At the recent International Diabetes Federation (IDF) World Diabetes Congress 2025 in Bangkok, Thailand, IDF President Professor Peter Schwarz announced the launch of a working group to develop formal diagnostic criteria and therapeutic guidelines for a type of diabetes linked to malnutrition that was formally classified as “type 5 diabetes” during an international meeting of experts in India earlier this year. The working group will also establish a global research registry and develop education modules to train healthcare professionals.
The Type 5 Diabetes Working Group is co-chaired by Dr Meredith Hawkins, an endocrinologist and founding director of the Global Diabetes Institute at the Albert Einstein College of Medicine in New York, and Dr Nihal Thomas, a professor of endocrinology at Christian Medical College (CMC) in Vellore, India.
Type 5 diabetes is estimated to affect between 20 to 25 million people worldwide, primarily in regions such as Asia and Africa. This recognition marks a pivotal moment in the understanding of diabetes and how the condition affects lean and malnourished teens and young adults in low- and middle-income countries (LMICs).
The concept of type 5 diabetes refers to severe insulin-deficient diabetes (SIDD), characterised by elevated levels of insulin deficiency and poor metabolic control. Unlike type 2 diabetes, type 5 diabetes, also known as malnutrition-related diabetes, is primarily caused by chronic undernutrition, especially during childhood or adolescence. Type 1 diabetes is the result of autoimmune destruction of insulin-producing cells. Type 2 diabetes is characterised by the body’s inability to use the insulin it produces. Type 5 diabetes is distinct. It is believed to stem from impaired pancreatic development due to long-term nutrient deficiencies.
Although type 5 diabetes has been observed for over 70 years, it has been largely overlooked in global health discussions. The condition was first noted in the mid-20th century and often misclassified as type 1 or 2 diabetes. Previously, prevailing theories suggested that the condition developed due to insulin resistance. In recent years, renewed research—led by Dr. Hawkins—confirmed its distinct metabolic profile.
People with type 5 diabetes are insulin deficient, but not insulin resistant. Many may be able to manage their diabetes with oral medication rather than with injections of insulin. Given that type 5 diabetes is mostly found in low-resource settings, this cost-effective approach could prove important in regions already struggling to tackle the rising number of people living with the condition.
Speaking at the recent IDF World Diabetes Congress, Professor Schwarz said:
“The recognition of type 5 diabetes marks a historic shift in how we approach diabetes globally. For too long, this condition has gone unrecognised, affecting millions of people and depriving them of access to adapted care. With the launch of the Type 5 Diabetes Working Group, we are taking decisive steps to correct this. This is about equity, science, and saving lives.”
