At the International Diabetes Federation (IDF) World Diabetes Congress 2025 in Bangkok, type 5 diabetes – also known as malnutrition-related diabetes – was officially recognized as a distinct entity. This form of diabetes affects between 20 and 25 million people worldwide, mainly in South Asia and sub-Saharan Africa, where chronic malnutrition during childhood or adolescence remains common.
Unlike types 1 and 2, this diabetes is neither autoimmune, nor linked to overweight or insulin resistance. It reflects altered metabolic development due to prolonged deficiency of energy and essential micronutrients, which has a lasting effect on pancreatic function. This particular metabolic profile is marked by severe insulin deficiency, reduced hepatic glucose production, preserved muscular glucose uptake, little or no insulin resistance, and low visceral fat mass.
Until recently, this form of diabetes was often misclassified as type 1 or type 2 diabetes, and therefore poorly managed. Official recognition by the IDF marks a decisive turning point in the global approach to diabetes.
An international working group, co-led by Dr Meredith Hawkins (Albert Einstein College of Medicine, New York) and Prof Nihal Thomas (Christian Medical College, Vellore, India), has been mandated to develop formal diagnostic criteria, therapeutic guidelines, an international research registry and training modules for healthcare professionals.
As a reminder:
Type 1: autoimmune destruction of pancreatic β-cells.
Type 2: insulin resistance and progressive decompensation.
Type 3: secondary forms (genetic, drug-induced, pancreatic).
Type 4: gestational diabetes.
Type 5: undernutrition diabetes, now defined by specific clinical, metabolic and social criteria.
What about MODY?
MODY diabetes (Maturity-Onset Diabetes of the Young) is one of the genetic forms grouped under type 3. This hereditary, monogenic form of diabetes occurs at an early age, but without autoimmunity or obesity. It requires precise molecular diagnosis. This classification enables us to better adapt diagnosis and management to profiles that have hitherto been poorly understood
Official recognition by the International Diabetes Federation (IDF) has several aims:
Improve early detection of cases, which are often misdiagnosed today.
Adapt treatment protocols: this type of diabetes responds poorly to conventional oral antidiabetics.
Guide nutritional policies in the countries concerned, with a focus on vulnerable populations.
In practice: recognition of type 5 diabetes avoids confusion with type 2 diabetes in skinny, young patients who are often inaccessible to standard care.
Therapeutic approaches focus on progressive reconstitution of metabolic reserves, with particular attention paid to :
a protein-enriched diet,
a moderate reduction in fast carbohydrates,
correction of micro nutritional deficiencies (zinc, iron, B vitamins, etc.).
According to Dr. Meredith Hawkins (Albert Einstein College of Medicine):
“We now need to define a specific nutritional strategy for these patients, while respecting their social and economic context.”
An Atypical Form ofDiabetesAmong Individuals With Low BMI. Lontchi-Yimagou E, Dasgupta R, Anoop S, Kehlenbrink S, Koppaka S, Goyal A, Venkatesan P, Livingstone R, Ye K, Chapla A, Carey M, Jose A, Rebekah G, Wickramanayake A, Joseph M, Mathias P, Manavalan A, Kurian ME, Inbakumari M, Christina F, Stein D, Thomas N, Hawkins M. Diabetes Care. 2022 Jun 2;45(6):1428-1437. doi: 10.2337/dc21-1957.
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