Diabetes Has a Fifth Type: Ignored for Decades, Recognized at Last!
The Diabetes Type the World Debated for 70 Years; Now Officially Recognized
For nearly 70 years, there’s been a riddle about this Medical issue that has remained at the border of global Health, affecting millions of people. Yet it was never named but always debated and mostly dismissed. Patients from Asia, Africa, and many other malnourished regions were misdiagnosed, without proper clarity of the alignment, and the scientists often considered whether those alignments even existed. This has now reached a decisive decision.
After decades of disagreement and neglect, the IDF (International Diabetes Federation) has formally recognized Type 5 Diabetes as a distinguished disease category. This marks a pivotal moment in Diabetes Research and care. IDF is now urging international Health authorities, including the WHO (World Health Organization), to adopt the classification, bringing long-overdue visibility to a condition linked to chronic malnutrition and believed to affect up to 25 million people across the globe, especially in low- and middle-income countries where Healthcare access remains limited.
The Forgotten History of Type 5 Diabetes
Type 5 Diabetes was first documented in 1955 in Jamaica, when clinicians observed a form of Diabetes in severely undernourished patients that did not match existing definitions. Though the WHO acknowledged the condition in the 1980s, disagreement over its cause and Diagnosis persisted.
By 1999, citing a lack of conclusive evidence, the WHO withdrew the classification entirely. For years afterward, scientists debated whether the condition was a distinct disease or simply a variation of other types of this disease. The absence of agreed Diagnostic criteria meant patients were often misclassified and mistreated.
How Type 5 Diabetes Differs From Other Forms
Diabetes is typically grouped into well-known categories. Type 1 Diabetes results from autoimmune destruction of insulin-producing pancreatic cells. Type 2 Diabetes develops when the body becomes resistant to Insulin, often linked to diet and lifestyle. Type 3c Diabetes arises from direct pancreatic damage, while Gestational Diabetes occurs during pregnancy due to hormonal changes.
Type 5 Diabetes does not fit neatly into any of these groups. Formerly known as MRDM (Malnutrition-Related Diabetes Mellitus), the condition appears to originate from chronic nutrient deficiency, rather than Insulin resistance or autoimmune attack. As a result, it is frequently misdiagnosed as Type 1 or Type 2 Diabetes.
“Understanding the specific types of Diabetes someone has is crucial to providing the right treatment,” said Craig Beall, a Diabetes Researcher at the University of Exeter, in May. His statement highlights the Clinical risk of treating fundamentally different conditions with the same approach.
Evidence Strengthens the Case for Recognition
In recent years, growing evidence from human as well as animal studies has shown that prolonged nutritional deficiency can permanently damage Pancreatic development. These changes disrupt insulin secretion and the body’s ability to regulate blood sugar, creating a metabolic profile distinct from that of other forms of diabetes.
A major Research innovation came in the year 2022, when Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine’s Global Diabetes Institute, published Research establishing a unique metabolic signature for malnutrition-related Diabetes.
Hawkins and her colleagues conducted a small Clinical Trial in South India, revealing that individuals with MRDM are Insulin-deficient, similar to people with Type 1 Diabetes, but to a lesser extent. Crucially, unlike people with Type 2 Diabetes, they remain sensitive to Insulin, rather than resistant to it.
Rahul Garg, a physician at F.H. Medical College and Hospital in India, wrote in a recent review that “Type 5 Diabetes stands apart with its unique pathogenesis, theorized to involve compromised pancreatic development resulting from extended periods of nutritional insufficiency.” His assessment underscores why existing Diabetes-related classifications fail to explain the condition.
Why does a Name and Recognition Matter?
For many years, Hawkins has urged that the lack of formal recognition has directly hindered Diagnosis, treatment development, as well as Research funding.
She stated that “Malnutrition-related Diabetes is more common than tuberculosis and nearly as common as HIV/AIDS, but the lack of an official name has hindered efforts to diagnose patients or find effective therapies. 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.”
Following the IDF’s decision, a Type 5 Diabetes Working Group has been established, with Hawkins as chair. The group aims to develop formal Diagnostic criteria, create treatment guidelines, establish a global Research registry, and train Healthcare professionals to recognize and manage the condition safely.
Treatment Challenges and Patient Risk
Treating Type 5 Diabetes requires particular caution. Because patients are not primarily Insulin-resistant, standard Insulin-heavy treatment protocols may be inappropriate.
People with this disease may require only minimal Insulin supplementation or alternative methods to stimulate Insulin secretion. Excess Insulin can trigger dangerous drops in blood sugar.
“Inappropriate Insulin treatment could induce Hypoglycemia (low blood sugar levels), which can be a particular risk in settings with food insecurity and where glucose monitoring might not be affordable,” Hawkins and her colleagues warned in a review published after the condition’s formal recognition.
A Global Health Issue Beyond Borders For The Fifth Type of Diabetes
Even though most commonly reported in Africa & Asia, Type 5 Diabetes is not confined to those regions alone. Undernourishment is rising in parts of the Caribbean and Latin America, driven by complex Economic, Environmental, as well as Political factors that continue to deepen Health inequalities over there.
Some Researchers stated that the IDF’s move is long overdue, while other Researchers caution that Diagnostic uncertainty remains due to the varied ways malnutrition-related Diabetes presents. Yet, without formal recognition, advancing Research or accurately estimating prevalence has been nearly impossible.
“There is no quick fix, and so we expect the fight against this disease to require substantial further Research and advocacy,” Hawkins said. Reflecting on years of Clinical experience, she added, “Once you have seen young patients dying from inappropriate treatment of a neglected form of Diabetes, there’s no turning back.”
With its official announcement, “Type 5 Diabetes” has finally emerged from decades of darkness, opening the doors to safer therapeutics, better Diagnosis, as well as long-awaited global attention for millions who have long remained unseen till now.
