The MRC/UVRI and LSHTM Uganda Research Unit, in collaboration with the MEIRU Research Unit in Malawi, University of Yaoundé 1 in Cameroon, University of Cape Town in South Africa, and the University of Exeter in the UK, is spearheading a landmark four-year study titled, “Improving outcomes for people with type 2 diabetes in sub-Saharan Africa” under the NIHR Global Health Research Group. This research study aims to tackle Type 2 diabetes (T2D) in sub-Saharan Africa (SSA), with a special emphasis on the under-researched population of lean patients.

Discussions about the study took center stage at the NIHR Steering Committee meeting, held at the MRC/UVRI and LSHTM Uganda Research Unit from November 11-14, 2024. Researchers presented innovative strategies for diagnosing and managing T2D among lean patients, a population often overlooked in traditional approaches.

The project uses a data-driven methodology to examine lifestyle factors such as diet and physical activity contributing to T2D in lean individuals; evaluate the efficacy of low-cost, tailored glucose-lowering medications and; develop structured education programmes to empower patients with personalized self-management tools. The project not only aims to improve healthcare outcomes but also seeks to strengthen local research capacity and set a new benchmark for addressing non-communicable diseases in the region.

In his opening remarks, Dr. Gerald Mutungi, Assistant Commissioner for non-communicable diseases at Uganda’s Ministry of Health, highlighted the rising burden of diabetes:

“The number of diabetes cases has significantly increased. Diabetes clinics are overwhelmed with patients of whom a large proportion is relatively young and non-obese. This research serves as a valuable opportunity to understand why diabetes is affecting lean and physically active individuals. It also provides a chance to promote prevention and early diagnosis," he said.

Investigating diet and physical activity
Unlike most T2D patients, who are often overweight or obese, lean diabetes patients face unique challenges and their response to conventional treatments remains unknown due to limited research in this area. Led by Professor Moffat Nyirenda (MRC/UVRI & LSHTM Uganda Research Unit) and Professor Rob Andrews (University of Exeter), researchers will employ advanced tools like photographic food diaries and accelerometry to objectively analyze patients' diets and physical activity. These insights will guide tailored interventions that better meet the needs of lean T2D patients.

Empowering patients 
Diabetes is a condition predominantly managed by the person with diabetes, with the support and guidance of health care professionals. To be able to make informed choices about diabetes self-management (e.g., dietary choices, physical activity, and reducing alcohol/smoking), people living with diabetes need to be empowered and equipped with practical and culturally relevant self-management skills.  Under the leadership of Dr. Nambusi Kyegombe (MRC/UVRI & LSHTM Uganda Research Unit) and Professor Rob Andrews, the group will co-develop and pilot a localised structured education for T2D patients in Uganda and Malawi. the programme integrates evidence-based strategies, psychological learning theories, and input from community stakeholders.

Optimizing therapy 
Research led by Associate Professor Angus Jones (University of Exeter) and Professor Eugene Sobngwi (University of Yaoundé) focuses on understanding whether response to oral glucose lowering therapy is altered in lean type 2 diabetes. The study will evaluate the efficacy, safety and tolerability of common therapies such as metformin and sulfonylureas. This research addresses the distinct needs of lean patients, who represent up to 60% of T2D cases in sub-Saharan Africa, by tailoring treatments to their unique physiology.

Improving diagnosis 
To address the high rates of undiagnosed T2D in the region, the group will use existing data to improve diabetes diagnosis by identifying the best approaches to identify those at high risk of type 2 diabetes who will benefit from diagnostic testing and/or prevention strategies. This study will utilize data from Uganda’s General Population Cohort (GPC) and Malawi’s MEIRU Population Cohort. By analyzing clinical markers such as age, BMI, sex, and blood pressure, the team aims to develop cost-effective, targeted screening models. These tailored approaches aim to identify high-risk individuals earlier, significantly reducing complications and improving outcomes.

About the NIHR Global Health Research Group 
This collaboration aims to create a robust network of skilled researchers and clinicians in SSA by developing contactable cohorts of well-characterized diabetes patients to support future studies; conducting reciprocal visits and training between Exeter, Uganda, and Cameroon to strengthen diagnostics and laboratory capacities; and establishing sustainable research platforms to support long-term advancements in science and healthcare. The project will initially focus on Uganda, leveraging the infrastructure and expertise of the MRC/UVRI and LSHTM Uganda Research Unit, before expanding to Cameroon.