In a small village in rural Ethiopia, 19-year-old Amina weighs just 90 pounds. She’s been losing weight, feeling exhausted, and struggling with blurred vision for months. Her local clinic diagnosed her with type 1 diabetes and prescribed insulin, but the treatment made her blood sugar plummet dangerously. Amina’s story isn’t unique—it’s a glimpse into a newly recognized condition: type 5 diabetes. Officially classified by the International Diabetes Federation (IDF) in April 2025, this form of diabetes, driven by malnutrition, affects an estimated 20-25 million people, primarily young, underweight individuals in low-income countries. Unlike the more familiar type 1 and type 2, type 5 diabetes demands a fresh approach to diagnosis and treatment, exposing a long-overlooked global health crisis.
A New Diabetes Emerges
Type 5 diabetes, also called malnutrition-related diabetes, was formally recognized at the IDF’s World Diabetes Congress in Bangkok on April 8, 2025. The condition, first noted in the 1960s in undernourished populations in South Asia and sub-Saharan Africa, was briefly classified by the World Health Organization (WHO) in 1985 but dropped in 1999 due to insufficient evidence. Decades later, groundbreaking research led by Dr. Meredith Hawkins at Albert Einstein College of Medicine has reshaped our understanding. A 2022 study in Diabetes Care revealed that type 5 diabetes is distinct: it stems from severely reduced insulin secretion, not insulin resistance (type 2) or autoimmune destruction of insulin-producing cells (type 1). This metabolic defect is often rooted in chronic malnutrition, starting in the womb, where poor maternal nutrition impairs fetal pancreatic development.
The condition primarily affects lean teenagers and young adults with a body mass index (BMI) below 18.5 kg/m², common in regions like South Asia, sub-Saharan Africa, and parts of Latin America. A 2023 meta-analysis in The Lancet Diabetes & Endocrinology linked malnutrition to impaired pancreatic function, estimating that 200 million children under five in low-income countries face stunting—a key risk factor. Symptoms like fatigue, weight loss, and blurred vision mimic type 1 diabetes, leading to frequent misdiagnoses. Yet, standard insulin therapy can be ineffective or even fatal, causing dangerous hypoglycemia (low blood sugar).
Why It Matters: A Global Health Blind Spot
The recognition of type 5 diabetes highlights a critical gap in global health. “For too long, this condition has been mislabeled or ignored, leaving millions without proper care,” says IDF President Dr. Peter Schwarz. An estimated 20-25 million people, mostly in low- and middle-income countries, live with type 5 diabetes, a number comparable to the global HIV/AIDS population. In countries like India, Bangladesh, Uganda, and Rwanda, where food insecurity persists, the disease reflects the enduring impact of poverty and malnutrition.
Dr. CS Yajnik, a diabetes expert at KEM Hospital in Pune, India, explains the science: “Undernutrition in early life—before and after birth—damages the pancreas’s ability to produce insulin. This isn’t about overeating or lifestyle, but about survival in resource-scarce settings.” Unlike type 2 diabetes, linked to obesity, or type 1, an autoimmune condition, type 5 is a direct consequence of scarcity. Urbanization has fueled type 2 diabetes in wealthier nations, but in rural, low-resource areas, type 5 remains a silent epidemic.
Treatment Challenges and Hopes
Managing type 5 diabetes is complex. High-dose insulin, standard for type 1, can cause severe hypoglycemia because patients’ bodies still respond to insulin, unlike in type 1. Dr. Hawkins’ research suggests a careful combination of low-dose insulin and oral medications, such as metformin, may stabilize blood sugar. However, no global treatment guidelines exist yet. An IDF working group, co-chaired by Dr. Hawkins, is developing diagnostic and therapeutic protocols, expected by 2027.
Nutrition is central to treatment. Dr. Hawkins advocates diets rich in protein (from affordable sources like legumes or fish) and essential micronutrients, with fewer carbohydrates. But in resource-poor settings, access to such foods is limited. “It’s a cruel irony,” says Dr. Hawkins. “The very malnutrition causing this disease makes treatment harder.” A 2025 WHO report underscores the challenge: over 50% of households in sub-Saharan Africa lack consistent access to nutrient-rich foods.
Looking Ahead: A Call to Action
The recognition of type 5 diabetes is a pivotal step, but much work remains. Accurate diagnosis is critical to avoid harmful treatments, yet many clinics in low-income countries lack the tools or training to distinguish type 5 from other forms. Research into affordable, effective therapies is urgent, as is addressing the root cause: malnutrition. Global health initiatives, like the WHO’s Global Diabetes Compact, aim to improve access to care, but funding for non-communicable diseases in low-income settings remains low.
For readers in wealthier nations, this news underscores the global interconnectedness of health. Supporting organizations like the IDF or WHO, advocating for food security, or donating to nutrition programs can make a difference. For those in affected regions, seeking specialized care and prioritizing protein-rich foods, where possible, may help manage symptoms.
Type 5 diabetes is more than a medical condition—it’s a call to address the inequities of poverty and hunger. As Dr. Schwarz puts it, “This is about giving a voice to the most vulnerable.” Amina, and millions like her, deserve care tailored to their reality. With continued research and global commitment, type 5 diabetes could shift from a hidden crisis to a manageable challenge.
Sources:
- Hawkins, M., et al. (2022). Malnutrition-related diabetes: A distinct metabolic disorder. Diabetes Care, 45(6), 1289-1297. https://doi.org/10.2337/dc22-0156
- International Diabetes Federation. (2025, April 8). IDF recognizes type 5 diabetes. World Diabetes Congress, Bangkok. https://www.idf.org/news
- Yajnik, C. S., & Ganpule-Rao, A. (2023). Malnutrition and pancreatic dysfunction: Implications for diabetes. The Lancet Diabetes & Endocrinology, 11(4), 245-253. https://doi.org/10.1016/S2213-8587(23)00012-3
- World Health Organization. (2022). Global report on stunting and malnutrition. https://www.who.int/publications/i/item/9789240048737
- Additional reporting from Medscape (April 11, 2025) and WIONews (April 15, 2025).
