At the World Diabetes Congress 2025 held in Thailand last week, the International Diabetes Federation’s president, Peter Schwarz, made two important announcements. The first was the formal classification and recognition of type 5 diabetes as a form of the non-communicable disease, and the second was the launch of a working group to “develop formal diagnostic criteria and therapeutic guidelines” for the new condition.
“The recognition of type 5 diabetes marks a historic shift in how we approach diabetes globally. For too long, this condition has gone unrecognised, affecting millions of people and depriving them of access to adapted care. With the launch of the type 5 diabetes working group, we are taking decisive steps to correct this. This is about equity, science, and saving lives,” Schwarz had said at the conference.
The federation even went on to say that globally 20-25 million people are affected by type 5 diabetes, especially in Asia and Africa.
But what is type 5 diabetes? How is it caused? Is it treatable? And should you even care about it?
Dr Ashok Kumar Jhingan, senior director, centre for diabetes, thyroid, obesity and endocrinology, BLK-MAX Super Speciality Hospital, says, “Malnutrition-related diabetes mellitus (MRDM), also known as type 5 diabetes, is one type of diabetes that is associated with malnutrition and affects young individuals in low- and middle-income countries.”
First discovered over 70 years ago, in Jamaica in 1955, the disease was classified by the World Health Organization in 1985, under two categories — fibrocalculous pancreatic diabetes (FCPD) and protein deficient pancreatic diabetes (PDPD), says Dr Aasim Maldar, consultant, endocrinologist and diabetologist, PD Hinduja Hospital and MRC.
Dr Maldar adds, “In 1999 though, this classification was dropped citing a lack of evidence that malnutrition or protein deficiency causes diabetes. Malnutrition-related diabetes has historically been vastly underdiagnosed and poorly understood.”
The causal factors
While type 5 diabetes is primarily caused by chronic malnutrition during childhood or adolescence, other factors can also contribute to it. For instance:
- Deficiencies of protein, micronutrients, and vitamins
- Chronic pancreatitis
- High carbohydrate diet
- Infection and inflammation
- Genetic predisposition
- Exposure to pollutants or toxins
- Limited access to health care
- Poor sanitary conditions
According to the International Diabetes Federation, “The concept of type 5 diabetes refers to severe insulin-deficient diabetes (SIDD), characterised by elevated levels of insulin deficiency and poor metabolic control. It is believed to stem from impaired pancreatic development due to long-term nutrient deficiencies.”
Dr Ajay Agarwal, senior director, internal medicine, Fortis Hospital, Noida, agrees with this. “Type 5 diabetes is seen in people with extremely low body mass index (BMI) of less than 18.5 kg/m2,” he says.
“Prolonged under-nutrition impairs pancreatic development and function, particularly affecting both endocrine (insulin-secreting beta cells) and exocrine (enzymes required for fats, proteins and carbohydrate digestion) components of the pancreas,” Dr Maldar of PD Hinduja Hospital emphasises.
Dr Jhingan says that the markers of type 5 diabetes can be increased thirst, urinary frequency, fatigue, and accidental weight loss. To this, adds Dr Maldar that biochemical markers like fasting hyperglycemia, low or absent c-peptide levels, low serum insulin levels, and negative pancreatic autoantibodies can also be indicators of MRDM.
Additionally, while the condition has commonly presented itself in young adults, type 5 diabetes or MRDM can affect anyone who has had a “documented history of under-nutrition during childhood,” explains Dr Maldar. This could include individuals from disadvantaged socio-economic backgrounds, those who were exposed to recurrent infections due to an immunocompromised system, people who did not have access to protein-rich diets, or even rural communities that rely majorly on foods like cassava for their nutritional intake.
The way ahead
With the International Diabetes Federation noting that many people are at risk of type 5 diabetes, what is the way ahead? Can it be cured? Not as of now, say experts.
However, it can be treated and managed with appropriate medical and nutritional support, and lifestyle modifications. Dr Maldar says, “Prognosis improves significantly with early diagnosis, nutritional repletion, and sustained glycemic control.”
Dr Jhingan notes, “The first step of treatment is insulin therapy, in order to regulate blood glucose.” When the federation had officially recognised MRDM as a type of diabetes, it had also stated, “People with type 5 diabetes are insulin deficient, but not insulin resistant. Many may be able to manage their diabetes with oral medication rather than with injections of insulin.”
An important part of managing the disease would also include dietary management with a focus on higher protein and carbohydrates, adds Dr Jhingan. “Routine follow-ups and monitoring with health care providers are extremely necessary too,” he says.
“Treatment approach would also include enzyme replacement therapy in cases with exocrine pancreatic insufficiency, supplementation of antioxidants or vitamins in selected cases (like vitamin A or zinc), and avoidance of cassava or dietary toxins,” says Dr Maldar.
It’s also important to understand that there’s a lot that is still not known about type 5 diabetes. Dr Jhingan says, “MRDM is a disorder of multifactorial nature, and its etiology is most probably multifactorial as well. More studies must be conducted in order to discover more about the etiology and pathophysiology of MRDM.” “Researches are ongoing on newer modalities of approach to manage this form of diabetes,” adds Dr Agarwal.