New Form of Diabetes Recognized by IDF
This year, the International Diabetes Federation (IDF) has officially acknowledged a fifth form of diabetes, a development that has stirred discussions over the years. They are now encouraging other health organizations, including the World Health Organization (WHO), to do the same.
Type 5 diabetes is seldom talked about or studied, yet it is believed to impact roughly 25 million individuals globally, with a significant concentration in low- and middle-income countries where healthcare access is scarce.
The condition was first identified in Jamaica back in 1955, but it faded from discussions for quite some time. Although the WHO recognized it in the 1980s, the acknowledgment faced criticism.
For nearly seventy years, scientists have debated the very existence of type 5 diabetes. In 1999, the WHO reversed its classification due to insufficient evidence. Currently, there’s no consensus on diagnosis or treatment methods.
Compared to type 1, type 2, type 3c, and gestational diabetes, type 5 diabetes is not associated with obesity, lifestyle choices, pregnancy, or immune responses. Instead, it appears to arise mainly from malnutrition.
Formerly referred to as malnutrition-related diabetes mellitus (MRDM), this type often gets misidentified as other diabetes variations.
Interestingly, since insulin resistance doesn’t seem to be the central issue for type 5 diabetes, conventional treatments may not be effective. In some cases, they could even cause harm.
“Understanding the specific types of diabetes someone has is crucial for providing the correct treatment,” noted Craig Beall, a diabetes researcher at the University of Exeter, earlier this year.
Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine’s Global Diabetes Institute, has long advocated for the formal recognition of type 5 diabetes. This form largely affects people in Asia and Africa facing serious food shortages.
“Malnutrition-related diabetes is more prevalent than tuberculosis, almost as widespread as HIV/AIDS, yet the absence of an official designation has complicated the diagnosis and treatment of patients,” Hawkins mentioned earlier in the year.
“I’m optimistic that this formal acknowledgment as type 5 diabetes will lead to advancements against this often-overlooked disease that significantly impacts lives and can be deadly.”
In recent years, various studies have highlighted how chronic nutritional deficiencies can disrupt pancreatic function, affecting insulin secretion and blood sugar regulation.
Hawkins’ research, published in 2022, was the first to identify a distinct metabolic profile for malnutrition-related diabetes.
She and her team conducted a small trial in southern India, showing that individuals with MRDM are insulin-deficient like those with type 1 diabetes, but to a lesser extent, while remaining insulin-sensitive unlike those with type 2 diabetes who typically develop resistance.
“Type 5 diabetes is characterized by unique development mechanisms believed to be linked to prolonged nutritional deficits,” explained Rahul Garg, a physician in India, in a recent review.
Some experts argue that this move has been overdue, while others claim it’s unwarranted due to diagnostic inconsistencies arising from the diverse cases linked to malnutrition.
Interestingly, there’s a split in opinions about the prevalence of type 5 diabetes; some believe it’s increasing, while others feel its occurrence is decreasing. Much of this discussion hinges on accurate diagnosis and recognition.
Without a formal title and acknowledgment, securing research funding remains difficult, which complicates understanding the condition and determining how many individuals it affects.
This year, the IDF established a working group for type 5 diabetes, led by Hawkins, to develop diagnostic criteria and treatment guidelines, as well as create a global research registry and training for healthcare providers.
Given its unique metabolic profile, doctors treating type 5 diabetes may need to be particularly careful when managing insulin levels. Some patients might only need small amounts of supplementary insulin or alternative methods to boost insulin production, to avoid drastic fluctuations in blood sugar.
Hawkins and her colleagues emphasized that “inappropriate insulin treatment can lead to hypoglycemia, a serious risk in areas with food scarcity where glucose monitoring may not be easily accessible.”
The issue isn’t restricted solely to Asia and Africa; undernourishment is increasingly becoming a challenge in parts of Latin America and the Caribbean as well, compounded by a complicated mix of environmental, political, and economic issues that intensify health disparities and extreme poverty.
“There isn’t a quick solution, so we anticipate the battle against this disease to necessitate considerable further research and advocacy,” Hawkins stated earlier this year. “Having witnessed young patients suffering due to inadequate treatment for this neglected diabetes type, there’s no way to look back.”
