After years of being overlooked and frequently misdiagnosed, Type 5 diabetes has finally been officially acknowledged as a distinct form of the disease by the International Diabetes Federation (IDF). This recognition is a significant step forward, especially considering the condition’s connection to malnutrition-induced insulin deficiencies. It primarily affects lean and undernourished teenagers and young adults in low- and middle-income countries, but its clinical understanding and treatment have long been neglected.
Understanding Type 5 Diabetes
Type 5 diabetes is a unique form of the disease that primarily affects malnourished individuals in developing regions. Unlike Type 2 diabetes, which is characterized by insulin resistance, Type 5 involves abnormal function of pancreatic beta cells, leading to insufficient insulin production. Dr. Nihal Thomas, a prominent endocrinologist and member of the Type 5 Diabetes Working Group, explains that this form of diabetes is markedly different from the more common Type 2, where insulin resistance remains the key issue.
The term ‘Type 5’ was officially introduced and endorsed by Prof. Peter Schwarz, President of the IDF, in January 2025. The official recognition came during the 75th World Congress for Diabetes held in Bangkok earlier this month, though the disease itself is not new. First documented in Jamaica in 1955 as J-type diabetes, it was later categorized by the World Health Organization (WHO) in 1985 as “malnutrition-related diabetes mellitus,” though this classification was removed in 1999 due to insufficient evidence linking malnutrition to the disease.
Over the years, this form of diabetes has been reported in several countries, including India, Sri Lanka, Bangladesh, and various African nations. Today, it affects approximately 25 million people globally, with a significant focus on malnutrition as a contributing factor.
Distinctive Characteristics of Type 5 Diabetes
Type 5 diabetes displays several markers that differentiate it from other forms of diabetes. According to Dr. Thomas, individuals with this condition typically have a body mass index (BMI) lower than 18.5 kg/m², significantly lower than that observed in Type 2 diabetes. Insulin secretion is also drastically reduced, coming close to levels seen in Type 1 diabetes, but higher than in Type 2.
Body scans reveal a notably lower percentage of body fat in those with Type 5 diabetes. Furthermore, these individuals often suffer from deficiencies in proteins, fiber, and essential micronutrients, all of which are vital for proper health and metabolic function.
The Role of Malnutrition in the Development of Type 5 Diabetes
The primary cause of Type 5 diabetes is malnutrition, which can begin even before birth. Dr. C.S. Yajnik, a key member of the Type 5 Diabetes Working Group, explains that maternal malnutrition during pregnancy increases the risk of diabetes in offspring later in life. While India’s rapid urbanization and improved nutrition have led to concerns about overnutrition, malnutrition remains a significant factor, particularly in regions with limited resources.
Dr. Yajnik further clarifies that when a child experiences undernutrition both in utero and during early childhood, the risk of developing Type 5 diabetes increases, especially when accompanied by continued malnutrition into adulthood.
Treatment Options for Type 5 Diabetes
As Type 5 diabetes has only recently been recognized as a distinct disease, formal diagnostic criteria and treatment guidelines are still under development. The Type 5 Diabetes Working Group is focused on refining these criteria over the next few years, particularly in low-resource settings.
Current treatment strategies include a high-protein diet, which is critical for individuals with low BMI to help promote weight gain. Depending on the person’s activity levels and nutritional intake, adequate amounts of carbohydrates and fats may also be necessary. In some cases, anti-diabetic medications or insulin may be prescribed, but treatment is tailored to each individual’s glucose levels and overall therapeutic response.
This newfound recognition of Type 5 diabetes is a promising development in global diabetes care, offering hope for better diagnosis, treatment, and management of this often-overlooked disease.
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