The International Diabetes Federation has officially recognized a fifth form of diabetes, known as Type 5 diabetes, urging global health authorities to adopt this classification that affects millions worldwide, particularly in low- and middle-income countries.
The International Diabetes Federation (IDF) has officially recognized Type 5 diabetes as a distinct form of the disease in 2025, a move that has reignited discussions surrounding the classification and treatment of diabetes. The IDF’s announcement reflects decades of debate and controversy regarding this particular type of diabetes, which is said to affect an estimated 25 million people globally, especially in regions with limited access to healthcare.
Type 5 diabetes, previously referred to as malnutrition-related diabetes mellitus (MRDM), was first described in 1955 in Jamaica. However, it remained largely forgotten for many years. Even after the World Health Organization (WHO) acknowledged its existence in the 1980s, the classification was withdrawn in 1999 due to insufficient evidence to support its clinical validity. Since then, the medical community has been divided on whether Type 5 diabetes exists, with ongoing debates about its diagnosis and treatment methods.
Unlike Type 1 diabetes, which is an autoimmune condition that destroys insulin-producing cells in the pancreas, and Type 2 diabetes, which is primarily linked to insulin resistance, Type 5 diabetes appears to arise from chronic nutrient deficiencies. This form of diabetes has been frequently misdiagnosed as other types, complicating effective treatment.
Impact of Nutritional Deficiencies
Craig Beall, a diabetes researcher at the University of Exeter, emphasized the importance of recognizing the specific types of diabetes for appropriate treatment. He noted, “Understanding the specific types of diabetes someone has is crucial to providing the right treatment.” This sentiment echoes the calls from experts like Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine’s Global Diabetes Institute, who has advocated for global recognition of Type 5 diabetes. Hawkins pointed out that malnutrition-related diabetes is more prevalent than tuberculosis and nearly as common as HIV/AIDS, yet the lack of an official classification has hindered diagnosis and treatment efforts.
Hawkins noted, “I’m hopeful that this formal recognition as Type 5 diabetes will lead to progress against this long-neglected disease that severely debilitates people and is often fatal.” Recent research has provided insights into the unique metabolic profile of Type 5 diabetes, establishing it as a distinct condition characterized by compromised pancreatic function resulting from extended periods of nutritional deficiency.
Research and Recognition
In 2022, Hawkins and her colleagues published a study that established a unique metabolic profile for patients suffering from MRDM, demonstrating that while these individuals are insulin-deficient like those with Type 1 diabetes, they remain insulin-sensitive, unlike many with Type 2 diabetes. Dr. Rahul Garg, a physician at F.H. Medical College and Hospital in India, described Type 5 diabetes as having a unique pathogenesis, theorizing that it involves impaired pancreatic development due to chronic nutritional insufficiencies.
In response to the growing body of evidence, the IDF has taken significant steps to advance the recognition of Type 5 diabetes. In 2025, the organization established a working group dedicated to Type 5 diabetes, chaired by Hawkins. This group aims to develop formal diagnostic criteria and therapeutic guidelines, establish a global research registry, and create training programs for healthcare professionals tasked with managing this condition.
Challenges in Treatment
One of the key challenges associated with treating Type 5 diabetes lies in its distinct metabolic profile. Healthcare providers must navigate the complexities of managing insulin levels for patients, who may require minimal insulin supplementation or alternative approaches to stimulate insulin secretion. Overzealous insulin treatment could lead to hypoglycemia, particularly in regions facing food insecurity where glucose monitoring is not readily accessible.
As the issue of undernutrition grows, particularly in parts of Latin America and the Caribbean, health disparities linked to diabetes are becoming increasingly pronounced. Hawkins remarked that while there is no quick fix for the challenges posed by Type 5 diabetes, ongoing research and advocacy efforts are essential for addressing this neglected condition. “Once you have seen young patients dying from inappropriate treatment of a neglected form of diabetes, there’s no turning back,” she stated.
With the IDF’s formal recognition of Type 5 diabetes, the hope is that this will lead to enhanced research funding and improved understanding of the condition’s prevalence and treatment protocols. As experts continue to study the implications of this classification, the global health community remains vigilant in addressing the needs of those affected by this newly recognized form of diabetes.
