Type 5 Diabetes: A New Label for Malnutrition-Related Diabetes

Type 5 diabetes has been officially recognised as a distinct form of diabetes by the International Diabetes Federation (IDF) at the World Diabetes Congress held in Bangkok on April 8, 2025. Type 5 diabetes is also known as malnutrition-related diabetes.

This form of diabetes predominantly affects young, lean individuals from low- and middle-income countries, especially in South Asia and sub-Saharan Africa. Unlike Type 1 and Type 2 diabetes, Type 5 diabetes presents with a unique metabolic profile, prompting revised diagnostic criteria and treatment approaches.

What is Type 5 diabetes?

Type 5 diabetes has a link to early-life undernutrition. It is present in patients who are often underweight. They do not show typical symptoms of insulin resistance or autoimmunity. Many of these individuals are young males with diabetes despite being malnourished and physically active.

Type 1 diabetes is autoimmune. Type 2 diabetes involves insulin resistance, often linked to obesity. In contrast, Type 5 diabetes shows poor insulin secretion. However, it does not involve insulin resistance or autoantibodies.

A history of ignorance

Malnutrition-related diabetes was first described in Jamaica in 1955. The World Health Organization (WHO) acknowledged its existence in 1985. However, in 1999, the classification was removed due to a lack of conclusive evidence.

For decades, this form of diabetes went unnoticed, leading to misdiagnosis or improper treatment.

Research confirms distinct biology

The turning point came with collaborative research led by Dr. Meredith Hawkins from Albert Einstein College of Medicine, New York, and Dr. Nihal Thomas from Christian Medical College (CMC), Vellore, India. The findings are published in Diabetes Care. It involved detailed metabolic assessments of men suspected to have this condition, compared with patients having Type 1 or Type 2 diabetes, and healthy controls.

Researchers found that:

• These patients had normal or low insulin sensitivity, unlike those with Type 2 diabetes.
• They exhibited poor insulin secretion, but no autoimmune markers (unlike Type 1 diabetes).
• Their BMI was significantly lower than that of other diabetic groups, often falling below 19.
• They showed resistance to standard insulin therapies, increasing the risk of fatal hypoglycemia.

These metabolic markers, along with clinical history, proved Type 5 diabetes is a distinct disease, not merely a variant of the known types.

The global burden: Hidden in plain sight

Malnutrition-related diabetes is rarely seen in high-income countries. Researchers estimate that it may affect up to 80 million people worldwide. In countries like India and parts of sub-Saharan Africa, studies suggest 20% of all diabetes cases could be this form, especially among undernourished youth.

However, due to a lack of awareness and outdated classifications, it results in misdiagnoses. Many patients succumb to complications within a year of diagnosis, especially when wrongly treated with insulin.

What changes with the IDF recognition?

The IDF’s recognition of Type 5 diabetes opens the door for:

• Dedicated diagnostic criteria, such as malnutrition history, lean body type, and absence of insulin resistance or autoimmunity.
• New treatment guidelines, which may include oral hypoglycemics and nutritional interventions rather than insulin.
• Improved training for healthcare providers in vulnerable regions.
• Inclusion in global diabetes statistics, helping attract funding and research support.

Dr. Meredith Hawkins highlighted that the recognition of Type 5 diabetes marks an important milestone for previously overlooked patients and called for region-specific research and interventions.

Similarly, Dr. Nihal Thomas added that this classification brings dignity to patients whose symptoms did not align with traditional diabetes categories

A New Chapter in Diabetes Care

With the formal recognition of Type 5 diabetes, global health takes a critical step toward inclusivity in diabetes care. This milestone not only promises better clinical outcomes but also sheds light on the intersections of poverty, nutrition, and chronic illness.

As research progresses, it will be crucial to empower local healthcare workers with context-specific knowledge. Provide affected individuals with the resources they need to manage their condition safely and effectively.

Sources: Inputs from various media channels

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