Type 5 diabetes is no longer a footnote. On April 9, 2025 the International Diabetes Federation confirmed that chronic undernutrition can seed a very different form of blood‑sugar trouble, giving the condition its own place in the global classification system.
“Malnutrition‑related diabetes has historically been vastly under‑diagnosed and poorly understood,” said Dr. Meredith Hawkins as the vote was announced.
Hawkins is an endocrinologist at Albert Einstein College of Medicine and founding director of the Global Diabetes Institute (GDI).
Why a fifth type matters
Nearly one in nine adults worldwide now lives with some form of diabetes, and more than 250 million people remain unaware of their status, according to the 11th edition of the IDF Diabetes Atlas.
Most public campaigns focus on type 2 diabetes, yet an estimated 20 to 25 million lean adolescents and young adults in Asia and Africa carry the new diagnosis of type 5, a burden comparable in size to HIV infection in the same regions.
Unlike type 2, type 5 takes hold where food is scarce, not plentiful. That reality undercuts a long‑standing public narrative that ties diabetes exclusively to over‑nutrition.
For governments counting every healthcare dollar, a distinct label matters. Budgets follow labels, and without one, entire populations have slipped through screening and treatment programs designed for very different metabolic problems.
“This is about equity, science, and saving lives,” said Professor Peter Schwarz, president of the IDF, summing up the stakes during the Bangkok congress.
Early hunger leaves a lasting mark
Decades of animal work show that a low‑protein diet during gestation or adolescence stunts pancreatic growth and the formation of beta cells, the tiny factories that make insulin.
Human epidemiology echoes that biology, linking low birth weight and recurring childhood malnutrition to impaired glucose control later on.
Researchers now group type 5 under severe insulin‑deficient diabetes, a label that captures the core defect: the pancreas never learned to keep up with sugar loads, even though the rest of the body remains sensitive to insulin.
In South India, investigators tracked adults whose body‑mass index averaged just 18.3 kg/m² yet whose blood sugar routinely soared; birth‑weight records, where available, pointed to under‑nutrition in the womb.
Community nutrition programs are therefore viewed not only as anti‑hunger measures but also as long‑range diabetes prevention.
Public‑health economists note a secondary benefit. Feed a girl properly before and during pregnancy, and her children may avoid the same metabolic trap, breaking an expensive inter‑generational cycle of disease.
State‑of‑the‑art euglycemic clamp studies, published in 2022, confirmed that type 5 patients secrete dramatically less insulin than matched controls while showing normal or even heightened insulin sensitivity.
The same work found little visceral fat and modest liver fat, a stark contrast to type 2 profiles. In practical terms, these young adults do not carry the metabolic baggage that fuels insulin resistance in obesity‑driven diabetes.
Autoantibody screens stay negative, ruling out the immune‑mediated beta‑cell destruction that defines type 1 diabetes.
The numbers therefore line up: glucose levels look dangerous, C‑peptide looks scant, but inflammatory markers typical of autoimmunity are absent.
Because the pancreas is small, many experts suspect that oral drugs that nudge the remaining beta cells may help more than high‑dose insulin injections, a strategy that could lower costs and reduce dangerous hypoglycemia in food‑insecure settings.
Diabetes type causes clinical confusion
“Doctors are still unsure how to treat these patients, who often don’t live for more than a year after diagnosis,” Dr. Hawkins warned.
Younger clinicians, trained on the obesity paradigm, may reach for large insulin doses that push already fragile patients into ulcerating hypoglycemia.
Misclassification also skews surveillance data. When a thin teenager in rural Uganda shows up with elevated glucose but no ketosis, the chart often reads “type 1,” obscuring the true epidemiology and directing precious insulin supplies away from those who need them.
A 2025 commentary in the Bangladesh Journal of Endocrinology emphasized the threat: standard insulin regimens carry “potentially fatal consequences” for type 5 patients who are mis‑typed as type 1, because even small dosing errors provoke sharp glucose crashes.
Simple screening cues can help. A BMI below 19 kg/m² in the absence of autoantibodies should prompt consideration of type 5, especially when the history includes prolonged childhood hunger.
Steps for care of diabetes type 5
Two weeks after the Bangkok vote, the IDF launched a dedicated working group to write diagnostic criteria, compile treatment algorithms, and build an international patient registry by 2027.
The panel, co‑chaired by Hawkins and Dr. Nihal Thomas of Christian Medical College in Vellore, India, will test low‑dose insulin, sulfonylureas, and structured nutrition programs in multi‑site trials. Results could reshape essential‑medicine lists in low‑income countries.
Public‑health agencies are already modeling the economic impact. Analysts predict that shifting even half of misdiagnosed cases from insulin vials to oral drugs could save tens of millions of dollars each year, funds that might be redirected to maternal nutrition.
Advocates also press for the inclusion of pancreas‑focused imaging in major nutrition cohorts. Measuring organ size early could identify high‑risk children before glucose spirals out of control.
“We are taking decisive steps to correct this,” said Schwarz, insisting that momentum will continue. Policies built on that momentum will decide whether type 5 becomes another silent killer or a preventable relic of poverty.
The study is published in Diabetes Care.
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