This April, the International Diabetes Federation officially acknowledged a new classification of diabetes, termed type 5 diabetes. This condition affects approximately 25 million individuals globally, primarily in low- and middle-income countries where food scarcity is prevalent. Historically, misdiagnosis has led to inappropriate treatments, resulting in dangerous complications for these patients.
The introduction of this new classification paves the way for tailored treatment strategies that align with the unique biological characteristics of affected individuals. Understanding diabetes requires a nuanced approach, as the body relies on precise chemical signals to convert food into energy. While type 1 diabetes is an autoimmune disorder destroying insulin-producing cells, type 2 diabetes is characterized by insulin resistance, and gestational diabetes occurs due to hormonal changes during pregnancy. Type 3c arises from direct damage to the pancreas.
A Hidden Variant
Despite these well-defined categories, a variant remained overlooked. In 1955, physician P. Hugh-Jones documented cases of undernourished youths in Jamaica exhibiting an atypical form of diabetes that did not fit existing classifications. This anomaly, termed J-type diabetes, was marked by a lack of ketoacidosis, a common complication in untreated type 1 diabetes.
The World Health Organization briefly recognized this condition in 1985 but later retracted its classification due to insufficient evidence linking malnutrition directly to diabetes. This lack of recognition stunted research efforts and left patients without appropriate diagnostic options.
Understanding the Mechanism
To unravel the complexities of this underreported diabetes type, Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine, conducted extensive research into its metabolic mechanisms. Hawkins emphasized that malnutrition-related diabetes is more prevalent than tuberculosis and nearly as common as HIV/AIDS, yet its lack of formal recognition has hindered patient diagnosis and treatment.
In a pivotal 2022 study, Hawkins' team identified a unique metabolic profile among these patients, revealing that, unlike type 1 and type 2 diabetes, their primary issue was not autoimmune destruction or insulin resistance, but rather a significant defect in insulin secretion.
Impact of Misdiagnosis
Misdiagnosing type 5 diabetes can lead to severe treatment complications. Standard insulin regimens for type 1 diabetes may induce hypoglycemia in these patients, while type 2 diabetes management strategies, such as aggressive weight loss, can be detrimental for those facing starvation.
A Transformative Step Forward
In January 2025, a gathering of 39 international experts in Vellore, India, culminated in the Vellore Declaration, advocating for the classification of type 5 diabetes. This led to the International Diabetes Federation's historic announcement, which aims to establish diagnostic criteria, therapeutic guidelines, and a global research registry.
Hawkins expressed optimism that this recognition will catalyze advancements in addressing this long-overlooked condition. The acknowledgment of type 5 diabetes highlights the critical need for ongoing research and advocacy to combat the long-term impacts of undernutrition on health.
