A new form of diabetes that affects lean and malnourished teenagers and young adults in low- and middle-income countries has been officially recognised as a distinct form of the disease after decades, and named ‘Type 5 Diabetes’.

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The World Diabetes Congress, organised by the International Diabetes Federation (IDF) in Bangkok, Thailand, recently, officially recognised malnutrition-related diabetes distinct from both type 1 and type 2, and named it ‘Type 5 Diabetes’.

The vote took place on April 8 at the World Diabetes Congress.
The term ‘Type 5 Diabetes’ was proposed by IDF president Prof Peter Schwarz.
The vote took place after a panel met in India in January this year to draft a consensus statement about the condition, due to be published soon, Meredith Hawkins, MD, professor of medicine at Albert Einstein College of Medicine, Bronx, New York, told Medscape Medical News.

In 2022, a study published in Diabetes Care by Dr. Hawkins and her colleagues at Christian Medical College in Vellore, India, demonstrated that malnutrition-related diabetes is fundamentally different from types 1 and 2.

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“People with this form of diabetes have a profound defect in the capacity to secrete insulin, which wasn’t recognised before,” said Dr. Hawkins.

“Malnutrition-related diabetes has historically been vastly underdiagnosed and poorly understood…The IDF’s recognition of it as ‘type 5 diabetes’ is an important step toward raising awareness of a health problem that is so devastating to so many people,” Hawkins said.

Malnutrition-related diabetes was first identified in Jamaica in 1955. It was most common in lean and undernourished young adults in low- and middle-income countries who have a low body mass index. They were misdiagnosed as having type 1 diabetes, but despite high blood glucose levels and high insulin requirements, they don’t develop ketonuria or ketosis.

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Then in 1985, the World Health Organization officially classified “malnutrition-related diabetes mellitus” as a distinct diabetes type, but 14 years later, in 1999, dropped the category, citing a lack of evidence that malnutrition or protein deficiency causes diabetes.

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Type 5 diabetes patients have a significantly lower BMI, often of less than 18.5 kg/m2 and insulin secretion is also severely reduced, much lower than in Type 2 diabetes but just above the levels in type 1 diabetes. 
Unlike Type 2 diabetes, the liver’s production and release of glucose into the bloodstream is lower, and body scans reveal a much lower percentage of body fat compared to Type 2 cases. 

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Type 5 diabetes causes pancreatic beta cells to function abnormally, leading to insufficient production of insulin, while in Type 2, the body resists insulin action despite producing it. 

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Nutrition, both in the womb and after birth, plays a major role in diabetes. If a foetus does not get the right amount of nutrition while growing, the baby has a higher risk of developing diabetes later. In contrast, if a baby is under- or overnourished before birth and then gains too much weight later, it can lead to Type 2 diabetes. 
Type 5 diabetes, or malnutrition-related diabetes, affects those who are undernourished both before and after birth.

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A working group, to be co-chaired by Dr. Hawkins, has been tasked with developing formal diagnostic and therapeutic guidelines for type 5 diabetes over the next 2 years.

However, experts say that a high-protein diet is important, and depending on the patient’s BMI and physical activity, an adequate amount of carbs and fats are needed to ensure weight gain.
Anti-diabetic medicine or insulin is considered on the basis of blood glucose levels and therapeutic response on an individual basis, they advise.