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This review discusses the epidemiology, clinical presentation, aetiopathogenesis and management of four atypical diabetes subtypes commonly reported in Black African populations. These are ketosis-prone diabetes (KPD), fibrocalculous pancreatic diabetes (FCPD), type 2 diabetes in individuals without overweight or obesity, and malnutrition-related diabetes (MRD). The review summarises current insights into these atypical diabetes subtypes in Black African populations and provides practical recommendations to guide their precision diagnosis and management in the African region. These four atypical diabetes subtypes exhibit phenotypic features that diverge from those of classical type 1 and type 2 diabetes. KPD is characterised by unprovoked, transient, index episodes of diabetic ketoacidosis, often in the absence of markers of islet cell autoimmunity, with frequent subsequent insulin independence and diabetes remission. FCPD typically presents in young lean individuals, with a strong male preponderance and with radiological evidence of pancreatic calcifications, reduced beta cell reserve and severe hyperglycaemia without ketosis. Type 2 diabetes in individuals without overweight or obesity is characterised by normal BMI with a trend towards low levels of markers of visceral adiposity, insulin resistance and an exaggerated\u00a0beta cell secretory dysfunction. MRD is associated with a previous and persistent history of undernutrition, with features of undernutrition such as stunting and BMI &lt;18.5 kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    , resistance to diabetic ketoacidosis, no evidence of visceral or ectopic adiposity, and severe beta cell secretory dysfunction. The high prevalence and heterogeneous presentation of these atypical forms of diabetes in African populations highlight the urgent need for enhanced collaborative research to better define their epidemiology, improve diagnostic accuracy and develop context-appropriate management strategies tailored to diverse African populations.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical Abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s00125-026-06697-3","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T14:15:48Z","timestamp":1772460948000},"page":"1432-1443","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Atypical diabetes subtypes in Black African populations"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5631-2810","authenticated-orcid":false,"given":"Jean Claude","family":"Katte","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0302-3668","authenticated-orcid":false,"given":"Charlotte","family":"Bavuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7824-2569","authenticated-orcid":false,"given":"Sarah H.","family":"Wild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8996-7747","authenticated-orcid":false,"given":"Meredith","family":"Hawkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4614-9519","authenticated-orcid":false,"given":"Nihal","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5457-6572","authenticated-orcid":false,"given":"Eugene","family":"Sobngwi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2120-4806","authenticated-orcid":false,"given":"Moffat J.","family":"Nyirenda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5127-3031","authenticated-orcid":false,"given":"Davis","family":"Kibirige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"issue":"11","key":"6697_CR1","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1016\/S2213-8587(23)00159-6","volume":"11","author":"RD Leslie","year":"2023","unstructured":"Leslie RD, Ma RCW, Franks PW, Nadeau KJ, Pearson ER, Redondo MJ (2023) Understanding diabetes heterogeneity: key steps towards precision medicine in diabetes. 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Diabetes Care 49(Suppl 1):S27\u2013S49. https:\/\/doi.org\/10.2337\/dc26-S002","journal-title":"Diabetes Care"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06697-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-026-06697-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06697-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:07:58Z","timestamp":1777028878000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-026-06697-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":97,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["6697"],"URL":"https:\/\/doi.org\/10.1007\/s00125-026-06697-3","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]},"assertion":[{"value":"3 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"We would like to thank B. Morgan from the Education and Research Centre at Wythenshawe Hospital in Manchester, UK, for conducting the database search and retrieving the articles relevant to this review article.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"No dataset is available for this review article. The studies reviewed are published and available online.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"No funding was received for this review article. JCK, ES, MJN and DK are supported by a National Institute for Health and Care Research award (NIHR156184) using UK international development funding from the UK Government to support global health research. JCK is also supported by the NIHR Exeter Biomedical Research Centre (NIHR Exeter BRC) and a Wellcome Trust Early-Career Award (326531\/Z\/25\/Z). DK is also supported by Horizon Europe (project ID: 101145612). The views expressed are those of the authors and not necessarily those of the NIHR, the UK Government or the European and Developing Countries Clinical Trials Partnership (EDCTP).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"JCK, DK, and CB wrote the initial draft of this manuscript. All authors critically reviewed, revised and approved the final draft of the manuscript. JCK and DK are the guarantors of this work and, as such, take responsibility for the integrity of the review.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}