Type 5 diabetes recognised as distinct form of disease: why is this significant?

By Admin

17 Apr, 2025

For decades, a form of diabetes affecting millions in low- and middle-income countries remained misdiagnosed, overlooked in research, and largely misunderstood by the global medical community. Now, that’s finally changing. The International Diabetes Federation (IDF) has officially recognised Type 5 diabetes — a malnutrition-related form of diabetes — as a separate and distinct disease. But what exactly is this condition, and why is its recognition so significant?

What Is Type 5 Diabetes?

Type 5 diabetes primarily affects lean, undernourished teenagers and young adults in low-income regions, such as parts of Asia, Africa, and Latin America. Unlike the more well-known Type 2 diabetes, where the body becomes resistant to insulin, Type 5 diabetes is caused by insufficient production of insulin due to impaired pancreatic function.

Dr. Nihal Thomas, an endocrinologist at Christian Medical College, Vellore, and part of the Type 5 Diabetes Working Group, explains that the beta cells in the pancreas — responsible for producing insulin — do not function normally in these individuals. This is directly linked to chronic malnutrition, often beginning in the womb.

The Long Road to Recognition

Though only officially named Type 5 diabetes in 2024 by IDF President Prof. Peter Schwarz, this condition is not new. It was first described in Jamaica in 1955 as “J-type diabetes.” Later, the World Health Organization (WHO) referred to it as “malnutrition-related diabetes mellitus” in 1985, but removed the classification in 1999 due to a lack of clear evidence.

In reality, the condition was quietly spreading across countries such as India, Bangladesh, Sri Lanka, Ethiopia, Uganda, Rwanda, and South Korea, predominantly affecting the undernourished youth in the Global South. Today, Type 5 diabetes is estimated to impact nearly 25 million people worldwide.

Why Is This Recognition So Significant?

1. Correct Diagnosis: For years, patients with Type 5 diabetes were often misdiagnosed with Type 1 or Type 2 diabetes, leading to ineffective treatment. Official recognition paves the way for accurate diagnosis.
   
   

2. Targeted Treatment: Recognising the condition enables the development of specific treatment protocols, tailored to the unique needs of undernourished individuals.
   
   

3. Public Health Policy: It encourages governments and health organisations to incorporate Type 5 diabetes into public health programs, especially in resource-poor settings.
   
   

4. Focused Research: This opens the door to dedicated research, which could lead to improved care, preventive strategies, and possibly, reversal.
   
   

What Are the Symptoms and Markers?

According to Dr. Thomas, patients with Type 5 diabetes exhibit the following markers:

• Very low BMI (below 18.5 kg/m²)
  
  

• Severely reduced insulin secretion, although not as low as in Type 1 diabetes
  
  

• Lower body fat percentages than typical diabetic individuals
  
  

• Poor dietary intake of proteins, fibre, and essential nutrients
  
  

• No genetic or autoimmune causes detectable
  
  

The Root Cause: Malnutrition Starting Before Birth

Dr. C. S. Yajnik, director of the Diabetes Unit at KEM Hospital, Pune, elaborates that the origins of Type 5 diabetes can be traced back to the womb. Poor maternal nutrition leads to inadequate fetal development, particularly of organs like the pancreas. If this is followed by continued postnatal malnutrition, the risk of developing Type 5 diabetes becomes high.

He also notes the dual burden of malnutrition in countries like India — where undernutrition and obesity coexist — complicating the public health response further.

How Can It Be Treated?

Currently, there is no standardised treatment for Type 5 diabetes, but experts suggest:

• A high-protein diet to support muscle mass and metabolic function
  
  

• Adequate intake of carbohydrates and fats based on individual BMI and energy needs
  
  

• Nutritional rehabilitation to restore overall health
  
  

The Type 5 Diabetes Working Group will continue to define diagnostic and therapeutic guidelines over the next two years, considering different populations and resource limitations.

Final Thoughts

The official recognition of Type 5 diabetes is a monumental step forward in global health equity. It sheds light on how poverty, poor maternal nutrition, and inadequate childhood diets can have lifelong effects — and how millions suffering in silence can finally receive proper diagnosis and care. As the global medical community takes steps to better understand this condition, we inch closer to a future where every form of diabetes gets the attention it deserves.