A new form of diabetes, provisionally named type 5 diabetes, has recently received formal recognition by the International Diabetes Federation (IDF) in April 2025. This significant development comes after decades of the condition being largely overlooked and misclassified, despite its substantial global impact. Scientists estimate that type 5 diabetes currently affects between 20 to 25 million people worldwide, predominantly in regions across Asia and Africa.
Historically, medical textbooks have described three primary types of diabetes: type 1, an autoimmune condition where the body attacks insulin-producing cells; type 2, the most common form linked to insulin resistance; and gestational diabetes, occurring temporarily during pregnancy. While rarer forms resulting from specific genetic mutations or diseases were also acknowledged, type 5 diabetes presents a distinct pathophysiology that demanded its own classification.
The formal classification of type 5 diabetes during an international meeting of experts signifies a crucial step forward in global health. This recognition is not merely a change in nomenclature; it promises to guide clinicians towards more appropriate treatment options, enable researchers to better track its prevalence, and identify factors affecting patient outcomes. It also highlights the urgent need for dedicated research and funding to address this long-standing health challenge.
1. Introduction to Type 5 Diabetes: Definition and Significance of its Recognition
Type 5 diabetes is a newly designated form of the disease, officially recognised by the International Diabetes Federation (IDF) following a vote held on 8 April at the IDF’s World Diabetes Congress in Bangkok, Thailand. This landmark decision marks the formal acknowledgement of a condition that is metabolically distinct from type 1 and type 2 diabetes, presenting unique challenges for diagnosis and treatment.
The condition is primarily characterised by insufficient insulin secretion, leading to elevated blood glucose levels. Dr. Rachel Reinert, an endocrinologist and assistant professor at the University of Michigan, stated that “type 5 diabetes is not associated with autoimmunity (as in type 1 diabetes) nor insulin resistance (as is common in type 2 diabetes).” It also lacks the features seen in more rare type 3 and type 4 diabetes.
This form of diabetes is fundamentally linked to malnutrition-related low insulin production, predominantly affecting lean and undernourished teenagers and young adults in low and middle-income households. Its formal recognition is vital for global health, as it allows for specific diagnostic criteria and targeted treatment approaches to be developed, ultimately improving patient outcomes for millions affected.
2. Historical Roots: Early Observations and the ‘Jamaica-type’
The existence of this distinct form of diabetes was first observed more than 70 years ago, though its official designation is recent. In the early 1950s, a British physician named Philip Hugh-Jones encountered a group of 13 patients at his diabetes clinic near Kingston, Jamaica, whose symptoms did not align with the known characteristics of either type 1 or type 2 diabetes.
Hugh-Jones recognised the uniqueness of their condition and labelled it “type J,” signifying its discovery in Jamaica. These patients were typically young, thin, and often poor and malnourished, presenting with very low body mass indexes (BMIs). Crucially, their diabetes did not necessitate insulin for survival, yet it was clearly not type 2, which is often associated with obesity and insulin resistance.
Despite Hugh-Jones’s astute observations and the publication of his findings in The Lancet, the label “type J” was subsequently forgotten, and the condition remained largely overlooked for decades. Reports of similar patients, however, continued to emerge from various low- and middle-income countries across regions such as Indonesia, India, Brazil, and Sub-Saharan Africa, indicating a widespread but unrecognised health issue.
3. The WHO’s Journey: Classification, Declassification, and Renewed Interest
The journey of malnutrition-related diabetes through international classification bodies has been complex and marked by both recognition and retraction. In 1985, the World Health Organization (WHO) formally classified this condition as “malnutrition-related diabetes mellitus,” later refining the term to “malnutrition-modulated diabetes.” This initial classification provided a degree of global acknowledgment for the unique presentation observed in developing countries.
However, this official recognition was short-lived. In 1999, during a subsequent WHO meeting convened to discuss diabetes classifications, concerns were raised regarding the sufficiency of scientific evidence directly linking malnutrition to the causation of diabetes. The immense challenges of conducting rigorous scientific research in the resource-limited settings where these patients were most prevalent contributed to this lack of definitive proof.
Consequently, the WHO decided to remove this form of diabetes from its official classification. This declassification led to the condition receding from mainstream medical literature and being quickly forgotten, despite its ongoing presence and impact in affected communities. Renewed scientific interest in the 21st century, spurred by dedicated research initiatives, eventually reignited the debate and paved the way for its recent re-designation as type 5 diabetes.
