New Form of Diabetes Recognized After Long Controversy
In 2025, the International Diabetes Federation (IDF) officially acknowledged a fifth type of diabetes, a move that’s been a long time coming amidst ongoing debate. They’re now encouraging other organizations, particularly the World Health Organization (WHO), to recognize it as well.
Type 5 diabetes, which hasn’t been extensively studied, is believed to affect around 25 million individuals globally, particularly in low- and middle-income countries with limited healthcare access.
Initially described in Jamaica back in 1955, this form of diabetes faded from discussion for many years. Even when the WHO noted it in the 1980s, it sparked controversy.
For nearly seventy years, researchers have been divided on the existence of type 5 diabetes. In 1999, the WHO even retracted its classification due to insufficient evidence. There has yet to be a consensus on how to properly diagnose or treat this condition.
To clarify the definitions, type 1 diabetes is an autoimmune disease that impairs the pancreas’s insulin production. Type 2 diabetes results from insulin resistance linked to lifestyle choices, while type 3c diabetes usually arises from pancreatic damage. Gestational diabetes comes from hormonal shifts during pregnancy.
In contrast, type 5 diabetes appears to be related to nutrient deficiencies, previously termed malnutrition-related diabetes mellitus (MRDM), and is often misidentified as other forms.
Since insulin resistance may not be the main factor in type 5 diabetes, existing treatments could potentially do more harm than good.
Craig Beall, a researcher from the University of Exeter, emphasized the importance of understanding the specific types of diabetes for effective treatment.
Meredith Hawkins, an endocrinologist, has been vocal about the need for global acknowledgment of type 5 diabetes, particularly affecting populations in Asia and Africa facing severe food scarcity.
In her words, malnutrition-related diabetes is more prevalent than tuberculosis and almost as much as HIV/AIDS, yet its lack of a recognized name has impeded proper diagnosis and treatment development.
“I’m hopeful that now, with formal recognition as type 5 diabetes, we can make real progress against this overlooked condition that causes significant suffering and can often be fatal,” she stated.
Studies in recent years have shown the lasting effects of chronic nutrient deficiencies on pancreatic health, affecting insulin secretion and blood sugar regulation.
Hawkins’ previous work laid the foundation for a unique metabolic profile related to malnutrition-related diabetes. Her small-scale study in India found that while MRDM patients exhibit insulin deficiency similar to type 1 diabetes, they are still somewhat insulin sensitive, unlike those with type 2 diabetes.
Researchers are increasingly recognizing that type 5 diabetes stands out with its unique underlying processes, potentially tied to insufficient nutrition affecting pancreatic development.
Right now, the IDF is putting forth significant efforts to officially recognize and categorize type 5 diabetes.
Some scientists feel this decision is well overdue, while others are skeptical, citing diagnostic uncertainties linked to varying diabetes cases related to malnutrition.
There’s ongoing debate about whether the rate of type 5 diabetes cases is rising or falling, which hinges on how well the condition is diagnosed and understood.
The absence of a formal name makes it tough to secure funding for research, which complicates forming standardized diagnoses or estimating prevalence.
In 2025, the IDF set up a working group for type 5 diabetes, led by Hawkins, to create diagnostic criteria, therapeutic guidelines, and global research initiatives.
The unique metabolic characteristics of type 5 diabetes mean that healthcare providers must be cautious in managing insulin treatments. Patients with this type may only require small amounts of supplementary insulin or may benefit from different approaches to promoting insulin secretion, to avoid dangerously low or high blood sugar levels.
This issue isn’t just an Asian or African problem. Undernutrition is rising in regions of Latin America and the Caribbean due to a complex web of environmental, political, and economic challenges, resulting in health inequities and heightened poverty.
As Hawkins pointed out, addressing this disease isn’t straightforward—in-depth research and sustained advocacy will be essential. Reflecting on her experiences, she remarked, “When you see young patients struggle or even die due to the mishandling of a neglected diabetes type, you can’t just walk away from that.”
