Swati Sri
April 15, 2026: The International Diabetes Federation (IDF) has officially recognized a distinct fifth type of diabetes known as Type 5 diabetes or malnutrition-related diabetes mellitus (MRDM), This condition was first identified nearly 70 years ago but was long neglected by the medical community. It is believed to affect up to 25 million people worldwide, primarily in low- and middle-income countries.
Type 5 diabetes is a form of diabetes directly linked to chronic malnutrition or undernutrition occurring during early childhood or adolescence. Unlike Type 1 diabetes (an autoimmune condition destroying insulin-producing cells) or Type 2 diabetes (characterized by insulin resistance often associated with obesity), Type 5 diabetes stems from nutrient deficiency that compromises pancreatic development and function.
The condition was first described in 1955 in Jamaica and was initially referred to as J-type diabetes. In 1985, the World Health Organization (WHO) briefly recognized malnutrition-related diabetes as a separate classification, only to remove it in 1999 due to what the organization claimed was insufficient scientific evidence. This removal left millions of patients without proper diagnostic criteria or targeted treatment protocols for over two decades.
According to Dr. Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine’s Global Diabetes Institute and chair of the newly formed IDF Type 5 Diabetes Working Group, “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.”
Who Is affected?
Type 5 diabetes primarily impacts populations in low- and middle-income nations where food insecurity is prevalent. The highest concentrations of cases are found in:
- Southeast Asia
- Sub-Saharan Africa
- Parts of Central and South America
- Caribbean countries
The condition affects young, lean individuals—typically teenagers or young adults with a body mass index (BMI) of 18.5 kg/m² or less. These patients are frequently misdiagnosed as having Type 1 diabetes due to their age and low body weight, or occasionally as Type 2 diabetes, leading to potentially dangerous treatment approaches.
Dr. Michael Boyne, professor of endocrinology at The University of the West Indies in Kingston, Jamaica, notes that “People have been confusing it with type 1 or type 2 diabetes. We’ve never really had that diagnostic category in any sort of survey that says how common it is.”
When was it recognized?
The formal recognition came in April 2025 at the World Diabetes Congress, when the IDF proposed classifying malnutrition-related diabetes as “Type 5 diabetes.” This decision followed a consensus report published in The Lancet Global Health and a two-day meeting held at Christian Medical College in Vellore, India, in January 2025.
The IDF’s announcement marked the culmination of decades of advocacy by researchers who have long argued that this distinct metabolic condition required separate classification to ensure proper diagnosis and treatment.
While Type 5 diabetes is most prevalent in developing regions, research is being conducted globally:
- India: Christian Medical College in Vellore has been instrumental in studying the metabolic profiles of affected patients
- Jamaica: The University of the West Indies continues research where the condition was first identified
- United States: Albert Einstein College of Medicine in New York and Baylor College of Medicine are leading international collaborative efforts
- Uganda and other African nations: Field studies have documented the devastating impact of misdiagnosis
The IDF has established a Type 5 Diabetes Working Group with Dr. Hawkins as chair, tasked with developing formal diagnostic criteria, therapeutic guidelines, a global research registry, and healthcare professional training programs.
The formal recognition of Type 5 diabetes addresses a critical gap in global health equity. For decades, patients with this condition have received inappropriate treatments that could cause severe harm or even death.
The metabolic profile of Type 5 diabetes is distinct: patients experience moderate to severely elevated glucose concentrations, low C-peptide levels, ketosis resistance, and critically, a lack of insulin resistance combined with decreased insulin secretion (though not as severe as in Type 1 diabetes).
Dr. Hawkins’ research, published in Diabetes Care in 2022, established that people with Type 5 diabetes are insulin-deficient like those with Type 1 diabetes, but not to the same degree, and remain insulin-sensitive—unlike Type 2 diabetes patients who develop resistance.
This unique profile means that standard Type 2 diabetes treatments can be dangerous. Dr. Hawkins warns: “Please do not treat this like type 2 diabetes and put them on a GLP-1 that will make them lose weight. They already have a low BMI, they already have a low lean body mass; you would cause them a lot of harm by doing that.”
Diagnosis and treatment
Currently, there are no formal diagnostic guidelines for Type 5 diabetes, which is a primary focus of the IDF working group. Traditional diagnosis has relied on clinical features including: undernutrition during infancy and early childhood, low BMI (under 18.5 kg/m² for adults), absence of clinical signs of insulin resistance, low C-peptide levels and Ketosis resistance
Dr. Nihal Thomas of Christian Medical College suggests that imaging studies such as ultrasound or CT scans of the pancreas may help differentiate Type 5 diabetes from fibrocalculous pancreatic diabetes, another undernutrition-related condition.
Treatment approaches require careful consideration:
Insulin Therapy: Patients may need minimal amounts of supplementary insulin due to their insulin sensitivity. Dr. Hawkins observed in Uganda that “the amount of insulin that would be appropriate for type 1 diabetes was way too much for them,” causing fatal hypoglycemia in food-insecure settings.
Oral Medications:
- GLP-1 receptor agonists should be avoided due to their weight-loss effects
- Sulfonylureas have been used but require more research on long-term efficacy
- DPP-IV inhibitors show theoretical promise but cost remains a barrier in impoverished populations
Dr. Mandeep Bajaj of Baylor College of Medicine emphasizes that “providing these patients with low-cost, energy-dense foods that are high in protein and complex carbohydrates to improve the nutritional condition, is very important.”
Physical Activity: Programs to increase muscle mass may benefit patients, though implementation challenges exist in underresourced settings.
Global implications
The IDF is urging other health authorities, including the World Health Organization, to follow their lead in recognizing Type 5 diabetes. However, WHO has indicated that while the classification could be reintroduced with sufficient evidence, “the name will not necessarily be type 5 diabetes.” The American Diabetes Association currently does not recognize Type 5 diabetes but will host a joint symposium with the IDF in 2026.
As Dr. Peter Schwarz, president of the IDF, stated: “The recognition of type 5 diabetes marks a historic shift in how we approach diabetes globally. For too long, this condition has gone unrecognized, affecting millions of people and depriving them of access to adapted care. This is about equity, science and saving lives.”
For the estimated 25 million people potentially affected by Type 5 diabetes, this ecognition represents the first step toward appropriate care—and potentially survival.
Diabetes now affects 588.7 million adults globally, according to the International Diabetes Federation’s 2025 Atlas, a figure projected to surge 44.81% by 2050.
In a related development, an international research team has identified a previously unknown form of diabetes that strikes newborns, revealing critical insights into how genetic mutations can destroy insulin-producing cells within the first six months of life.
The discovery, published in The Journal of Clinical Investigation, pinpoints mutations in the TMEM167A gene as the culprit behind a rare syndrome affecting both metabolism and brain development.
While neonatal diabetes represents a tiny fraction of cases, affecting approximately 1 in 100,000 to 500,000 births, its genetic mechanisms illuminate pathways relevant to all forms of the disease.