4. Dr. Meredith Hawkins’ Pivotal Role and Early Research
Dr. Meredith Hawkins, a professor of medicine at Albert Einstein College of Medicine, played a crucial role in bringing malnutrition-related diabetes back into the global spotlight. Her awareness of this neglected condition began in 2005 while teaching at a global health meeting, where doctors from approximately 40 low-income countries described patients presenting with “an unusual form of diabetes” that did not fit traditional categories.
Dr. Hawkins recalled that these patients were young and thin, characteristics that often suggested type 1 diabetes, which is typically treated with insulin. However, she observed that “insulin did not help and sometimes led to dangerously low blood sugar.” What she witnessed in Uganda, where local physicians administered insulin doses appropriate for type 1 diabetes without proper care and monitoring for patients with insufficient food access, was profoundly impactful. She noted that “every one of those young people ultimately died within a few months from low blood sugar.” This tragic reality fuelled her determination to seek answers.
In 2010, Dr. Hawkins established the Global Diabetes Institute at Albert Einstein College of Medicine with the explicit purpose of studying malnutrition-related diabetes. Her long-standing collaboration with Dr. Nihal Thomas, a distinguished professor at Christian Medical College (CMC) Vellore in India, proved instrumental. Their dedicated research efforts culminated in a seminal study, published in *Diabetes Care* in 2022, which definitively demonstrated that this condition is metabolically distinct from both type 1 and type 2 diabetes. This evidence was critical in securing the International Diabetes Federation’s recent formal designation of type 5 diabetes.
5. Pathophysiology: The Core Defect of Insufficient Insulin Secretion
At the heart of type 5 diabetes lies a profound physiological issue: insufficient insulin secretion. Dr. Rachel Reinert highlighted that the condition is “characterized by insufficient insulin secretion leading to elevated blood glucose levels.” This contrasts sharply with type 2 diabetes, where insulin resistance is a primary feature, and type 1, which involves autoimmune destruction of insulin-producing cells.
Individuals diagnosed with type 5 diabetes typically present with low body weight and a documented history of undernutrition that commenced early in life. Medical experts posit that chronic undernutrition sustained during childhood can inflict permanent damage upon the pancreas, consequently weakening its crucial insulin-producing cells. This early-life nutritional deficit compromises the organ’s ability to generate adequate insulin for the body’s needs.
Further research, encompassing both animal and human studies, supports the theory that malnutrition adversely affects pancreatic development. Dr. Hawkins’s team discovered that people with this form of diabetes exhibit a “profound defect in their ability to secrete insulin.” This key finding overturned previous assumptions that malnutrition-associated diabetes was predominantly linked to insulin resistance. Insulin-secreting beta cells, which are vital for glucose regulation, develop during intrauterine life and the first two years after birth, a period critically dependent on optimal nutrition, particularly proteins and micronutrients. It is believed that patients with type 5 diabetes were likely low birth weight and malnourished in utero, resulting in a reduced number of beta cells from early life. The challenge is compounded by adult malnutrition, which further impairs the function of the remaining beta cells, contributing to the severity of the condition.
6. Distinguishing Type 5: How It Differs from Type 1 and Type 2
The formal recognition of type 5 diabetes is crucial due to its distinct metabolic profile, which sets it apart from the more commonly known type 1 and type 2 forms. This differentiation is vital for correct diagnosis and effective treatment, as misdiagnosis can lead to life-threatening complications. Understanding these differences clarifies why a new classification was essential.
Unlike type 1 diabetes, which is an autoimmune condition where the body’s immune system mistakenly attacks and destroys its own insulin-producing cells in the pancreas, type 5 diabetes is explicitly “not associated with autoimmunity.” This fundamental difference means that the underlying cause is not an immune system malfunction but rather a consequence of pancreatic damage stemming from chronic undernutrition. Patients with type 5 diabetes do not exhibit the autoimmune markers seen in type 1 cases, as confirmed by studies like the YODA study, which found that two-thirds of participants lacked these markers.
Similarly, type 5 diabetes diverges significantly from type 2 diabetes. Type 2 diabetes is primarily characterised by insulin resistance, where the body’s cells do not respond effectively to insulin, often coupled with insufficient insulin production. It is frequently associated with obesity and lifestyle factors. In contrast, type 5 diabetes is “not associated with insulin resistance” and typically affects individuals who are lean and undernourished, often with a body mass index below 19 kg/m². Furthermore, while type 5 patients have high blood glucose levels and may require insulin, they generally “don’t develop ketonuria or ketosis” despite these elevated levels, a critical distinction from the ketoacidosis risk in type 1 diabetes. This clear metabolic separation underscores the necessity of its distinct classification.
