Last Week, at the 75th Diabetes World Congress in Bangkok, the International Diabetes Federation (IDF) officially classified Type 5 diabetes as a distinct form of the disease affecting lean, undernourished young adults in low- and middle-income countries. “The recognition of type 5 diabetes marks a historic shift in how we approach diabetes globally. For too long, this condition has gone unrecognized, affecting millions of people and depriving them of access to adapted care,” said IDF President Peter Schwarz, while announcing the new classification. This landmark decision brings attention to a condition impacting an estimated 25 million people globally. The long misdiagnosed or overlooked, Type 5 diabetes now stands as a critical public health priority, offering hope for better diagnosis and treatment. Here is everything you need to know about it:
A Decade-Long Struggle for the recognition and final-definition
The roots of Type 5 diabetes trace back to 1955, when it was first identified in Jamaica as “J-type diabetes.” In 1985, the World Health Organization (WHO) termed it “malnutrition-related diabetes mellitus,” but the label was dropped in 1999 due to insufficient evidence. Cases persisted in countries like Sri Lanka, Bangladesh, Uganda, Ethiopia, and Rwanda, where malnutrition is widespread. A 2023 meta-analysis in The Lancet Diabetes & Endocrinology solidified the link between malnutrition and impaired pancreatic function, prompting the IDF to reclassify the condition as Type 5 diabetes in January 2025, with formal endorsement in April. This recognition marks a pivotal step toward addressing a long-neglected health crisis.
Type 5 diabetes primarily affects lean teenagers and young adults with a body-mass index (BMI) below 18.5 kg/m². Unlike Type 1 diabetes, driven by autoimmune destruction of insulin-producing cells, or Type 2, characterized by insulin resistance, Type 5 stems from malnutrition-induced damage to pancreatic beta cells. This leads to insulin secretion levels up to 70% lower than in healthy individuals. It is important to understand that what sets type 5 diabetes apart is that people with type 5 diabetes are insulin “deficient”, but not insulin “resistant”.
Key indicators include extreme fatigue, weight loss, and frequent infections, often mistaken for other diabetes types. Body scans show fat percentages as low as 10-12%, compared to 20-25% in healthy adults. Dietary assessments reveal deficiencies in proteins, zinc, and vitamin A, nutrients essential for pancreatic health. Unlike other diabetes forms, Type 5 lacks autoimmune or genetic triggers, making it a unique challenge.
Malnutrition’s lasting Impact
The concept of type 5 diabetes refers to severe insulin-deficient diabetes (SIDD), characterized by elevated levels of insulin deficiency and poor metabolic control. Type 5 diabetes often originates in the womb, where maternal malnutrition impairs fetal pancreatic development. A 2022 WHO report notes that 200 million children under five in low-income countries suffer from stunting due to chronic malnutrition, a major risk factor. Historical famines in regions like South Asia and ongoing food insecurity in sub-Saharan Africa amplify this issue. While urbanization has driven Type 2 diabetes through overeating, persistent undernourishment, both before and after birth fuels Type 5, highlighting the dual burden of malnutrition in low-resource settings.
Managing Type 5 diabetes centers on reversing malnutrition. High-protein diets, including affordable sources like legumes or fish, are critical for weight gain and blood sugar control. Carbohydrates and healthy fats are adjusted based on BMI and activity levels. Medications like metformin or low-dose insulin are prescribed depending on blood glucose levels, but nutrition remains the cornerstone. Previously, misdiagnosis led to ineffective treatments, such as high-dose insulin causing dangerous hypoglycemia. With Type 5’s recognition, the IDF is developing standardized protocols to improve outcomes.
Implications and the way forward
The official recognition of Type 5 diabetes by the International Diabetes Federation at the 75th Diabetes World Congress in Bangkok marks a turning point in global health. This distinct form of diabetes, affecting an estimated 25 million lean, undernourished young adults in low- and middle-income countries, has long been misdiagnosed or ignored. Rooted in malnutrition-induced pancreatic damage, Type 5 diabetes highlights the enduring impact of food insecurity, from maternal malnutrition to chronic undernourishment. Its classification as severe insulin-deficient diabetes (SIDD) paves the way for tailored treatments, emphasizing high-protein diets and precise medication protocols over ineffective high-dose insulin. This milestone offers hope to millions in regions like South Asia and sub-Saharan Africa, where malnutrition remains rampant. By prioritizing accurate diagnosis and accessible care, the IDF’s decision transforms Type 5 diabetes from a neglected crisis into a public health priority. As standardized protocols emerge, the global health community is poised to address this unique challenge, ensuring better outcomes for vulnerable populations and reinforcing the fight against the dual burdens of malnutrition and diabetes in resource-constrained settings.