A Distinct New Type of Diabetes Has Just Been Officially Recognized

Last updated on 26 AUG 2025

For decades, diabetes has been described as a battle fought on two main fronts one where the body’s own defenses destroy its ability to make insulin, and another where excess weight blunts the hormone’s effect. But far from the headlines about sugar-laden diets and sedentary lifestyles, a quieter, deadlier form has been taking root in places where food is scarce.

This newly named condition, type 5 diabetes, doesn’t fit the familiar narrative. It affects millions of lean teenagers and young adults, most in parts of Asia and Africa, whose pancreases never fully developed because of hunger early in life. The consequences are serious blood sugar levels that soar despite little or no fat, and treatments that can harm rather than heal when the condition is mistaken for more familiar types.

With its formal recognition by the International Diabetes Federation in 2025, type 5 is finally stepping out from the shadows of misdiagnosis. Its emergence challenges long-held assumptions about who gets diabetes, why, and how to treat it and it carries lessons for healthcare not just in low-income countries, but everywhere.

The Expanding Definition of Diabetes

Diabetes is often spoken of as though it comes in neat categories type 1, type 2, and, occasionally, gestational. But the truth is far more complex. Scientists now recognize that the term covers a spectrum of disorders that all result in high blood sugar but have very different origins, risk factors, and treatment needs. Some are genetic, others immune-driven, some linked to obesity, and others to damage from surgery or disease.

Type 1 diabetes is an autoimmune condition in which the body’s own immune system destroys the insulin-producing beta cells in the pancreas. It can strike at any age, and without insulin therapy, survival is not possible. Type 2 diabetes, by contrast, is the most common form and typically develops when the body becomes resistant to insulin or cannot produce enough of it often, but not always, associated with excess weight. Gestational diabetes arises during pregnancy, when hormonal changes impair insulin’s effectiveness, posing risks to both mother and baby.

Beyond these familiar categories lies a web of rarer forms: MODY (maturity-onset diabetes of the young), caused by single-gene mutations; neonatal diabetes, appearing in the first months of life; type 3c, developing after pancreatic injury or surgery; and diabetes linked to conditions like cystic fibrosis or prolonged steroid use. Each of these requires its own approach to diagnosis and care.

Now, with the official recognition of type 5 diabetes, the map of diabetes has expanded once again. This addition is more than a new label; it’s a reminder that diabetes is not a one-size-fits-all disease. It’s a family of conditions, and understanding the nuances between them can mean the difference between effective treatment and dangerous mistakes.

What Exactly Is Type 5 Diabetes?

Type 5 diabetes, officially recognized by the International Diabetes Federation in April 2025, is also known as malnutrition-related diabetes mellitus (MRDM). Unlike the more familiar types, it develops not from autoimmune attack or lifestyle-related insulin resistance, but from undernutrition early in life often during fetal development or childhood prevents the pancreas from fully maturing. The result is a smaller pancreas with fewer insulin-producing cells, leaving the body unable to keep blood sugar in check.

Those affected are typically lean adolescents or young adults, often with a body mass index (BMI) under 19 kg/m². Most cases are found in low-income countries, especially across Asia and Africa, where chronic food scarcity remains a reality. Experts estimate 20–25 million people worldwide live with the condition. However, some cases may also occur in high-income countries among people who have experienced prolonged malnutrition, such as children in foster care, migrants who faced food insecurity, or individuals with severe weight loss from illness, eating disorders, or medical treatments like bariatric surgery.

What makes type 5 particularly challenging is its frequent misclassification. Without the hallmark obesity of type 2 or the autoimmune markers of type 1, many patients are mistakenly diagnosed with one of these other forms. In practice, that misstep can be dangerous: type 5 patients may only need small amounts of insulin or even respond well to oral medications but standard type 1 insulin doses can drive their blood sugar dangerously low.

By giving type 5 its own place in the diabetes spectrum, clinicians now have a clearer signal to look for the pattern: low BMI, absence of autoantibodies, and a history of early-life hunger. This recognition also opens the door for research, better-targeted care, and policies that address not just the disease, but the poverty and malnutrition at its root.

