The International Diabetes Federation (IDF) has recognized a new classification for diabetes, called “type 5”. According to the Brazilian Diabetes Society (SDB), the update is actually the renaming of “diabetes related to malnutrition”, which mainly affects thin and malnourished adolescents and young adults.
Typing is considered more common in low- and middle-income countries, as it is closely linked to malnutrition, being more common in India, Thailand, Uganda, Ethiopia, Nigeria, among others.
At the IDF Congress, the entity’s president, Peter Schwarz, announced the creation of a working group to develop a formal diagnosis and therapeutic guidelines for the disease over the next two years.
Difference between other types of diabetes
This type of diabetes was described more than 70 years ago and was once called tropical diabetes, as it appeared more in tropical countries, and type J diabetes, because the first case was described in Jamaica, in 1955. This is a disease that affects young individuals under 30 years of age and of very low weight, with a BMI below 18.5-19. Because it affects young and thin people, this type is often confused with diabetes mellitus 1 (DM1), but there are many differences between them.
DM1 is an autoimmune disease where the person’s antibodies nullify the pancreas’ ability to produce insulin. As a result, the person’s insulin reserve is depleted weeks or months after diagnosis. In cases of type 5 diabetes, people probably suffered significant protein-calorie malnutrition during intrauterine life or in early childhood, during the organ formation phase, which caused a decrease in insulin-producing pancreatic cells, called beta cells. Therefore, insulin secretion is small, but greater than in the case of DM1. Another important difference is that in DM1, as there is no insulin production, the person needs to take several applications of the hormone to avoid a serious complication, which is when the body produces too much ketone, making the blood acidic, called ketoacidosis, which can even lead to death. Type 5 diabetes does not cause ketoacidosis because the body has a reserve of insulin, although it is not enough to control blood sugar levels.
In relation to type 2, the difference is more obvious, as around 90% of cases are linked to overweight or obesity, exactly the opposite of type 5. Insulin resistance is caused by excess weight and usually only appears after 35-40 years of age.
According to doctor Fernando Valente, director of the Brazilian Diabetes Society, in Brazil we do not have data on the prevalence of type 5 diabetes.
There may be cases, but they are possibly labeled as DM1 because of overlapping characteristics, such as the early age of onset of diabetes and low BMI,” explains.
The doctor also says that studies on this type of diabetes indicate that it is more common in men living in rural areas. Therefore, they may not even receive the correct diagnosis precisely because they are low-income countries, where people hardly go to the doctor, do not receive adequate treatment and have very high blood sugar levels, which favors the development of chronic complications of diabetes, such as blindness, kidney and heart problems and lower limb amputations.
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The classification of this type of diabetes is important so that its symptoms and causes are better known, leading to a more accurate diagnosis.
“This will also make this type of diabetes better studied, bringing greater understanding of the disease and more precise and specific treatment.” Dr. Fernando reminds us that the treatment of this type of diabetes does not only involve insulin, but also an adequate intake of calories, proteins and micronutrients.