The International Diabetes Federation has quietly rewritten the textbooks this year. At its April 2025 congress in Bangkok, the IDF officially recognized “Type 5 diabetes” — also known as malnutrition-related diabetes mellitus (MRDM) — as a distinct form of the disease. For millions of people in low-income countries, this long-overdue classification could mean the difference between being misdiagnosed and finally getting the right care.
It’s a reminder that diabetes isn’t just type 1 or type 2. In fact, the story is far messier. Dozens of sub-types exist, shaped by genes, lifestyle, infections, even childhood nutrition. And now, with type 5 stepping into the spotlight, global health policy has to catch up.
Table of Contents
Type 1 Diabetes
Type 1 strikes when the immune system mistakenly destroys the pancreas’ insulin-producing beta cells. Doctors still don’t know the exact trigger, but it’s likely a mix of genetic predisposition and environmental sparks — sometimes viral infections. Unlike type 2, it’s not tied to weight or diet.
Treatment requires insulin for life, usually delivered through daily injections or pumps. Some people benefit from islet cell transplants or experimental stem-cell therapies that can reduce or even eliminate the need for insulin, though immune-suppressing drugs remain a barrier.
Type 2 Diabetes
This is the heavyweight: more than 90% of all diabetes cases globally. It’s linked to high BMI but also strikes people with normal weight, especially in South Asian, African, and Caribbean communities. Genetics play a major role.
Metformin remains the workhorse drug, enhancing insulin sensitivity and tamping down sugar production in the liver. Dozens of other medications exist, from GLP-1 receptor agonists to SGLT2 inhibitors. Meanwhile, lifestyle interventions can be powerful — one UK study showed a very low-calorie diet reversed diabetes in nearly half the participants after a year.
Gestational Diabetes
Pregnancy can unmask hidden metabolic issues. Around weeks 24–28, hormonal shifts sometimes make cells resistant to insulin. Risk factors include obesity, age, family history, and ethnicity.
Treatment starts with diet and exercise, sometimes adding tablets or insulin. For many women, the condition vanishes after childbirth — but the long-term risk of type 2 diabetes remains elevated.
Rare and Overlooked Forms
Diabetes isn’t a neat binary. A few lesser-known forms include:
- Neonatal diabetes: emerges in the first six months of life, often from a single gene mutation. Some patients can avoid insulin altogether with sulfonylurea tablets.
- MODY (Maturity Onset Diabetes of the Young): a collection of inherited sub-types, each tied to a different gene. They often masquerade as type 1 or type 2 but respond differently to treatment.
- Type 3c diabetes: caused by pancreatic damage — think surgery, cancer, or pancreatitis.
- Cystic fibrosis–related diabetes: nearly one-third of adults with cystic fibrosis develop it by age 40.
These forms highlight why precision diagnosis matters. A one-size-fits-all approach often fails.
Type 5 Diabetes: The New Kid on the Block
Here’s the breakthrough. Type 5 diabetes isn’t about overeating or immune dysfunction — it’s about undernutrition. Studies show that chronic protein-energy malnutrition in childhood can stunt pancreas development. A smaller pancreas means fewer insulin-producing cells, leaving people vulnerable later in life.
Unlike type 1, it’s not autoimmune. Unlike type 2, patients are usually underweight, sometimes with a BMI under 19. Symptoms echo other types — fatigue, weight loss, excessive thirst — but ketoacidosis (a dangerous complication common in type 1) is usually absent.
Roughly 20–25 million people worldwide may have type 5 diabetes, concentrated in South Asia and sub-Saharan Africa. For decades, patients were misclassified, leading to poor outcomes. Now, the IDF’s recognition, along with a new Type 5 Diabetes Working Group chaired by Dr. Meredith Hawkins (Einstein College of Medicine) and Dr. Nihal Thomas (CMC Vellore), aims to establish diagnostic criteria, registries, and treatment guidelines tailored for low-income regions.
| Feature | Type 1 | Type 2 | Type 5 (MRDM) |
|---|---|---|---|
| Cause | Autoimmune attack on beta cells | Insulin resistance + beta cell burnout | Malnutrition stunting pancreatic growth |
| Body type | Lean, any age | Often overweight/obese | Lean, undernourished |
| Insulin levels | Absent | Normal/high but ineffective | Severely reduced, non-autoimmune |
| Treatment | Lifelong insulin | Lifestyle + drugs (Metformin, GLP-1, etc.) | Nutritional rehabilitation + low-dose insulin |
Why This Matters
The IDF’s move isn’t just a label change. It’s a recognition of global inequality in healthcare. For too long, malnutrition-driven diabetes was invisible in Western-centric medicine. Now, governments, NGOs, and clinicians can target resources — from nutrition programs to specialized training — at communities most affected.
In practice, it means a young, underweight patient in rural India may no longer be misdiagnosed with type 1 and given dangerous high-dose insulin. Instead, treatment could blend nutrition support with carefully managed insulin, improving survival and quality of life.
Fact Check
Yes, type 5 diabetes is real and officially recognized. The International Diabetes Federation formally introduced it at the World Diabetes Congress in Bangkok, April 2025, following consensus meetings in India earlier that year. Multiple sources including IDF, Medscape, and Diabetes Voice confirm its legitimacy.
FAQs:
Is type 5 diabetes the same as type 3 or type 4 diabetes?
No. Type 5 refers specifically to malnutrition-related diabetes. Type 3 and type 4 are more research-driven classifications (Alzheimer’s-linked and age-related, respectively).
Can type 5 diabetes be cured with nutrition alone?
Nutrition helps, but most patients still need some form of insulin therapy, albeit at lower doses than type 1.
How common is type 5 diabetes in the US or Europe?
Extremely rare. It’s primarily seen in areas with chronic childhood malnutrition, such as parts of Africa and South Asia.
