| Kalkidan Hassen Abate grew up in Ethiopia’s north, where in the 1980’s what became known as the great famine claimed more than 300,000 lives. When images of the devastating hunger reached the rest of the world it gave rise to an unprecedented wave of solidarity that culminated in the Live Aid music concerts to mobilize funds for those who were starving. While the famine eventually passed, some of its effects have been insidious and long-lasting. Abate, now a professor of nutrition and public health at Jimma University in the country’s southwestern coffee growing region, started noticing atypical diabetes cases about a decade ago in lean young adults in rural farming communities. Turns out, many of these were people whose mothers had faced a severe lack of food when pregnant, or who had been malnourished in critical growth periods, particularly in the first few years of life. “We often see diabetes of this kind rising rapidly as people reach adulthood, especially if the pancreas has been stunted,” Abate says. That condition makes the organ less able to produce insulin and increases the risk of diabetes, even among those who eat a normal diet. Recently a group of global experts, citing evidence from countries including Bangladesh, Rwanda and Indonesia, called for this unusual form of the disease to be referred to as type 5 diabetes. Writing in The Lancet Global Health, they said about 25 million people, mostly in poorer countries, suffer from this under-researched form of the disease and called for the development of diagnostic criteria and treatment guidelines. Diabetes, which affects nearly 600 million people globally, is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. The most common form of the disease, type 2, is often linked to obesity, a sedentary lifestyle and a diet high in sugar. The countries worst affected by the new form of diabetes largely have poorly resourced public healthcare systems that are already stretched from fighting recurrent infectious disease outbreaks. They aren’t prepared for an upswell in cases among lean, healthy-looking individuals who suffered through famine decades ago. As Africa’s second most populous nation after Nigeria and one of the fastest-growing economies in the region, Ethiopia already has a diabetes rate of more than 5%, putting it among the countries with the highest prevalence in sub-Saharan Africa. The East African nation simply doesn’t have enough insulin for what may be a latent diabetes surge, Abate says. What’s more, he says the problem could be amplified globally in the future as both wars and climate change worsen famine risk. — Janice Kew | 