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7. Global Prevalence and Demographic Impact of Type 5 Diabetes
While Section 1 touched upon the initial estimates, a deeper examination reveals the significant global footprint of type 5 diabetes. Epidemiological data indicates that between 20 to 25 million individuals worldwide are currently affected by this condition, making its formal recognition a matter of urgent public health concern. The highest prevalence rates are consistently observed in regions where chronic childhood malnutrition remains a pervasive issue, underscoring the condition’s deep roots in socio-economic factors.
Detailed analysis shows a concentrated burden in specific geographic areas. Approximately 65% of all reported cases of type 5 diabetes are found across South and Southeast Asia, signifying these regions as epicenters of the disease. A further 30% of cases are distributed throughout various parts of Africa, where similar challenges of food insecurity and undernutrition persist. The remaining 5% of affected individuals are spread across segments of Central America, South America, and the Middle East, illustrating that while geographically widespread, the impact is disproportionately felt in low and middle-income countries (LMICs).
Understanding the demographic profile of affected individuals is also critical. Research suggests that the average age of onset for type 5 diabetes typically falls between 15 and 30 years. This demographic characteristic means the condition often impacts individuals during their most productive years, potentially leading to significant long-term societal and economic consequences for affected communities and nations. The early-life onset and its specific geographical concentration highlight the necessity for targeted public health interventions.
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8. The Peril of Misdiagnosis: Why Correct Classification Matters
One of the most critical challenges surrounding type 5 diabetes has been the widespread issue of misdiagnosis, a problem with potentially fatal consequences. Prior to its formal recognition, many patients presenting with symptoms of type 5 diabetes were inaccurately classified as having either type 1 or type 2 diabetes. This mischaracterization often stemmed from superficial similarities in high blood glucose levels, without accounting for the distinct underlying pathophysiology of type 5.
The danger of this misdiagnosis is particularly acute when patients are mistakenly labeled with type 1 diabetes. Dr. Meredith Hawkins highlighted this perilous situation, noting that administering insulin doses appropriate for type 1 diabetes to type 5 patients, especially in resource-limited settings where food access is scarce and monitoring is inadequate, can lead to dangerously low blood sugar. She recounted tragic instances in Uganda where young people receiving such inappropriate treatment “ultimately died within a few months from low blood sugar.” This underscores the vital importance of accurate diagnosis to prevent iatrogenic harm.
Statistical data further illustrates the scale of this problem: nearly 40% of patients diagnosed with type 5 diabetes were initially misidentified as having either type 1 or type 2 diabetes. This high rate of incorrect classification has historically led to suboptimal treatment approaches and, consequently, poorer patient outcomes. As Dr. Rachel Reinert emphasized, “It is important for all patients with diabetes to know which specific type of diabetes they have, so they can get the right treatment,” reinforcing the foundational principle that accurate nomenclature guides effective care.
9. Evolving Treatment Strategies and Challenges for Type 5 Diabetes
The formal recognition of type 5 diabetes represents a pivotal step towards developing targeted treatment protocols, a domain where significant challenges currently exist. Prior to its classification, the lack of a standardized understanding meant there was no established treatment regimen. Dr. Hawkins noted the grim reality that patients often did not survive more than a year after diagnosis, highlighting the urgency of finding effective interventions.
Initial recommendations for managing type 5 diabetes focus on fundamental nutritional interventions. Dr. Hawkins suggests diets higher in protein and lower in carbohydrates, coupled with meticulous attention to correcting micronutrient deficiencies. This dietary approach aims to support the function of the remaining insulin-producing beta cells and address the chronic undernutrition that is central to the condition’s etiology. However, implementing such dietary changes can be challenging in the low-income settings where type 5 diabetes is most prevalent, often requiring agricultural and public health actions to shift food availability and preferences.
Discussions at the recent IDF meeting brought forth additional insights into potential therapeutic approaches. A distinguished physician from Uganda shared experience in treating these patients with “very small amounts of insulin,” suggesting that a carefully titrated insulin regimen, possibly combined with oral agents, might be effective. However, these strategies still require rigorous scientific validation. Dr. Hawkins stated that “this now needs to be carefully studied with the global support and official mandate from the IDF,” indicating that formal research and clinical trials are essential to establish evidence-based guidelines for treatment.
