The newly recognised form of diabetes, linked to chronic undernutrition and affecting up to 25 million people, requires different diagnosis and treatment from types 1 and 2.
After decades on the margins of diabetes research, the International Diabetes Federation has formally recognised a fifth category of the disease, giving long-delayed visibility to a condition linked to chronic undernutrition and most common in poorer countries. The federation said in August 2025 that type 5 diabetes, previously described as malnutrition-related diabetes mellitus, affects people mainly in low- and middle-income nations, with the greatest burden seen in South-East Asia and sub-Saharan Africa.
The move matters because type 5 diabetes does not fit neatly into the better-known forms of the disease. Type 1 diabetes is caused by the immune system destroying the pancreas’s insulin-producing cells, while type 2 diabetes is driven largely by insulin resistance. Type 5 diabetes appears instead to arise from prolonged nutritional deficiency, which can impair pancreatic development and leave patients with too little insulin rather than too much resistance to it.
Researchers have been arguing over the condition for nearly 70 years. It was first described in Jamaica in the 1950s and later acknowledged by the World Health Organisation in the 1980s, before the classification was withdrawn in 1999 because of limited evidence and uncertainty over diagnosis. That lack of consensus helped keep the condition out of mainstream diabetes care, even though scientists now estimate it may affect as many as 25 million people worldwide.
Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine’s Global Diabetes Institute, has been among the strongest advocates for formal recognition. Her work, including a study published in 2022, helped define a distinctive metabolic pattern in patients with malnutrition-related diabetes: they tend to be insulin-deficient, but not in the same way as people with type 1 diabetes, and they do not show the insulin resistance typical of type 2 diabetes.
That distinction matters for treatment. Hawkins and other specialists have warned that people with type 5 diabetes may be harmed if they are managed as though they have type 2 diabetes, because standard approaches may not match their underlying physiology. In settings where food insecurity is common and glucose monitoring is limited, inappropriate insulin use can also raise the risk of dangerous low blood sugar.
The federation has begun trying to close that gap. In April 2025, it launched a type 5 diabetes working group chaired by Hawkins to develop diagnostic criteria, outline treatment guidance, build a global research registry and create education materials for health workers. The effort reflects a wider push to persuade other health authorities, including the World Health Organisation, to follow the federation’s lead.
The recognition also brings fresh attention to the role of undernutrition in diabetes more broadly. Studies cited by researchers have suggested that early-life malnutrition can have lifelong effects on the pancreas, while recent reviews have pointed to similar concerns in parts of Latin America and the Caribbean, where poverty and environmental pressures are deepening health inequalities. For advocates, the new classification is only a starting point. The harder task, they say, is turning acknowledgement into diagnosis, research funding and treatment that reflects the condition’s true cause.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
