Daijiworld Media Network - New Delhi
New Delhi, Sep 18: A group of global health experts is urging formal recognition of Type-5 diabetes, a lesser-known form of diabetes linked to chronic undernutrition, which is estimated to affect over six million people in India and up to 25 million worldwide. Their findings and recommendations have been detailed in a new article published on Thursday in The Lancet Global Health.
Unlike more familiar forms of diabetes, Type-5 diabetes predominantly impacts lean, undernourished adolescents and young adults in low- and middle-income countries, particularly in regions like India, Bangladesh, Sri Lanka, Nigeria, Ethiopia, and Indonesia. Many affected individuals have no access to proper diagnosis or treatment, often being misclassified under the umbrella of Type 1 or Type 2 diabetes.
“An individual with a history of intrauterine and postnatal undernutrition is at high risk of developing Type-5 diabetes,” said Dr. Meredith Hawkins, Professor of Medicine at the Global Diabetes Institute, Albert Einstein College of Medicine (USA), in a statement.
In India alone — which has around 101 million people living with diabetes — it is estimated that approximately 6% of those (about 6 million individuals) are underweight and may fall under the Type-5 category.
Although the World Health Organization (WHO) previously recognised a form of malnutrition-related diabetes in 1985, it was later delisted in 1999, leading to decades of neglected research, funding gaps, and diagnostic confusion. The renewed push for formal classification aims to establish clear diagnostic criteria, which experts say is crucial for effective treatment and policy support.
Unique Characteristics of Type-5 Diabetes
According to Dr. Hawkins, individuals with Type-5 diabetes typically:
• Are under 30 years of age
• Come from low-income backgrounds
• Have a BMI below 18.5 kg/m², unlike overweight Type-2 diabetes patients
• Show symptoms similar to Type-1 and Type-2 diabetes, such as:
o Excessive urination (polyuria)
o Excessive hunger (polyphagia)
o Excessive thirst (polydipsia)
However, they also show signs of severe undernutrition, such as:
• Sunken eyes
• Stunting and wasting
• Pallor and fatigue
Unlike Type-1 diabetes, patients with Type-5 do not experience diabetic ketoacidosis — a serious complication — and lack islet cell antibodies, which are markers of autoimmune diabetes.
From a biochemical standpoint, patients with Type-5 are insulin sensitive, not resistant (as seen in Type-2), and have intermediate insulin levels — lower than Type-2, but higher than Type-1.
Why Misdiagnosis is Dangerous
Because of overlapping symptoms with other types of diabetes, patients with Type-5 are frequently misdiagnosed, leading to dangerous treatment mismatches:
• Misdiagnosed as Type-1 → Given high doses of insulin, risking severe hypoglycaemia, especially in the context of food insecurity
• Misdiagnosed as Type-2 → Prescribed GLP-1 agonists or other weight-loss-inducing drugs, worsening their already fragile nutritional state
“More research is needed to understand the long-term consequences of this condition,” Dr. Hawkins emphasized.
What Formal Recognition Could Achieve
Formal recognition of Type-5 diabetes would enable:
• Standardised diagnostic protocols across healthcare systems
• Better training for clinicians in low-resource settings
• Accurate screening and classification of patients
• Development of targeted treatment guidelines suitable for undernourished populations
Additionally, it would help secure international research funding and public health support, similar to efforts already in place for more commonly recognised forms of diabetes.
As global cases of diabetes rise — particularly in economically vulnerable regions — recognising Type-5 diabetes could play a pivotal role in reducing misdiagnosis, preventing complications, and improving outcomes for millions who remain invisible within existing health frameworks.