{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:58Z","timestamp":1792787278037,"version":"4.5.0"},"reference-count":15,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Yaound\u00e9 Central Hospital, Changing Diabetes in Children (CDiC) programme"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["326531\/Z\/25\/Z"],"award-info":[{"award-number":["326531\/Z\/25\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute for Health and Care Research (NIHR) global health","award":["17\/63\/131"],"award-info":[{"award-number":["17\/63\/131"]}],"id":[{"id":"https:\/\/ror.org\/0187kwz08","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute for Health and Care Research (NIHR) global health","award":["NIHR156184"],"award-info":[{"award-number":["NIHR156184"]}],"id":[{"id":"https:\/\/ror.org\/0187kwz08","id-type":"ROR","asserted-by":"crossref"}]},{"name":"LEAD Center, University of Colorado Anschutz","id":[{"id":"https:\/\/ror.org\/03wmf1y16","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NIHR Exeter Biomedical Research Centre"},{"name":"MRC\/UVRI & LSHTM Uganda Research Unit, Uganda","id":[{"id":"https:\/\/ror.org\/02qzk8434","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,11]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Diabetes affects over 24\u2009million people in Africa, with type 1 and type 2 diabetes being the most recognised forms. Recent studies in sub-Saharan Africa have identified a substantial proportion of children and young adults with clinically diagnosed type 1 diabetes (T1D) who lack evidence of islet autoimmunity despite severe insulin deficiency, suggesting a distinct non-autoimmune insulin-deficient diabetes subtype (NAID). This study aims to characterise the clinical phenotype, assess the underlying pathophysiology and longitudinal progression of this diabetes subtype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a prospective observational study comprising a cross-sectional comparative analysis and a 3-year longitudinal follow-up cohort. The study will recruit 355 children and young adults aged below 25 years with recently (diabetes duration \u226412 months) diagnosed T1D, with an anticipated estimate of 240 NAID and 115 autoimmune T1D cases. In addition, a minimum of 240 age-matched and sex-matched individuals without diabetes will be recruited as healthy controls. Participants will undergo detailed clinical phenotyping, laboratory assessment including islet autoantibody and C-peptide testing and biospecimen collection for biomarker analyses. A nested mechanistic substudy will include a mixed meal tolerance test and pancreatic MRI to assess pancreatic function and structure. Participants with diabetes will be followed for 3 years to assess longitudinal changes in endogenous insulin secretion, glycaemic response and acute metabolic complications. The study will provide the first prospective characterisation of NAID in sub-Saharan Africa and is expected to improve understanding of its clinical phenotype, natural history and underlying biology, thereby informing future diagnostic and therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study protocol was approved by the National Ethics Committee for Human Health Research (IRB No 2026\/05\/1930\/CE\/CNERSH\/SP\/SPA). All participants will provide written informed consent or assent with parental consent, where appropriate, before enrolment into the study. Research findings will be disseminated through peer-reviewed publications, policy briefs, stakeholder meetings and presentations at national and international scientific conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT15312527\">NCT15312527<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-127640","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:34:40Z","timestamp":1790523280000},"page":"e127640","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective Study of Non-Autoimmune Insulin-Deficient Diabetes Subtype in Young Individuals in sub-Saharan Africa (PANDA study): study protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct15312527","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5631-2810","authenticated-orcid":false,"given":"Jean Claude","family":"Katte","sequence":"first","affiliation":[{"name":"Department of Clinical and Biomedical Sciences, University of Exeter Faculty of Health and Life Sciences, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Gwan","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Diseases Research, RSD Institute, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesmin","family":"Dehayem","sequence":"additional","affiliation":[{"name":"National Obesity Centre and The Endocrinology and Metabolic Diseases Unit, Central Hospital of Yaounde, Yaound\u00e9, Cameroon"},{"name":"Department of Internal Medicine and Specialities, University of Yaounde I Faculty of Medicine and Biomedical Sciences, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moffat","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"NCD Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"NCD Theme, MRC\/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hattersley","sequence":"additional","affiliation":[{"name":"Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0883-7599","authenticated-orcid":false,"given":"Angus","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, UK"},{"name":"Macleod Diabetes Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5457-6572","authenticated-orcid":false,"given":"Eugene","family":"Sobngwi","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Diseases Research, RSD Institute, Yaound\u00e9, Cameroon"},{"name":"National Obesity Centre and The Endocrinology and Metabolic Diseases Unit, Central Hospital of Yaounde, Yaound\u00e9, Cameroon"},{"name":"Department of Internal Medicine and Specialities, University of Yaounde I Faculty of Medicine and Biomedical Sciences, Yaound\u00e9, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"2026092507051440000_16.9.e127640.1","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1001\/jama.2026.0048","article-title":"Type 1 Diabetes: A Review","volume":"335","author":"Jacobsen","year":"2026","journal-title":"JAMA"},{"key":"2026092507051440000_16.9.e127640.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2025.112277"},{"key":"2026092507051440000_16.9.e127640.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30582-7"},{"key":"2026092507051440000_16.9.e127640.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-021-05568-3"},{"key":"2026092507051440000_16.9.e127640.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-023-06004-4"},{"key":"2026092507051440000_16.9.e127640.6","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S002"},{"key":"2026092507051440000_16.9.e127640.7","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1014626","article-title":"The phenotype of type 1 diabetes in sub-Saharan Africa","volume":"11","author":"Katte","year":"2023","journal-title":"Front Public Health"},{"key":"2026092507051440000_16.9.e127640.8","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/S2213-8587(17)30181-X","article-title":"Diabetes in sub-Saharan Africa: from clinical care to health policy","volume":"5","author":"Atun","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026092507051440000_16.9.e127640.9","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1007\/s00125-026-06697-3","article-title":"Atypical diabetes subtypes in Black African populations","volume":"69","author":"Katte","year":"2026","journal-title":"Diabetologia"},{"key":"2026092507051440000_16.9.e127640.10","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/S2213-8587(25)00120-2","article-title":"Non-autoimmune, insulin-deficient diabetes in children and young adults in Africa: evidence from the Young-Onset Diabetes in sub-Saharan Africa (YODA) cross-sectional study","volume":"13","author":"Katte","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026092507051440000_16.9.e127640.11","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1007\/s00125-025-06576-3","article-title":"Heterogeneity in clinically diagnosed type 1 diabetes: characterising a unique cohort with maintained C-peptide secretion in Ghana","volume":"69","author":"Aniagyei","year":"2026","journal-title":"Diabetologia"},{"key":"2026092507051440000_16.9.e127640.12","unstructured":"Novo Nordisk . Changing diabetes in children programme for children with type 1 diabetes. 2026."},{"key":"2026092507051440000_16.9.e127640.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0256029","article-title":"Development of a standardized MRI protocol for pancreas assessment in humans","volume":"16","author":"Virostko","year":"2021","journal-title":"PLoS ONE"},{"key":"2026092507051440000_16.9.e127640.14","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-017-0265-4"},{"key":"2026092507051440000_16.9.e127640.15","doi-asserted-by":"crossref","DOI":"10.2196\/65377","article-title":"Research Electronic Data Capture (REDCap) for Population-Based Data Collection in Low- and Middle-Income Countries: Opportunities, Challenges, and Solutions","volume":"27","author":"Le","year":"2025","journal-title":"J Med Internet Res"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-127640","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:34:43Z","timestamp":1790523283000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-127640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":15,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,25]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjopen-2026-127640"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-127640","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}