The Emergence of Type 5 Diabetes: A Malnutrition-Related Metabolic Disorder

For years, the connection between malnutrition and diabetes has been underappreciated. Now, a notable development in diabetes research has officially recognized “diabetes related to malnutrition” as a distinct form of the disease, classified as “type 5 diabetes.” This landmark decision was made on April 8th at the World Congress of Diabetes in Bangkok, Thailand, organized by the International Diabetes Federation (IDF).

This recognition marks a crucial step forward in addressing a health issue that disproportionately affects vulnerable populations.

Understanding Type 5 Diabetes: A Conversation with Dr. Meredith Hawkins

Dr. Meredith Hawkins, a respected medical educator at Albert Einstein College of Medicine in New York, shed light on the implications of this newly classified diabetes type. According to Dr. Hawkins, the recognition of type 5 diabetes by the IDF is a pivotal moment.

Diabetes related to malnutrition has been an underdiagnosed and poorly understood ancient… Its IDF recognition as “type 5 diabetes” is an important step towards awareness of a health problem that is so devastating to so many people.
Dr. meredith Hawkins, Albert Einstein College of Medicine

this condition primarily impacts young men in low- and middle-income countries (LMICs) who typically have a body mass index (BMI) below 19. While frequently enough misdiagnosed as type 1 diabetes, these patients do not exhibit ketonuria or ketoacidosis, despite experiencing elevated blood sugar levels and requiring substantial insulin doses. This distinction is critical for accurate diagnosis and effective treatment.

A Historical Viewpoint: From Obscurity to Recognition

The link between malnutrition and diabetes was initially documented in Jamaica as early as 1955 and gained formal recognition from the World Health Association (WHO) in 1985. Though, this classification was discontinued in 1999 due to a perceived lack of definitive evidence. Recent research and sustained international advocacy have led to the rediscovery and re-evaluation of this critical connection, culminating in the official recognition of type 5 diabetes.

challenging existing Paradigms: Key Research Findings

In 2022, Dr. Hawkins and her team published the results of advanced metabolic tests conducted on 73 Asian Indian men. Among these participants, 20 were diagnosed with what is now known as “type 5 diabetes” after ruling out other known forms of diabetes through complete immunogenetic analyses. this research revealed several key characteristics of type 5 diabetes:

• Significantly lower total insulin secretion compared to healthy individuals and those with type 2 diabetes.
• Reduced endogenous glucose production.
• Increased glucose absorption relative to type 2 diabetes patients.
• Lower levels of visceral fat and hepatocellular lipids.

It seems that people with this form of diabetes have a profound defect in the ability to secrete insulin, which was not previously recognized. This discovery has revolutionized how we understand this condition and how we should treat it.
Dr. Meredith hawkins,Albert Einstein College of Medicine

Treatment Strategies: A Cautious Approach

Currently,there are no established treatment protocols specifically for type 5 diabetes. However, preliminary evidence suggests that very low doses of insulin, combined with oral medications, may be the most effective approach. Dr. Hawkins emphasizes the potential dangers of administering excessive insulin doses to these patients,which can be life-threatening.

Moreover, nutritional interventions may play a crucial role in managing type 5 diabetes. dr. Hawkins suggests that:

I suspect that their nutrition should include much larger amounts of protein and fewer carbohydrates, with special attention to deficient micronutrients… But this aspect should be studied carefully, now that there is a global will and an official mandate from IDF.
Dr. Meredith hawkins,Albert Einstein College of medicine

Looking Ahead: Developing Diagnostic and Treatment Guidelines

A dedicated working group has been formed to develop formal diagnostic and treatment guidelines for type 5 diabetes within the next two years. This initiative marks the beginning of a new era in the global approach to diabetes, acknowledging the disease’s complexity and the diverse manifestations influenced by patients’ socio-economic and nutritional backgrounds. The development of these guidelines is a critical step in ensuring that individuals with type 5 diabetes receive appropriate and timely care.