A New Type of Diabetes Is Officially Recognized, and 25 Million People May Have It

For nearly seventy years, what’s now called Type 5 diabetes has remained in a kind of medical limbo. First identified in Jamaica in 1955, it was recognized by the World Health Organization in the 1980s, only to have that classification withdrawn in 1999 due to a lack of consensus. Researchers fiercely debated the condition, with some arguing it was just a variation of existing types. Without an official name, the disease remained largely invisible, making it nearly impossible to secure research funding or establish reliable diagnostic methods.

This lack of clarity has had serious consequences, especially in low- and middle-income countries. Because its symptoms are similar to other forms of diabetes, patients are often misdiagnosed. This isn’t a minor administrative mistake; as recent research has shown, standard treatments for Type 1 or Type 2 diabetes can be dangerously ineffective or even harmful for those whose condition stems from nutritional deficiencies. The push for formal recognition, led by endocrinologists like Meredith Hawkins from the Albert Einstein College of Medicine’s Global Diabetes Institute, has been driven by the urgent need to protect vulnerable patients from inappropriate care.

A Distinct Metabolic Fingerprint

What finally set Type 5 diabetes apart from its better-known counterparts was a small but revealing study conducted in south India. According to findings published by Hawkins and her colleagues in 2022, individuals with malnutrition-related diabetes exhibit a unique metabolic profile that challenges previous assumptions.

The research showed that these patients are insulin-deficient, like those with Type 1 diabetes, but crucially, they do not experience the same extreme depletion. Moreover, unlike the vast majority of Type 2 patients who develop insulin resistance, those with this condition remain fully sensitive to insulin.

Is Your Diabetes Treatment Putting Your Life at Risk?

The practical risks of confusion surrounding Type 5 diabetes are stark. Because insulin resistance isn’t the primary issue, standard protocols for managing blood sugar need to be completely reevaluated. Meredith Hawkins and her team, who published a review following the IDF’s formal recognition, warn that treating these patients requires extreme caution.

“Inappropriate insulin treatment could induce hypoglycaemia [low blood sugar levels], which can be a particular risk in settings with food insecurity and where glucose monitoring might not be affordable.” 

For a malnourished patient, where consistent glucose monitoring may be unaffordable, a standard dose of insulin intended for a Type 2 patient could have fatal consequences. It’s this reality, of young patients dying from improper treatment, that has fueled the decades-long fight for recognition.

A Global Health Blind Spot

Although Type 5 diabetes has mostly been linked to Asia and Africa in the past, experts now warn that it’s spreading. The root cause, a drastic shortage of nutrients during vital pancreatic development periods, spans across more than one region.

As researchers pointed out after its official recognition, malnutrition is becoming an increasing issue in parts of Latin America and the Caribbean.

“There is no quick fix, and so we expect the fight against this disease to require substantial further research and advocacy,” Hawkins explained in an interview for Montefiore Einstein.”Once you have seen young patients dying from inappropriate treatment of a neglected form of diabetes, there’s no turning back.”

The diabetes working group set up by the IDF now has the huge job of creating clear diagnostic guidelines and training healthcare workers worldwide. Their aim is simple: wherever food insecurity is a problem, doctors should be able to recognize and properly treat Type 5 diabetes.

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