The Science Behind Type 5: When Hunger Shapes the Pancreas

The story of type 5 diabetes begins long before a blood sugar test ever comes back abnormal in the womb, at the dinner table, or in the fields where food is scarce. Decades of research have shown that prolonged undernutrition in early life can permanently alter the body’s metabolic machinery, with one organ in particular bearing the brunt: the pancreas.

Animal studies have been especially revealing. In experiments, rodents fed a low-protein diet during pregnancy or adolescence developed smaller pancreases with fewer beta cells the insulin-producing “factories” of the body. Human studies mirror these findings: populations with low birth weights and a history of recurrent childhood malnutrition are more likely to have reduced pancreatic volume and impaired insulin production as adults.

Type 5 diabetes falls under the category of severe insulin-deficient diabetes. Unlike type 2 diabetes, where the body resists insulin, people with type 5 remain sensitive to the hormone but simply don’t make enough of it. This distinction is critical, because it means the root problem is not insulin resistance but a limited supply from an underdeveloped pancreas.

Advanced studies, such as euglycemic clamp tests published in 2022, confirmed the pattern: type 5 patients secrete dramatically less insulin than healthy peers but display normal or even heightened insulin sensitivity. They typically have little visceral fat and only modest amounts of liver fat, a stark contrast to the metabolic profile of obesity-driven diabetes. Moreover, antibody tests that would point to type 1 diabetes come back negative, ruling out autoimmune destruction as the cause.

This unique “metabolic fingerprint” explains why type 5 doesn’t respond well to the same treatment playbook used for other forms of diabetes. Overdosing with insulin in these patients can lead to severe hypoglycemia, while therapies that stimulate the remaining beta cells or improve overall nutrition may offer safer, more effective control.

The Global and Local Impact

Type 5 diabetes is not a rare anomaly it’s a public health issue on the scale of major infectious diseases in some parts of the world. Experts estimate that 20–25 million people are living with the condition, most in low-income regions of Asia and Africa where food insecurity is widespread. In these areas, its prevalence among lean adolescents and young adults is comparable to that of HIV, yet it has long been overlooked in public health campaigns dominated by type 2 diabetes messaging.

The stakes are high. Misclassification as type 1 diabetes often leads to inappropriate high-dose insulin treatment, which can trigger life-threatening hypoglycemia in patients whose insulin needs are minimal. Beyond the personal harm, this misdiagnosis wastes scarce medical resources diverting insulin supplies from patients who truly need them and inflating healthcare costs in settings where every dollar counts. Public health economists have projected that simply shifting half of misdiagnosed type 5 patients from insulin to oral drugs could save tens of millions of dollars annually in low-income countries, money that could be reinvested in maternal and child nutrition programs.

While type 5 is most visible in regions facing chronic undernutrition, it’s not confined to them. Clinicians in high-income countries are beginning to recognize similar metabolic patterns in individuals with a history of severe weight loss, whether from prolonged illness, eating disorders, bariatric surgery, or extreme dieting. Although these cases don’t always meet the classic definition of type 5, they highlight an important truth: malnutrition and metabolic vulnerability can exist anywhere.

Recognizing type 5 diabetes as a distinct condition changes the conversation. It broadens the understanding of who is at risk, underscores the role of poverty and early-life nutrition in shaping lifelong health, and ensures that prevention, screening, and treatment strategies are built on accurate science rather than outdated assumptions. For governments and healthcare systems, it’s not just a medical classification it’s a call to recalibrate policies to include the silent, lean, and often young patients who have been left out of the diabetes narrative.

Recognizing and Diagnosing Type 5

Identifying type 5 diabetes requires looking beyond the usual patterns most clinicians are trained to expect. Unlike type 2 diabetes, patients are not overweight, and unlike type 1, they rarely present with autoimmune markers or diabetic ketoacidosis at diagnosis. Instead, they often arrive with high blood sugar levels in a body that is strikingly lean, sometimes with a body mass index (BMI) under 18.5 kg/m².

