A New Classification emerges: Understanding Diabetes Type 5

After decades of research and observation, a distinct form of diabetes, primarily affecting thin, malnourished teenagers and young adults in low-to-middle-income countries, has been officially recognized. this new classification, termed Diabetes Type 5, marks a significant step forward in understanding the complexities of diabetes and its diverse manifestations.

The formal acknowledgment occurred at the recent World Diabetes Congress in Bangkok, Thailand, organized by the International Diabetes Federation (IDF). This decision underscores the critical need to differentiate malnutrition-related diabetes from the more commonly known Type 1 and Type 2 diabetes.

The Path to Recognition: A Consensus Emerges

The formal vote to recognize Diabetes Type 5 took place on April 8th at the World Diabetes congress, following extensive discussions and a consensus-building meeting held in India earlier this year. IDF President Prof. Peter Schwarz was instrumental in proposing the new classification.

Dr. Meredith Hawkins, a professor of medicine at Albert Einstein College of Medicine, highlighted the importance of this recognition, stating:

Recognition of IDF as ‘Diabetes Type 5’ is an important step to increase awareness of health problems that are very destroyed for so many people.
dr. Meredith Hawkins, Albert Einstein College of Medicine

Dr. Hawkins and her colleagues at Christian Medical College in Vellore, India, published a study in diabetes Care in 2022, providing crucial evidence that diabetes related to malnutrition is fundamentally different from Types 1 and 2.

Distinguishing features of Diabetes Type 5

Diabetes related to malnutrition was initially identified in Jamaica in 1955. It predominantly affects young adults in low and middle-income countries who are also malnourished, resulting in a low body mass index (BMI). Thes individuals frequently enough present with high blood glucose levels and elevated insulin needs, but, unlike those with Type 1 diabetes, they do not typically develop ketonuria or ketosis.

While the World Health Institution (WHO) briefly classified malnutrition-related diabetes as a distinct type in 1985, this categorization was rescinded in 1999 due to a perceived lack of evidence linking malnutrition or protein deficiency directly to diabetes. Though, renewed research and clinical observations have as solidified the case for reclassification.

Key characteristics that differentiate Diabetes Type 5 include:

• Significantly lower BMI,often below 18.5 kg/m². For context, a healthy BMI generally falls between 18.5 and 24.9 kg/m².
• Reduced insulin secretion, lower than that observed in Type 2 diabetes but slightly above Type 1 levels.
• lower liver glucose production and release into the bloodstream compared to Type 2 diabetes.
• Lower percentage of body fat compared to Type 2 diabetes cases.
• Abnormal pancreatic beta cell function, leading to insufficient insulin production. This contrasts with Type 2 diabetes, where the body becomes resistant to insulin despite producing it.

The Role of Nutrition: From Womb to Adulthood

Nutrition, both during fetal development and after birth, plays a critical role in the development of all forms of diabetes.Insufficient fetal nutrition can increase the risk of developing diabetes later in life. Conversely, excessive weight gain after a period of undernutrition can contribute to the development of type 2 diabetes.

Diabetes Type 5 specifically affects individuals who experience malnutrition both before and after birth, highlighting the profound impact of early nutrition on metabolic health.

Moving Forward: Diagnostic and therapeutic Guidelines

A working group, led by Dr. Hawkins,has been tasked with developing formal diagnostic and therapeutic guidelines for diabetes Type 5 over the next two years.These guidelines will be crucial for improving the diagnosis and management of this often-overlooked condition.

Current expert recommendations emphasize the importance of a high-protein diet, tailored to the individual’s BMI and physical activity level. Sufficient carbohydrates and fats are also necessary to ensure healthy weight gain. The use of anti-diabetic medications or insulin should be considered based on blood glucose levels and individual therapeutic responses.

The Global Impact of Diabetes

The recognition of Diabetes Type 5 comes at a crucial time, as diabetes continues to be a major global health challenge. According to the World Health Organization (WHO), an estimated 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and diabetes is a leading cause of blindness, kidney failure, heart attack, stroke and lower limb amputation.

By understanding the nuances of Diabetes Type 5, healthcare professionals can provide more targeted and effective care to vulnerable populations, ultimately improving health outcomes and reducing the burden of this complex disease. The recognition of Diabetes Type 5 is a crucial step in addressing the diverse challenges posed by diabetes worldwide.