The International Diabetes Federation (IDF) has formally recognised “type 5 diabetes,” a form of the disease caused by malnutrition, as an official diagnostic category after decades of scientific debate. The organisation has called on other bodies, including the World Health Organization (WHO), to follow suit.
Type 5 diabetes is estimated to affect around 25 million people worldwide, mostly in low- and middle-income countries where access to health care is limited. The condition was first described in Jamaica in 1955 but went largely overlooked for decades afterward. The World Health Organization partially recognised it in the 1980s, but scientific disputes over the diagnosis persisted, and it was dropped from classification in 1999 for lack of sufficient evidence.
Diabetes comes in several forms. Type 1 is an autoimmune condition in which the body attacks its own pancreas and stops producing insulin, while type 2 develops when the body loses sensitivity to insulin, often linked to diet and lifestyle. Type 3c usually results from physical damage to the pancreas, and gestational diabetes stems from hormonal changes during pregnancy. Type 5, believed to be linked to malnutrition, was previously known as malnutrition-related diabetes mellitus and was frequently confused with other forms of the disease.
Because insulin resistance is not considered the main driver of the condition, standard diabetes treatments can be ineffective or even harmful for these patients. Craig Beall, a diabetes specialist at the University of Exeter, said in May 2025 that correctly identifying each type of diabetes is critical to choosing the right treatment approach.
Hawkins’ research provides new evidence
Meredith Hawkins, an endocrinologist at the Global Diabetes Institute at Albert Einstein College of Medicine, has spent years pushing for the condition to gain official status. She says malnutrition-related diabetes is more widespread than tuberculosis and comparable in prevalence to HIV/AIDS, yet the lack of a formal name has hindered accurate diagnosis and the development of appropriate treatments. The disease mostly affects people in Asian and African countries experiencing severe food shortages.
In a study published in 2022, Hawkins was the first to demonstrate the distinct metabolic profile of the condition. Her small-scale trial in southern India found that patients with this form of diabetes had an insulin deficiency similar to, but milder than, type 1 diabetes, while, unlike type 2 diabetes, they did not lose their sensitivity to insulin.
Rahul Garg, a physician at F.H. Medical College and Hospital in India, wrote in a recent review that type 5 diabetes has a distinct developmental mechanism, explained by the damage long-term malnutrition inflicts on pancreatic formation.
Some experts have called the recognition “long overdue,” while others argue the decision is premature, citing “diagnostic uncertainty” stemming from the variability of malnutrition-related diabetes cases. There is also no consensus among specialists on whether the number of cases is rising or falling.
The International Diabetes Federation set up a dedicated task force on type 5 diabetes in 2025, led by Meredith Hawkins. The group’s mandate is to develop diagnostic standards and treatment guidelines, build an international scientific registry and train health workers.
Because of the condition’s distinct metabolic features, doctors must take extra care when determining insulin doses: some patients may need only small amounts of supplemental insulin, while others may require alternative approaches that stimulate the body’s own insulin production. Hawkins and her co-authors noted in a review that incorrect insulin treatment can cause dangerously low blood sugar, particularly in regions with food insecurity where monitoring blood glucose is difficult.
The problem is not confined to Asia and Africa — hunger is also becoming an increasingly serious issue in parts of Latin America and the Caribbean. Hawkins said significant further research and advocacy are needed to tackle the disease. She stressed that there is no turning back after having seen young patients die from mistreatment of this long-overlooked form of diabetes.
Source: ScienceAlert
