Explained: What is Type-5 diabetes? Why the malnutrition-induced condition is back?

Nearly 75 years after being first recorded, the condition that previously remained undefined was designated as Type- 5 diabetes at the recently held International Diabetes Federation’s (IDF) World Diabetes Congress in Bangkok, Thailand.

The condition, occurring often in young and thin adults, was first reported in Jamaica in 1955, and then defined as J-type diabetes.

In the 1960s, the condition was reported in undernourished populations across India, Pakistan, and parts of sub-Saharan Africa.

While in 1985, the World Health Organization (WHO) recognised the condition as a distinct form of diabetes, it removed the designation in 1999 as there were no proper follow-up studies and supporting evidence.

What is Type-5 diabetes?

It is a malnutrition-related diabetes, typically affecting lean and malnourished teenagers and young adults in low- and middle-income countries.

Type 5 diabetes is estimated to affect 20-to-25 million people worldwide, mainly in Asia and Africa.

Earlier findings had suggested that malnutrition-related diabetes stemmed from insulin resistance.

However, insulin injections, as in Type 1 diabetes patients, will not benefit these patients. In some cases, it can cause dangerously low blood sugar.

It is because "people with this form of diabetes have a profound defect in the capacity to secrete insulin, which wasn't recognised before. This finding has revolutionised how we think about this condition and how we should treat it," said Meredith Hawkins, Professor of Medicine at the Global Diabetes Institute at Albert Einstein College of Medicine in New York, US.

In a 2022 study, published in the journal Diabetes Care, Hawkins, and her colleagues at Christian Medical College in Vellore, demonstrated that malnutrition-related diabetes is fundamentally different from Type-2 diabetes, typically, caused by obesity, and Type 1 diabetes, an autoimmune disease.

However, the expert noted that "doctors are still unsure how to treat these patients, who often don't live for more than a year after diagnosis".

To better understand the condition and develop treatments, the IDF has constituted a working group.

What will the working group do?

According to Hawkins, the condition has “historically been vastly under-diagnosed and poorly understood".

She said that "malnutrition-related diabetes is more common than tuberculosis and nearly as common as HIV/AIDS".

"The lack of an official name has hindered efforts to diagnose patients or find effective therapies," Hawkins said.

The working group has been tasked to develop formal diagnostic and therapeutic guidelines for type 5 diabetes over the next two years.

It will define diagnostic criteria and develop guidelines for the management of the disease. It will also establish a global registry to facilitate research collaborations, and develop education modules to train healthcare professionals worldwide.