Type 5 diabetes, long suspected to be a malnutrition-related form of the disease, has finally gained official recognition. At the World Diabetes Congress held in Bangkok in April 2025, experts acknowledged it as a distinct type of diabetes, now classified as “Type 5.” This comes seven decades after the condition was first reported in 1955. Dr. Nihal Thomas, Professor of Endocrinology at CMC Vellore and one of the lead researchers behind the breakthrough study, elaborated on its implications for diabetes care in India and beyond.
Global Prevalence and Challenges in Diagnosis
Researchers estimate that approximately 25 million people worldwide may be affected by Type 5 diabetes. However, actual numbers could be significantly higher, particularly in under-resourced regions such as sub-Saharan Africa and parts of South and Southeast Asia. Many of these cases may have been misclassified as Type 1 or Type 2 due to limited diagnostic capabilities and survey bias.
To accurately diagnose Type 5 diabetes, clinicians must conduct a combination of tests. These include an ultrasound scan of the pancreas (to rule out chronic pancreatitis), a C-peptide test (to measure insulin production), and GAD antibody testing (to rule out Type 1 diabetes). Making these diagnostic tools widely available is essential for identifying and treating Type 5 diabetes effectively.
Distinct Treatment Approach
Unlike Type 2 diabetes, which is characterized by insulin resistance, Type 5 diabetes involves insufficient insulin production without resistance. While Type 1 diabetes often leads to ketoacidosis, Type 5 does not. Interestingly, around 50% of Type 5 patients may manage their condition using oral medication, without the need for insulin therapy. However, further research is needed to understand the disease’s subtypes and optimize treatment protocols.
Dietary and Lifestyle Recommendations
Typical diabetes management involves dietary restrictions and increased physical activity. However, Type 5 diabetes demands a different approach. Since insulin production depends on both carbohydrates and amino acids (protein), researchers are exploring whether a high-protein diet could be beneficial. Many affected individuals consume low-protein diets, and even when placed on standard diets, they often remain underweight.
Therefore, a high-calorie, possibly high-protein diet may be necessary—though optimal guidelines are still under investigation. While many patients already engage in physical labor, resistance exercises are recommended where feasible. More clinical research is required to tailor effective lifestyle interventions for these patients.
Historical Background and Policy Challenges
The first documented case of Type 5 diabetes occurred in Jamaica in 1955. In India, Dr. BB Tripathy in Cuttack reported similar cases in 1963. By 1985, the World Health Organization (WHO) had acknowledged the condition—then termed “Malnutrition-Related Diabetes Mellitus (MRDM).” However, due to a lack of robust physiological studies, WHO retracted it from official classification in 1999.
Several factors contributed to its neglect. The name “malnutrition-related” carried stigma, discouraging recognition by policymakers and patients alike. Furthermore, the affected population typically belonged to impoverished communities with limited access to healthcare and research resources.
Breakthrough Research and Global Endorsement
It took a rigorous eight-year study led by CMC Vellore and the Albert Einstein College of Medicine in New York to conclusively distinguish Type 5 diabetes from other forms. Researchers had to rule out conditions such as Fibro Calculous Pancreatic Diabetes (FCPD), Type 1 and Type 2 diabetes, and genetic forms like MODY (Maturity-Onset Diabetes of the Young).
As reported by TOI, this groundbreaking work involved comprehensive testing, patient cooperation, and intensive monitoring. As a result, in April 2025, Dr. Peter Schwarz, President of the International Diabetes Federation, officially endorsed Type 5 diabetes at the World Diabetes Congress. Though WHO has not yet reintegrated it into its classification, the condition is listed in the International Classification of Diseases (ICD), marking a significant milestone.
Looking Ahead
This diabetes type highlights the intersection of poverty, malnutrition, and chronic disease. Its recognition underscores the need for inclusive healthcare policies, increased diagnostic access, and targeted research. Moving forward, renaming and reclassifying such conditions with dignity can drive greater public health attention, support policy formulation, and inspire innovative treatments tailored to underserved populations.