Symptoms can mimic those of other forms of diabetes increased thirst, frequent urination, blurred vision, fatigue but may overlap with signs of chronic undernutrition: stunted growth, muscle wasting, skin and hair changes, and in some cases, an enlarged parotid gland. These shared features make it easy to confuse type 5 with poorly controlled type 1, particularly in low-resource settings where advanced testing is unavailable.

In places where diagnostic tools are limited, a simple but telling combination can raise suspicion: a young patient with underweight, a history of early-life malnutrition, elevated blood sugar, and no detectable autoantibodies. Another important clue is the absence of ketones in the urine a finding common in type 1 at onset but not in type 5.

Where resources allow, more advanced diagnostics such as C-peptide testing can measure how much insulin the pancreas is still producing. Imaging studies to assess pancreatic size may also help, as type 5 is associated with a smaller pancreas. Unfortunately, such tools remain out of reach for many of the communities most affected.

The consequences of a missed or mistaken diagnosis can be severe. Standard insulin regimens designed for type 1 can push type 5 patients into dangerous hypoglycemia, while oral medications that stimulate remaining beta cells may be safer and more effective. This makes accurate classification not just an academic exercise, but a life-saving step one that relies as much on clinical awareness as on laboratory results.

Treatment Strategies and New Research Directions

For decades, the lack of recognition for type 5 diabetes meant that treatment was borrowed from other forms of the disease often with harmful results. The official classification now opens the door for therapies tailored to its unique biology, as well as research that could prevent it altogether.

Currently, many patients are started on low-dose insulin therapy, which can help stabilize blood sugar without the dangerous drops that larger doses might trigger. Some respond well to oral medications such as sulfonylureas, which stimulate the remaining beta cells to release insulin. These drugs are cheaper, easier to store than insulin in hot climates, and may reduce the burden on healthcare systems in low-income regions.

Nutrition support is increasingly seen as part of the treatment plan, not just a preventive measure. In food-insecure settings, structured feeding programs can help improve metabolic stability and overall health, especially in younger patients. Long-term, these programs may also break the cycle of malnutrition that seeds the disease in the first place.

The International Diabetes Federation has launched a global working group to create diagnostic criteria, develop treatment algorithms, and establish an international patient registry by 2027. Multi-site trials are underway to compare the safety and effectiveness of different approaches, including low-dose insulin, oral therapies, and combined nutrition support. The results could reshape essential medicines lists and influence healthcare policy in dozens of countries.

Prevention, however, may be the most powerful intervention. Studies suggest that proper maternal and childhood nutrition especially adequate protein intake during pregnancy and early development could dramatically reduce the risk of type 5 diabetes in the next generation. Public health economists argue that investing in nutrition today could save millions in future diabetes care, while improving quality of life for entire communities.

An Opportunity for Prevention and Better Care

The formal recognition of type 5 diabetes is more than a new entry in the medical textbooks it’s an invitation to rethink what we know about this complex disease. It reminds us that diabetes is not solely the consequence of excess, but can also be born of scarcity. For millions, it is not fast food and sedentary living that tip the balance, but a childhood without enough food to properly nourish a developing body.

Addressing type 5 requires action on multiple fronts: accurate diagnosis, appropriate treatment, and a deep investment in maternal and child nutrition. These steps are not just clinical best practices; they are acts of equity, ensuring that people in low-income settings receive care that reflects their reality. They also carry benefits that ripple through generations: a well-fed child today may grow into an adult who never needs a glucose meter.

The challenge now is to turn recognition into results. That means equipping healthcare providers with the knowledge to spot type 5, funding research that refines treatment strategies, and embedding nutrition programs into public health systems. It also means broadening the conversation about diabetes to include the voices and stories of those living with this lesser-known form.

If we meet that challenge, type 5 diabetes need not remain a hidden crisis. It can become a case study in how science, policy, and compassion intersect and how, together, they can rewrite the future of global health.

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