Dr. Jalal Taneera
College of Medicine, University of Sharjah
Coordinator of the Diabetes Research Group at the Sharjah Institute for Medical and Health Sciences

 

In a move considered a major turning point in the global understanding and care of diabetes, the International Diabetes Federation (IDF) has officially recognized a new type of the disease under the name “Type 5 Diabetes” after more than seven decades of being observed without a clear classification. The announcement came through an official vote during the Federation’s annual conference recently held in the Thai capital, Bangkok, with broad participation from international researchers and experts—marking a long-awaited acknowledgment of a health condition that has affected millions without proper diagnosis or care.

Alongside the recognition, an international task force was announced to establish diagnostic and treatment standards specific to Type 5 Diabetes. The task force is co-chaired by Dr. Meredith Hawkins, an endocrinologist and director of the Global Diabetes Institute at Albert Einstein College of Medicine in New York, and Dr. Nihal Thomas, Professor of Endocrinology at Christian Medical College in India. This group will be responsible for developing international diagnostic criteria, creating treatment guidelines tailored to the nature of the disease, establishing a global research registry, and designing training programs for healthcare workers.

Unlike Type 1 Diabetes, which is caused by an autoimmune disorder, and Type 2 Diabetes, which is associated with lifestyle and obesity, Type 5 is medically known as "Malnutrition-Related Diabetes." It is believed to result from impaired development and function of the pancreas due to severe nutritional deficiencies from childhood—or even before birth. According to medical reports, it is estimated that more than 25 million people worldwide have Type 5 Diabetes, the majority of whom are underweight adolescents and young adults in countries such as India, Ethiopia, Iran, Korea, and Sub-Saharan African nations.

Medical reports show that those with Type 5 Diabetes suffer from an extreme lack of subcutaneous fat, severe protein deficiency, and a shortage of essential nutrients. A key characteristic of this type is the severely impaired ability to secrete insulin. This feature was not previously understood and has led to a fundamental shift in how the disease is diagnosed and understood. For many years, numerous patients were misdiagnosed as having Type 1 Diabetes due to their thin body type and young age, resulting in them being given insulin doses far beyond what they needed, which worsened their health condition.

Historically, this type was first identified in 1955 in Jamaica, and subsequent cases were observed in various developing countries. In 1985, the World Health Organization was compelled to recognize this new form of diabetes under the name “Malnutrition-Related Diabetes,” but later removed the classification in 1999 due to a lack of scientific evidence and confusion with Type 1 and other secondary forms of diabetes. The credit for the current recognition goes to Dr. Hawkins and her colleagues, who led international efforts to uncover the metabolic mechanisms behind malnutrition-related diabetes. These efforts culminated in a 2022 study in which she demonstrated that this type of diabetes fundamentally differs from Type 1 and Type 2.

According to experts, there are still no clear international protocols for diagnosis or treatment. However, initial diagnosis is based on factors such as severe thinness, absence of autoimmune antibodies, low insulin production, chronic and severe nutritional deficiency, absence of insulin resistance, and the patient's age. In terms of treatment, insulin should be used with extreme caution, focusing on a protein-rich, low-carbohydrate diet, replenishment of micronutrient deficiencies such as iron, zinc, and vitamins, and the use of oral medications to stimulate insulin production.

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