Malnutrition-related diabetes formally recognised after years of debate

Following a vote at its World Diabetes Congress in Bangkok, the International Diabetes Federation (IDF) has voted to officially recognise malnutrition-related diabetes and name it “type 5 diabetes”. It follows the drafting in January of a consensus statement about the condition.

First described in Jamaica in 1955 and initially called malnutrition-related diabetes, type 5 diabetes is seen most commonly in lean and malnourished teens and young adults in low- and middle-income countries. It is estimated to affect up to 25 million people worldwide, but has largely been overlooked in Western scientific literature.

Often misdiagnosed as type 1 or type 2 diabetes, the condition has a distinct metabolic profile, which may stem from impaired pancreatic development resulting from chronic undernutrition during childhood or adolescence. Recent evidence shows that it is characterised by low insulin secretion, low endogenous glucose production and high glucose uptake. Despite high blood glucose levels and high insulin requirements, ketonuria and ketosis do not develop.

According to Professor Meredith Hawkins (co-Chair of the IDF’s newly launched Type 5 Diabetes Working Group), this new understanding of the condition has revolutionised how it should be treated. While there is no clear guidance yet, data suggests that very small amounts of insulin combined with oral agents may be a safe and cost-effective approach. Careful studies into nutritional requirements also need to be conducted.

Over the next 2 years, the Working Group will develop formal diagnostic and therapeutic guidelines. Type 5 diabetes has gone unrecognised for decades, depriving millions of people of the appropriate care. It is hoped that this historic shift will result in greater equity of care and save lives.