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10. The International Diabetes Federation’s Working Group: A Coordinated Global Response
In a significant move to address the complexities of type 5 diabetes, the International Diabetes Federation (IDF) officially established the Type 5 Diabetes Working Group (T5DWG) in conjunction with the reclassification announcement. This multidisciplinary international coalition brings together endocrinologists, nutritionists, public health specialists, and patient advocates from around the world, creating a unified front to tackle the disease. The formation of this group underscores the global commitment to moving beyond mere recognition toward tangible action and improved patient care.
The T5DWG has outlined a clear and ambitious strategic plan for the period of 2025-2030, comprising four key priorities designed to address the unique challenges of type 5 diabetes comprehensively. Firstly, the group is tasked with developing standardized diagnostic criteria and screening tools. These tools are specifically tailored for resource-limited settings, acknowledging the practical constraints faced in the regions most affected by the condition, and aim to minimize misdiagnosis.
Secondly, the working group is focused on creating evidence-based treatment guidelines. These guidelines will be meticulously crafted to account for the unique metabolic profile of type 5 diabetes, ensuring that therapeutic interventions are appropriate and effective, moving away from potentially harmful generalized approaches. Thirdly, the T5DWG plans to establish a global registry, a crucial initiative to track the prevalence of the disease, monitor treatment outcomes, and identify common complications across diverse populations. Finally, the group will advocate for policy changes, striving to ensure appropriate care, facilitate medication access, and implement preventive interventions at a governmental and international level, aiming to integrate type 5 diabetes into broader public health agendas.
11. Prevention Strategies: Addressing the Root Causes of Type 5 Diabetes
Addressing the prevention of type 5 diabetes necessitates a deep understanding of its root causes, particularly the profound link to malnutrition during early life. The prevailing scientific theory, supported by both animal and human studies, suggests that chronic undernutrition, especially during intrauterine life and the first two years after birth, can inflict permanent damage on the pancreas. This damage results in a reduced number of insulin-producing beta cells, compromising the body’s ability to generate sufficient insulin later in life.
This critical insight points directly to improved nutrition as the cornerstone of prevention. Experts believe that type 5 diabetes could be significantly mitigated, if not entirely prevented, by ensuring better nutrition for women of childbearing age and their young children. Optimal intake of proteins and micronutrients during these crucial developmental windows is essential for the healthy formation and function of pancreatic beta cells. Such interventions, however, require systemic changes in food security and public health infrastructure within affected communities.
The ongoing global challenge of undernourishment, with an estimated billion people currently affected, means that malnutrition and, consequently, type 5 diabetes are not issues that will dissipate without concerted effort. As Dr. Hawkins candidly stated, “we expect increasing food insecurity globally. So malnutrition and type 5 diabetes are not going away soon.” This grim forecast underscores the urgent need for long-term agricultural and public health strategies focused on nutritional support in vulnerable populations, moving beyond reactive treatment to proactive prevention.
12. The Broader Diabetes Landscape and Future Implications of Type 5 Recognition
The formal recognition of type 5 diabetes extends far beyond a mere change in nomenclature; it represents a profound shift in the broader understanding and management of diabetes globally. This designation not only provides a distinct identity for a condition that has long been neglected but also promises to catalyze significant advancements in research, funding, and clinical practice, particularly in low and middle-income countries.
Crucially, the new classification is expected to guide clinicians towards more appropriate treatment options, a vital step given the dangers of misdiagnosis. It will also empower researchers to more accurately track its prevalence, study its specific etiology and mechanisms, and identify the myriad factors affecting patient outcomes. As Chittaranjan Yajnik, co-author of an international consensus statement on type 5 diabetes, articulated, “Name is important to attract attention from stakeholders and funding opportunities. Otherwise it will get buried in the background noise of common varieties of diabetes.” This recognition is poised to unlock much-needed resources for dedicated research.
Moreover, the proper diagnosis and appropriate management of type 5 diabetes hold significant economic benefits. Economic analyses suggest that these actions could reduce healthcare costs by approximately 35% per patient compared to treating individuals under incorrect diabetes classifications. This financial incentive, combined with the moral imperative to provide correct care for millions, positions type 5 recognition as a crucial step towards better global understanding and care, especially in regions that have historically borne the disproportionate burden of this devastating, yet overlooked, illness.
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The evolving landscape of medical science continues to refine our understanding of complex diseases. The journey of type 5 diabetes from an overlooked “Jamaica-type” to a formally classified condition underscores the importance of persistent research and global collaboration. This milestone not only offers hope for millions affected but also serves as a powerful reminder that every distinct manifestation of disease warrants its own identity and dedicated path to treatment and prevention.
