A new type of diabetes mellitus has been identified: type 5

Malnutrition-related diabetes – typically affecting thin, malnourished adolescents and young adults in low- and middle-income countries – is now officially recognized as a distinct form of the disease known as type 5 diabetes.

This decision made by the International Diabetes Federation is due in large part to the research and work of Meredith Hawkins, MD, professor of medicine, the Harold and Muriel Block Endowed Chair in Medicine and founding director of the Global Diabetes Institute at Albert Einstein College of Medicine.

“Historically, diabetes related to inadequate nutrition has been extremely rarely diagnosed and poorly understood,” says Dr. Hawkins. – Recognizing type five diabetes is an important step toward raising awareness of a health problem that is so devastating for so many people.”

Obesity-related diabetes, known as type 2 diabetes, accounts for the majority of diabetes cases in developing countries. But increasingly, Dr. Hawkins says, young people are being diagnosed with diabetes caused not by too much food but by not enough – in other words, malnutrition. An estimated 20 million to 25 million people worldwide, mostly in Asia and Africa, have type 5 diabetes.

“Doctors still don’t know how to treat these patients, who often don’t live more than a year after diagnosis,” says the researcher.

Diet-related diabetes was first described 70 years ago, and several studies later revealed a high prevalence of the disease in poor countries. In response to these reports, the World Health Organization (WHO) recognized diet-related diabetes as a distinct form of the disease in 1985. However, in 1999, WHO rescinded this recognition due to a lack of follow-up studies and supporting evidence.

Dr. Hawkins first learned about diabetes associated with malnutrition in 2005 when she gave presentations at global health meetings. “Doctors from different countries told me they had many patients with an unusual form of diabetes,” she says.

The patients were young and thin, suggesting they had type 1 diabetes, which could be treated with insulin injections to regulate blood sugar levels. But the insulin did not help these patients, and in some cases caused dangerously low blood sugar levels. It didn’t appear that these patients had type 2 diabetes, which is usually associated with obesity. This was very confusing.

In 2010, Dr. Hawkins founded the Einstein World Diabetes Institute to lead an international effort to identify the metabolic defects that lead to diet-induced diabetes, a crucial step toward finding effective treatments.

In a 2022 study published in the journal Diabetes Care, Dr. Hawkins and her colleagues from Christian Medical College in Vellore, India, demonstrated that diabetes associated with malnutrition is fundamentally different from types 1 and 2 diabetes.

It had previously been suggested that diabetes associated with malnutrition was due to insulin resistance. But it turned out that people with this form of diabetes have a profound defect in their ability to secrete insulin, which had not previously been recognized. This discovery revolutionized the way the disease was thought about and treated.

In January 2025, Dr. Hawkins and her colleagues at Christian Medical College convened an international meeting in India to discuss the classification, diagnosis, and treatment of nutritionally deficient diabetes and to advocate for global awareness and research.

Researchers from several countries presented their findings to a panel of diabetes experts. The panel voted unanimously that malnutrition-related diabetes should be considered a separate form of the disease, a decision that was endorsed at the IDF World Diabetes Congress 2025 in Bangkok, Thailand.

The new challenge is to develop formal diagnostic and therapeutic guidelines for type 5 diabetes in the coming years.

Diet-related diabetes is more common than tuberculosis and almost as common as HIV/AIDS, but the lack of an official name has hampered efforts to diagnose patients and find effective treatments.

Official recognition of type 5 diabetes would lead to progress in the fight against this long-neglected disease, which is severely debilitating and often fatal.

Schneider Children's Medical Center Israel,Petah TikvaLeave a request

San Donato Hospital Group Italy,MilanLeave a request

Published: 10.04.2025

Updated: 11.04.2025

Medical expert:

PhD. Olexandr Voznyak

Medical author, Medical editor:

Stepan Yuk