What Is Type 5 Diabetes? What You Need to Know About This New Designation

The world of diabetes research has taken a major step forward with the official recognition of type 5 diabetes, a form of diabetes linked to malnutrition. First acknowledged by the International Diabetes Federation (IDF) in 2025, type 5 diabetes is not just a new name; it’s a call to action.

This condition has long gone underdiagnosed and misclassified, particularly in low- and middle-income countries. Now, with growing awareness and research, it’s essential to understand what type 5 diabetes is, how it differs from other types, what symptoms to look out for, and how it can be prevented and treated, especially through natural methods.

What is type 5 diabetes?

Type 5 diabetes, also known as malnutrition-related diabetes or malnutrition-related diabetes mellitus (MRDM), is a form of diabetes caused by early-life undernutrition, particularly protein-energy malnutrition, that impairs the development and function of the pancreas. It most commonly affects individuals who were undernourished during childhood and adolescence, particularly in parts of Africa, Asia and Latin America.

Unlike other forms of diabetes, type 5 is neither fully autoimmune (like type 1) nor purely lifestyle-related (like type 2).

According to the IDF, it’s believed this form of diabetes affects 20 million to 25 million people around the globe, particularly in African and Asian regions, and the “concept of type 5 diabetes refers to severe insulin-deficient diabetes (SIDD), characterised by elevated levels of insulin deficiency and poor metabolic control.”

The IDF has put together the Type 5 Diabetes Working Group to better understand this disease, and it’s “co-chaired by Dr. Meredith Hawkins, an endocrinologist and founding director of the Global Diabetes Institute at the Albert Einstein College of Medicine in New York, and Dr Nihal Thomas, a professor of endocrinology at Christian Medical College (CMC) in Vellore, India,” the IDF noted.

Researchers believe malnutrition-related diabetes is due to improper and impaired pancreatic development as a result of long-term malnutrition and certain nutritional deficiencies. In addition, those who have MRDM are deficient in insulin but do not have insulin resistance, and it appears many people who have it can treat it through lifestyle and oral medications as opposed to insulin injections.

Believe it or not, this type of diabetes isn’t new either. In fact, it was first unearthed in Jamaica in 1955, a full 70 years ago, especially in lower-income men with body mass indexes (BMI) of 19 and lower, but it was often misdiagnosed as type 1 diabetes.

That’s not all. The World Health Organization actually classified MRDM in 1985, only to declassify it in 1999 due to what it described as a lack of evidence that malnutrition can cause diabetes.

Now, thanks in large part to research conducted by Hawkins, type 5 diabetes is back in the spotlight. More specifically, a study she helped lead entitled “An Atypical Form of Diabetes Among Individuals With Low BMI” published in Diabetes Care in May 2022 thrust MRDM back into the limelight.

This study investigated an atypical form of diabetes prevalent in low- and middle-income countries (LMICs) among individuals with low BMI (<19 kg/m²), historically termed “malnutrition-related diabetes mellitus.” Here are the key findings in those who were determined to have type 5 diabetes:

Metabolic profile

• Insulin secretion: Lower total insulin secretion compared to non-diabetic lean individuals and type 2 diabetes (T2D) groups but higher than type 1 diabetes (T1D).
• Glucose metabolism:
  • Endogenous glucose production: 40% lower than in T2D (0.50 vs. 0.84 mg/kg·min), indicating reduced hepatic insulin resistance.
  • Peripheral insulin sensitivity: Glucose uptake was 2.4 times higher than in T2D (10.1 vs. 4.2 mg/kg·min).
• Body composition: Significantly lower visceral adipose tissue and hepatocellular lipid content compared to T2D.

Clinical characteristics

• Demographics: Predominantly affects young males (age 19-45) with low socioeconomic status, no family history of diabetes and no ketoacidosis.
• Diagnostic criteria:
  • BMI ≤19 kg/m², preserved C-peptide response (>0.5 ng/mL) and exclusion of autoimmune markers (GAD-65/IA-2 antibodies).
  • No pancreatic pathology or genetic mutations linked to MODY/lipodystrophy.

Distinctiveness from T1D and T2D

• vs. T1D: Preserved C-peptide levels, no autoimmune markers and ketosis resistance.
• vs. T2D: Lower hepatic insulin resistance, higher peripheral insulin sensitivity and absence of obesity-related metabolic features.

Implications

• Misclassification as T1D or T2D in LMICs may lead to inappropriate insulin therapy, risking hypoglycemia in food-insecure populations.
• The study advocated reclassifying this entity as a distinct form of diabetes (termed “low BMI diabetes” or “type 5 diabetes”) to guide tailored management.

This research underscored the need for further investigation into atypical diabetes subtypes in resource-limited settings to improve diagnostic accuracy and treatment outcomes, which has since occurred. And now, the IDF has officially recognized type 5 diabetes as its own disorder, though the American Diabetes Association has not yet joined the IDF in this regard.

Signs and symptoms

Type 5 diabetes symptoms may resemble other types of diabetes but often emerge in a different context. Key symptoms include:

• Unexplained weight loss
• Fatigue and muscle wasting
• Excessive thirst and urination (classic signs of hyperglycemia)
• Delayed wound healing
• Recurrent infections
• Signs of malnutrition (such as stunted growth or thin limbs)

Importantly, these symptoms typically occur in individuals with a history of chronic malnutrition and may appear at a younger age than type 2 diabetes.

Type 5 diabetes vs. other types

Here’s how type 5 diabetes compares to the more commonly known types:

While type 1 and type 2 diabetes dominate public understanding, type 5 diabetes is distinct in its origins and needs different approaches for treatment and management.

How to prevent/treat

Although type 5 diabetes is linked to early-life malnutrition, something that cannot be reversed in adulthood, there are steps that can be taken to manage and, in some cases, prevent complications:

1. Nutritional rehabilitation

Proper nutrition is foundational. Emphasis should be placed on:

• High-quality proteins (eggs, legumes, dairy, lean meats)
• Healthy fats (coconut oil, olive oil, avocados)
• Nutrient-dense vegetables and whole grains
• Supplementation if necessary (zinc, magnesium, B vitamins)

2. Blood sugar control with diet

Natural blood sugar stabilizers include:

• Bitter melon
• Fenugreek seeds
• Cinnamon
• Fiber-rich foods (chia seeds, flaxseeds, oats)

These support insulin sensitivity and reduce glucose spikes without the side effects of some medications.

3. Physical activity

Though people with type 5 diabetes may have limited energy reserves, light to moderate physical activity (such as walking, yoga or bodyweight exercises) can help improve insulin sensitivity and circulation.

4. Stress reduction

Malnutrition and diabetes both strain the body. Incorporating stress-reducing practices like meditation, breathing exercises and regular sleep can help regulate hormones and blood sugar.

5. Herbal and natural supplements

Some natural compounds that may help manage blood sugar include:

• Berberine
• Gymnema sylvestre
• Aloe vera extract
• And more

Consultation with a healthcare provider is recommended before starting any supplement regimen.

Conclusion

• Type 5 diabetes is a long-overlooked yet highly significant form of diabetes tied to early-life malnutrition.
• Its recent classification by the IDF signals a major advancement in global diabetes awareness and research.
• Understanding the unique causes, symptoms and natural treatment strategies for type 5 diabetes can help improve outcomes, especially in underserved communities.
• As with any chronic condition, early detection and personalized care, including nutritional and lifestyle interventions, are key to long-term health.
• If you suspect symptoms of type 5 diabetes, especially with a history of malnutrition, consult a healthcare provider for proper diagnosis and support.