New Type of Diabetes Officially Recognized

The International Diabetes Federation (IDF) has officially recognized a fifth form of diabetes, designating malnutrition-related diabetes mellitus (MRDM) as type 5 diabetes. This classification, formally established in January 2025 and endorsed at the World Diabetes Congress 2025 in Bangkok, Thailand, aims to address a condition that has been overlooked for decades.

Type 5 diabetes is estimated to affect between 20 million and 25 million people worldwide. It primarily impacts lean, malnourished teenagers and young adults living in low- and middle-income countries, with a high prevalence in sub-Saharan Africa and South-East Asia.

The recognition of this distinct form of the disease is intended to improve health equity and diagnostic accuracy. Because type 5 diabetes differs fundamentally from other forms of the disease, the IDF is urging other health authorities, including the World Health Organization (WHO), to adopt the classification.

Causes and Physiological Development

Unlike other forms of diabetes, type 5 diabetes stems from prolonged undernutrition, particularly during adolescence and early childhood. Factors such as chronic food insecurity, frequent infections, and poor maternal nutrition can impair the physical development of the pancreas.

This impairment leads to underdeveloped pancreatic tissue, which reduces the organ’s ability to produce sufficient insulin. The condition is classified as a non-autoimmune diabetes type.

The risk extends beyond those currently living in impoverished regions. Refugees and migrants from resource-poor settings may remain at risk for type 5 diabetes even after they have resettled in high-income countries.

Distinctions from Other Diabetes Types

The IDF now recognizes type 5 diabetes alongside four other primary classifications, each with distinct causes:

• Type 1 diabetes: An autoimmune condition that destroys the pancreas’s ability to produce insulin.
• Type 2 diabetes: Characterized by an insensitivity to insulin, often linked to obesity, diet, and lifestyle.
• Type 3c diabetes: Commonly caused by direct damage to the pancreas.
• Gestational diabetes: Triggered by hormonal changes during pregnancy.
• Type 5 diabetes: Caused by nutrient deficiency and underdeveloped pancreatic tissue rather than autoimmune reactions or insulin resistance.

Because insulin resistance is not the primary driver of type 5 diabetes, standard treatments used for other types may be ineffective. According to reported research, existing treatments for other forms of diabetes may not only fail to help patients with type 5 but could potentially cause harm.

Historical Controversy and Recognition

The medical community has debated the existence of malnutrition-related diabetes for nearly 70 years. It was first described in Jamaica in 1955, though it remained largely forgotten for several years afterward.

The World Health Organization recognized MRDM as a distinct form of diabetes in 1985. However, this designation was withdrawn in 1999 due to a lack of supporting evidence and follow-up studies.

The recent re-classification by the IDF follows extensive research and advocacy. Meredith Hawkins, M.D., M.S., a professor of medicine and the founding director of the Global Diabetes Institute at Albert Einstein College of Medicine, played a central role in the effort to secure the new designation on April 8, 2025.

Malnutrition-related diabetes has historically been vastly under-diagnosed and poorly understood. The IDF’s recognition of it as type 5 diabetes is an important step toward raising awareness of a health problem that is so devastating to so many people.

Meredith Hawkins, M.D., M.S.

Clinical Challenges and Prognosis

Type 5 diabetes is frequently misdiagnosed as other types of diabetes, which complicates patient care. Because the underlying cause is malnutrition rather than obesity or autoimmunity, the clinical presentation differs from the more common type 2 diabetes often seen in developing nations.

The prognosis for those diagnosed with type 5 diabetes can be severe. Dr. Hawkins noted that doctors remain unsure of the best treatment protocols, and some patients may not survive more than one year following their diagnosis.

The importance of precise classification is echoed by diabetes researcher Craig Beall of the University of Exeter, who stated in May 2025 that Understanding the specific types of diabetes someone has is crucial to providing the right treatment.