International Diabetes Federation revives malnutrition-related diabetes as type 5, 26 years after WHO dropped it

The physiological case for a separate category rests mostly on one study. In work published in 2022, Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine's Global Diabetes Institute, and colleagues ran a small trial in south India ^[9]. People with malnutrition-related diabetes were short of insulin, as in type 1, though less severely. Unlike people with type 2, they still responded to the insulin they had ^[9]. ScienceAlert describes this as the first work to establish a distinct metabolic profile for the condition ^[10]. The article does not give the number of participants. Separately, animal and human studies have tied chronic nutrient deficiency to lifelong damage to the pancreas's ability to secrete insulin ^[16].

"Type 5 diabetes stands apart with its unique pathogenesis, theorized to involve compromised pancreatic development resulting from extended periods of nutritional insufficiency," according to a recent review by Rahul Garg, who practises medicine at India's F.H. Medical College and Hospital ^[11]. The key word is "theorized". A metabolic profile measured in patients describes the insulin deficit. On its own it cannot show that malnutrition caused it; that would take people followed from deprivation to diagnosis.

The label matters at the bedside. The condition is commonly misdiagnosed as other types ^[6]. Because insulin resistance does not appear to be the main driver, existing treatments may not help and may even harm, according to ScienceAlert ^[7]. The same profile leaves doctors a narrow margin when they adjust these patients' insulin ^[17]. "Understanding the specific types of diabetes someone has is crucial to providing the right treatment," Craig Beall, a diabetes researcher at the University of Exeter, said in May 2025 ^[15].

How many people have the condition is also unsettled. Researchers do not agree on whether case numbers are growing or receding ^[13], and ScienceAlert notes that without more evidence it is impossible to say how many people the condition affects ^[20]. The patients Hawkins describes are mostly in Asia and Africa and face severe food insecurity ^[23], in countries where access to medical care is limited ^[22]. "Malnutrition-related diabetes is more common than tuberculosis and nearly as common as HIV/ AIDS, but the lack of an official name has hindered efforts to diagnose patients or find effective therapies," Hawkins said in 2025 ^[8].

We think the definition is the first problem and the split with WHO the second. WHO gave a lack of evidence as its reason for dropping the category ^[4], so restoring it after 26 years ^[21] would most plausibly wait on published criteria and registry data. Until then, a clinic following the federation and one following WHO cannot be sure they are describing the same patients, because there is little agreement on how to diagnose the condition ^[5]. "I'm hopeful that this formal recognition as type 5 diabetes will lead to progress against this long-neglected disease that severely debilitates people and is often fatal," Hawkins said ^[18].