A GrantDivision of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
R David LeslieBlizard Institute, Queen Mary University of London, London, UK.
David I W PhillipsMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
Elisabeth R TrimbleCentre for Public Health, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK. e.trimble@qub.ac.uk.ORCID 0000-0002-7385-0415

Funding

Algorithms to identify non-coding mutational burden and disease-relevant pathwaysR01DK101478 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI VOIGHT, BENJAMIN FRANKLIN · 2014 to 2018
$2.9M
Algorithms to identify non-coding mutational burden and disease-relevant pathwaysR56DK101478 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI VOIGHT, BENJAMIN FRANKLIN · 2019 to 2019
$272k
Genetic determinants of puberty and later life health outcomesK99HD099330 · NICHD · CHILDREN'S HOSP OF PHILADELPHIA · PI COUSMINER, DIANA · 2019 to 2019
$132k
NICHD NIH HHS K99 HD099330NIDDK NIH HHS R01 DK101478NIDDK NIH HHS R56 DK101478
6 · The paper itself

Abstract

aims/hypothesisWe aimed to characterise the immunogenic background of insulin-dependent diabetes in a resource-poor rural African community. The study was initiated because reports of low autoantibody prevalence and phenotypic differences from European-origin cases with type 1 diabetes have raised doubts as to the role of autoimmunity in this and similar populations.

methodsA study of consecutive, unselected cases of recently diagnosed, insulin-dependent diabetes (n = 236, ≤35 years) and control participants (n = 200) was carried out in the ethnic Amhara of rural North-West Ethiopia. We assessed their demographic and socioeconomic characteristics, and measured non-fasting C-peptide, diabetes-associated autoantibodies and HLA-DRB1 alleles. Leveraging genome-wide genotyping, we performed both a principal component analysis and, given the relatively modest sample size, a provisional genome-wide association study. Type 1 diabetes genetic risk scores were calculated to compare their genetic background with known European type 1 diabetes determinants.

resultsPatients presented with stunted growth and low BMI, and were insulin sensitive; only 15.3% had diabetes onset at ≤15 years. C-peptide levels were low but not absent. With clinical diabetes onset at ≤15, 16-25 and 26-35 years, 86.1%, 59.7% and 50.0% were autoantibody positive, respectively. Most had autoantibodies to GAD (GADA) as a single antibody; the prevalence of positivity for autoantibodies to IA-2 (IA-2A) and ZnT8 (ZnT8A) was low in all age groups. Principal component analysis showed that the Amhara genomes were distinct from modern European and other African genomes. HLA-DRB1*03:01 (p = 0.0014) and HLA-DRB1*04 (p = 0.0001) were positively associated with this form of diabetes, while HLA-DRB1*15 was protective (p < 0.0001). The mean type 1 diabetes genetic risk score (derived from European data) was higher in patients than control participants (p = 1.60 × 10 CONCLUSIONS/

interpretationThe majority of patients with insulin-dependent diabetes in rural North-West Ethiopia have the immunogenetic characteristics of autoimmune type 1 diabetes. Phenotypic differences between type 1 diabetes in rural North-West Ethiopia and the industrialised world remain unexplained.

Indexed as

AdolescentAdultAge of OnsetAutoantibodiesBlack PeopleChildC-PeptideDiabetes Mellitus, Type 1EthiopiaFemaleGenome-Wide Association StudyHLA-DRB1 ChainsHumansMalePrincipal Component AnalysisYoung Adultanti-GAD65 autoantibodyAutoantibodiesC-PeptideHLA-DRB1 ChainsICA512 autoantibodySLC30A8 protein, humanZinc Transporter 8AfricaAutoantibodiesEthiopiaGenomesHLARuralType 1 diabetes

Identifiers

PMID32705316
PMCPMC7476916

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.