Recognition of a New Type of Diabetes

In 2025, the International Diabetes Federation (IDF) formally acknowledged a fifth type of diabetes, ending years of debate surrounding the condition. This development has prompted the organization to encourage other health institutions, including the World Health Organization (WHO), to adopt the same recognition.

Type 5 diabetes remains a largely unexplored area in both conversation and research. It is estimated to affect as many as 25 million people globally, with a significant presence in lower-income countries where healthcare accessibility is limited.

First noted in Jamaica back in 1955, Type 5 diabetes was quickly forgotten. Even when the WHO acknowledged it in the 1980s, the classification sparked debate. For nearly 70 years, the existence of type 5 diabetes has been hotly contested, and in 1999, WHO renounced its classification due to insufficient evidence. The lack of consensus on diagnostic and treatment approaches has further complicated matters.

To clarify, Type 1 diabetes is an autoimmune issue that damages insulin production. Type 2 diabetes arises from insulin insensitivity often related to lifestyle choices. Type 3c diabetes typically results from pancreatic damage, while gestational diabetes occurs due to hormonal shifts during pregnancy.

Type 5 diabetes is understood to derive from nutrient deficiencies. Previously referred to as malnutrition-related diabetes mellitus, it is often misidentified as other types of diabetes.

Because insulin resistance doesn’t appear to be the primary issue here, existing treatments might not be effective—or even could be detrimental. This is concerning.

According to Craig Beall, a diabetes researcher at the University of Exeter, “Understanding the specific types of diabetes someone has is crucial to providing the right treatment,” a sentiment he shared in May 2025.

Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine, has long advocated for global acknowledgment of type 5 diabetes. The condition tends to affect individuals in Asia and Africa facing severe food shortages.

Hawkins noted, “Malnutrition-related diabetes is more prevalent than tuberculosis and nearly as common as HIV/AIDS, yet the absence of an official designation has stymied diagnoses and treatment development.” She expressed hope that this formal recognition could drive progress against what has been a long-ignored illness.

Recent studies involving both animals and humans have indicated that chronic nutrient deficiencies can severely impact pancreatic function, disrupting insulin secretion and blood sugar regulation.

The groundbreaking research by Hawkins published in 2022 identified a unique metabolic profile for malnutrition-related diabetes. A small trial conducted in south India demonstrated that individuals with MRDM are insulin-deficient like those with type 1 diabetes but remain insulin-sensitive, contrasting with those suffering from type 2 diabetes who become resistant.

As explained by Rahul Garg, a physician in India, “Type 5 diabetes is characterized by compromised pancreatic development due to prolonged nutritional insufficiency.” Given these insights, the IDF is taking measures to officially recognize type 5 diabetes.

There’s been a mix of reactions among researchers regarding this decision; some describe it as “long overdue,” while others caution against it, citing “diagnostic uncertainty” connected to various diabetes cases tied to malnutrition. The conflicting opinions on whether the prevalence of type 5 diabetes is on the rise or decline only add to the complexity surrounding its recognition.

Lacking a formal name complicates efforts to secure research funding, making it challenging to establish a standard diagnosis or determine the number of individuals affected.

To address these issues, the IDF set up a working group for type 5 diabetes in 2025, under Hawkins’ leadership. The group’s objectives include creating formal diagnostic criteria, establishing a global research registry, and providing training for healthcare professionals.

Given the distinct metabolic profile of type 5 diabetes, healthcare providers must be cautious when managing insulin levels for patients. Some individuals may need only minimal insulin, while others may require alternative methods for insulin secretion to prevent dangerous fluctuations in blood sugar.

The implications of improper insulin treatment extend beyond just one region. Undernourishment is becoming a pressing issue in parts of Latin America and the Caribbean, driven by a mix of environmental, political, and economic challenges that exacerbate health inequities.

As Hawkins put it, “We anticipate that tackling this disease will necessitate significant ongoing research and advocacy.” She also emphasized that witnessing young patients suffer from the consequences of mismanaged treatment is a powerful motivator for change.