A New Class of Diabetes Emerges: Type 5 Diabetes

Author: Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

On April 8, 2025, at the World Diabetes Congress of the International Diabetes Federation held in Bangkok, Thailand, Type 5 Diabetes was officially endorsed as a new class of diabetes following a congress vote.
This decision followed a panel meeting on the condition held earlier in January 2025.

What is Type 5 Diabetes?

Insulin is the hormone that helps the body regulate glucose. It is recognised as a form of insulin-deficient diabetes marked by insulin deficiency and poor metabolic control. It is believed to be caused by impaired development of the pancreas resulting from long-term childhood and adolescent malnutrition. The disease is estimated to affect 20–25 million people in Africa and Asia.

Traditionally, diabetes has been classified into Type 1 (insulin-deficient) and Type 2 (insulin-resistant) diabetes. Reference has also been made to Type 3 (brain-associated diabetes) and Type 4 (diabetes in elderly lean patients), although these have yet to be officially recognized.

Type 5 diabetes is often misdiagnosed as Type 1 diabetes because both are commonly seen in young people. 

It was first described in 1955 in a paper published in The Lancet by Hugh-Jones P.
He observed a distinct form of diabetes in individuals under 40 years old, which resembled Type 1 diabetes but was associated with insulin resistance and higher insulin requirements. Unlike typical Type 1 diabetes, ketones were not usually present in the urine of these patients. Hugh-Jones called this condition Type J Diabetes.

In 1985, the World Health Organization (WHO) introduced a criterion for the recognition of Malnutrition-Related Diabetes Mellitus (MRDM), although the disease was not given a distinct class name. This recognition was later dropped in the 1999 classification due to insufficient evidence.

A state-of-the-art metabolic study was conducted by Lomtchi-Yimagou and associates in India at the Christian Medical College, Vellore India, in collaboration with the Global Diabetes Institute at Albert Einstein College of Medicine.They compared individuals aged 19-45 years with features of malnutrition-associated diabetes to those with Type 1 diabetes, Type 2 diabetes, and individuals without diabetes.
Seventy-three participants were studied, 20 of whom met the WHO criteria for malnutrition-related diabetes. This study was published in Diabetes Care in 2022, with Professor Meredith Hawkins of Albert Einstein College of Medicine serving as the corresponding author.

Their study revealed that patients with malnutrition-associated diabetes had lower insulin secretion compared to those with Type 2 diabetes and those without diabetes, but higher insulin secretion than those with Type 1 diabetes. They also had higher glucose uptake by tissues and lower lean body mass.Importantly, the study found that insulin resistance was not a significant feature, unlike earlier reports from Jamaica. As a result, the use of high doses of insulin may be dangerous in these patients.

Importantly, their study found that insulin resistance was not a significant feature, unlike earlier reports from Jamaica. As a result, the use of high doses of insulin may be dangerous in these patients.

The recognition of Type 5 diabetes as a new class is expected to pave the way for further research, the development of diagnostic criteria, and tailored treatment options for this rare and often overlooked form of diabetes.

A working group co-chaired by ProfessorHawkins was inaugurated at the congress, and they are expected to develop diagnostic criteria and therapeutic guidelines for the disease.

Sources
International Diabetes Federation [Internet]. [cited 2025 Apr 28]. IDF launches new type 5 diabetes working group. Available from: https://idf.org/news/new-type-5-diabetes-working-group

Medscape [Internet]. [cited 2025 Apr 28]. Malnutrition-related diabetes officially named ‘type 5.’ Available from: https://www.medscape.com/viewarticle/malnutrition-related-diabetes-officially-named-type-5-2025a10008pd

An Atypical Form of Diabetes Among Individuals With Low BMI. Diabetes Care 2 June 2022; 45 (6): 1428–1437, Available from:https://diabetesjournals.org/care/article/45/6/1428/146920/An-Atypical-Form-of-Diabetes-Among-Individuals

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published April 28, 2025