New Type 5 Diabetes Discovered with Malnutrition Link

New Type 5 Diabetes Discovered with Malnutrition Link

In a groundbreaking development that's transforming our understanding of diabetes, researchers have officially identified a new type of the disease: Type 5 diabetes, which is directly related to chronic malnutrition. This discovery, announced in early 2025, emphasizes how undernutrition—especially in vulnerable populations—can cause severe health problems that have been overlooked for decades. Affecting millions around the world, this breakthrough offers hope for improved diagnosis and treatment options for those in low- and middle-income countries. Let's examine what this means, from its causes to the potential it holds for the future.

Type 5 diabetes, also known as malnutrition-related diabetes (MRDM), is a unique form of diabetes that is fundamentally different from the more common Type 1 and Type 2. Unlike Type 1, which results from autoimmune destruction of insulin-producing cells, or Type 2, often associated with obesity and insulin resistance, Type 5 develops from long-term nutrient deficiencies that hinder the pancreas's ability to function properly. This condition has been recognized for over 70 years but was often misclassified, leading to ineffective treatments and poor outcomes.

The International Diabetes Federation (IDF) officially designated it as Type 5 during an expert meeting in India in January 2025, with the announcement made at the IDF World Diabetes Congress in Bangkok in April. This advancement was motivated by years of research highlighting its distinct metabolic profile.

At its core, Type 5 diabetes is caused by chronic undernutrition, especially during critical growth periods like childhood and adolescence. Nutrient shortages—such as proteins, vitamins, and minerals—impair pancreatic development, leading to a significant defect in insulin secretion. This is particularly common in regions affected by poverty, food insecurity, and limited access to nutritious diets, such as parts of Asia and Africa.

Dr. Meredith Hawkins, a leading researcher at Albert Einstein College of Medicine, explains: "But it turns out that people with this form of diabetes have a profound defect in the capacity to secrete insulin, which wasn't recognized before. This finding has revolutionized how we think about this condition and how we should treat it." Unlike Type 2, where the body resists insulin, Type 5 patients are insulin deficient but not resistant, making insulin therapy potentially dangerous because it can cause severe low blood sugar.

Individuals with Type 5 diabetes are usually young, slim, and malnourished—often teenagers or young adults who exhibit severe insulin deficiency and poor blood sugar management. Common signs include excessive thirst, frequent urination, unexplained weight loss, fatigue, and wounds that heal slowly, similar to other types of diabetes. However, the main difference is their metabolic response: these patients may not respond well to standard insulin treatments, which can cause life-threatening complications.

Misdiagnosis remains a major problem; many are diagnosed with Type 1 or 2, resulting in subpar care. Dr. Hawkins states, "Doctors are still unsure how to treat these patients, who often don't survive more than a year after diagnosis." The IDF's Type 5 Working Group is developing new diagnostic criteria to tackle this issue, emphasizing malnutrition history and specific metabolic tests.

This new type affects an estimated 20 to 25 million people worldwide, making it more common than tuberculosis and almost as widespread as HIV/AIDS. It is concentrated in low- and middle-income countries, where malnutrition worsens the disease burden. In sub-Saharan Africa, for example, up to two-thirds of young diabetes cases might be misdiagnosed as Type 5.

The recognition of Type 5 underscores health inequities, as Professor Peter Schwarz of the IDF states: "The recognition of type 5 diabetes marks a historic shift in how we approach diabetes globally. For too long, this condition has gone unrecognised, affecting millions of people and depriving them of access to adapted care."

Pioneering work by Dr. Hawkins and her team, including a 2022 study in Diabetes Care, revealed Type 5's distinct nature through metabolic studies. This paved the way for the IDF's endorsement and the formation of a working group co-chaired by Dr. Hawkins and Dr. Nihal Thomas to create guidelines, a research registry, and educational resources over the next two years.

Looking ahead, experts hope for tailored treatments, such as oral medications that could be more affordable and effective than insulin in resource-poor settings. This could save lives and reduce the global diabetes burden.

The uncovering of Type 5 diabetes is a wake-up call to address malnutrition as a root cause of chronic diseases. By raising awareness, improving nutrition access, and advancing research, we can prevent and better manage this hidden epidemic. As Dr. Hawkins emphasizes, "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."