In April 2025, the International Diabetes Federation (IDF) formally recognised type 5 diabetes, also known as malnutrition-related diabetes, as a distinct clinical entity. This updated classification reflects decades of under-recognition and misdiagnosis, particularly in low and middle-income countries, where it predominantly affects lean adolescents and young adults suffering from chronic undernutrition.

Type 5 diabetes is estimated to affect between 20-25 million people globally, primarily in Asia and Africa. Unlike other types of diabetes, type 5 is characterised by severe insulin deficiency without insulin resistance. It arises from impaired pancreatic development due to prolonged undernutrition in early life. Importantly, this condition may be misdiagnosed as type 1 diabetes, leading to inappropriate insulin treatment and dangerous hypoglycaemic episodes.

This classification was endorsed at the IDF World Diabetes Congress 2025 in Bangkok, where IDF President Professor Peter Schwarz announced the establishment of a dedicated Type 5 Diabetes Working Group. Co-chaired by Dr Meredith Hawkins (Albert Einstein College of Medicine, USA) and Dr Nihal Thomas (Christian Medical College, India), the group will develop formal diagnostic and therapeutic guidelines, establish a global registry and launch training modules for clinicians.

Although the condition was briefly acknowledged by the WHO in the 1980s, formal recognition has remained elusive until now. Recent research led by Dr Hawkins has confirmed its distinct metabolic profile, highlighting the need for targeted care pathways. Many patients can be managed with oral agents and tailored nutritional support, rather than insulin, which is often a significant consideration in resource-limited settings.

For those working in diabetes care in the UK, especially those engaged in global health or working with migrant populations, this development underscores the importance of considering malnutrition-related diabetes in differential diagnoses. The IDF’s recognition marks a critical turning point in ensuring equitable diabetes care. It invites clinicians to move beyond traditional binary classifications and adopt a more nuanced approach.

As Professor Schwarz stated, “This is about equity, science, and saving lives.” Understanding and correctly identifying type 5 diabetes will be essential to advancing global diabetes care and improving outcomes for patients across the world.