Type 5 Diabetes Officially Recognized: A New Approach to Addressing Malnutrition-Linked Diabetes

After extensive discussion, the International Diabetes Federation (IDF) has officially acknowledged type 5 diabetes as a distinct diagnosis. This form of diabetes is primarily linked to childhood malnutrition and affects millions of teenagers and young adults, predominantly in regions such as Asia and Africa.

Risk in the United States

Type 5 diabetes doesn't only affect those abroad; certain populations in the United States, including those in foster care or migrants who have experienced food insecurity, might also be at risk. Meredith Hawkins, MD, founding director of the Global Diabetes Institute and co-chair of the IDF working group on type 5 diabetes, underscores the importance of awareness for these vulnerable groups.

Distinguishing Type 5 Diabetes

Diabetes, irrespective of its type, impacts the body's ability to process glucose, necessary for cellular energy. Unregulated glucose levels can lead to complications affecting eyes, kidneys, nerves, and the heart. Type 1 diabetes is characterized by the immune system attacking insulin-producing pancreatic cells, while type 2 arises from inefficient insulin use or production, often related to obesity.

Type 5 diabetes, however, results from childhood undernutrition, impairing pancreatic development and insulin production. Many experts have previously misclassified type 5 diabetes as type 1 or type 2 diabetes, according to Hawkins. Individuals with type 5 diabetes typically require minimal insulin or oral medication, as standard insulin dosages can dangerously reduce their blood sugar, leading to severe complications or even death.

Historical Context and Other Diabetes Classifications

While the American Diabetes Association (ADA) currently recognizes types 1 and 2 diabetes, gestational diabetes, and forms linked to conditions such as cystic fibrosis or genetic disorders, other organizations have identified additional types. For example, type 3 is linked to insulin resistance and Alzheimer’s, and type 4 is found in lean, older adults.

The Role of Severe Weight Loss

Although type 5 diabetes lacks a specific diagnostic test, assessments focus on the patient's clinical picture. While primarily defined by malnutrition, understanding type 5 diabetes may also assist those in high-income countries experiencing severe weight loss due to bariatric surgery or GLP-1 medications. Some colleagues in Japan have noted similar profiles in young women who deliberately starve themselves, mirroring type 5 symptoms. However, Hawkins advises caution in labeling these cases as type 5, emphasizing its roots in early-life malnutrition.

Weight loss can impact muscle mass, crucial for glucose processing. Skeletal muscle, the largest insulin-sensitive tissue, plays a significant role in glucose uptake. Reduction in muscle mass can lead to insulin resistance, resulting in elevated blood sugar levels.

Recognition in the U.S.

The American Diabetes Association has yet to classify type 5 diabetes officially. This hesitation may stem from ongoing internal reviews required to reach a consensus on these new developments. Hawkins anticipates that the ADA will soon address the issue formally.

While malnutrition-linked type 5 diabetes cases might have already appeared in the U.S., healthcare providers might not have been vigilant in diagnosing it. Rozalina McCoy, MD, emphasizes the need for careful treatment for those with a history of childhood malnutrition, as well as individuals facing malnutrition due to eating disorders or medical weight loss treatments.