Medical Community Officially Recognizes Type 5 Diabetes After Decades of Controversy

A Long-Overlooked Disease Finally Gets Recognition

After nearly seven decades of scientific debate and controversy, the International Diabetes Federation officially recognized Type 5 diabetes in 2025, marking a watershed moment for global diabetes care. The condition was formally classified as type 5 diabetes at an international meeting of experts convened in January 2025, with the new classification endorsed by the International Diabetes Federation at the World Diabetes Congress 2025 in Bangkok, Thailand.

Type 5 diabetes is rarely discussed or researched, and yet it is thought to impact up to 25 million people worldwide, especially those in low- and middle-income nations where access to medical care is limited. The journey to recognition has been tumultuous— first described in 1955 in Jamaica, then forgotten about for many years, even once it was acknowledged by the WHO in the 1980s, the diagnosis created controversy, and in 1999, WHO withdrew the classification due to a lack of evidence.

What makes this recognition particularly significant is that "Malnutrition-related diabetes is more common than tuberculosis and nearly as common as HIV/AIDS, but the lack of an official name has hindered efforts to diagnose patients or find effective therapies," according to Dr. Meredith Hawkins, who expressed hope that "this formal recognition as type 5 diabetes will lead to progress against this long-neglected disease that severely debilitates people and is often fatal."

The Devastating Impact of Misdiagnosis

People with type 5 diabetes often have a body mass index below 19 kg/m² and do not show signs of autoimmune β-cell destruction, which distinguishes it from type 1 diabetes. Until recently, there were no standard diagnostic criteria for type 5 diabetes, resulting in many people being incorrectly diagnosed with type 1 or type 2 diabetes and receiving treatments that did not meet their specific needs, leading to poor outcomes and further entrenched inequalities in care.

The consequences of these misdiagnoses can be life-threatening. Inappropriate insulin treatment could induce hypoglycemia, which can be a particular risk in settings with food insecurity and where glucose monitoring might not be affordable. This creates a dangerous cycle where the most vulnerable populations receive treatments that could harm rather than help them.

Type 5 diabetes is a form of diabetes linked to chronic undernutrition that is prevalent in low-income regions, typically appearing in adolescents and young adults and may presenting symptoms similar to type 1 diabetes. However, the underlying causes and treatment requirements are fundamentally different from other diabetes types.

Building a Framework for Better Care

The International Diabetes Federation has established a Working Group to develop formal diagnostic criteria to help healthcare providers distinguish type 5 diabetes from other types and to support accurate and timely treatment, chaired by Dr Meredith Hawkins and co-chaired by Dr Nihal Thomas, with the Working Group also creating a global patient registry to gather data, and supporting research and designing training modules for healthcare professionals, particularly in low- and middle-income countries.

For type 5 diabetes, treatment must focus not only on glucose control but also on addressing nutritional deficits, with management including nutritional support to correct long-term undernutrition. This dual approach represents a fundamental shift from traditional diabetes care models that focus primarily on blood sugar management.

The recognition comes at a critical time when the global burden of diabetes is accelerating, with new data from the 11th edition of the IDF Diabetes Atlas estimating that some of the steepest increases are expected in Africa and South-East Asia, where type 5 diabetes is most prevalent and the rates of malnutrition and undernourishment are highest.

A New Chapter in Global Health Equity

The official recognition of Type 5 diabetes represents more than just medical taxonomy—it's an acknowledgment of health disparities that have been systematically overlooked. By acknowledging the distinct pathophysiology of type 5 diabetes and the social determinants driving its emergence, the medical community is taking up the interrupted journey toward addressing a long-neglected condition affecting millions in under-resourced regions.

This development signals a broader shift in how the medical community approaches diabetes globally. Rather than applying one-size-fits-all solutions, healthcare providers can now develop targeted interventions that address the root causes of malnutrition-related diabetes. The working group has ambitious goals, including establishing diagnostic criteria by 2027 and creating educational programs specifically designed for healthcare workers in affected regions.

As researchers continue to study this newly recognized condition, the hope is that millions of people previously trapped in cycles of misdiagnosis and ineffective treatment will finally receive the specialized care they need. The recognition of Type 5 diabetes may well prove to be a turning point in addressing one of global health's most persistent inequities.