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Type 2 diabetes in African individuals who are lean (<25 kg/m2 BMI) differs clinically and pathophysiologically from that in overweight or obese patients, with impaired insulin secretion rather than insulin resistance predominating. This phenotype exhibits a higher prevalence of microvascular complications such as retinopathy and stroke, but a lower burden of hypertension and estimated 10-year cardiovascular disease risk. These divergent complication patterns underscore the need for tailored diagnostic and therapeutic strategies in lean African patients with type 2 diabetes.
