The World Health Organization (WHO) recently formally recognized the idea of “type 5 diabetes.” Implementation of this new classification for malnutrition-related diabetes mellitus is a big step forward in understanding and adapting the diagnosis of diabetes to LMICs. This first classification of researchers was recognized in Jamaica back in 1955. It has a devastating impact on these young men, whose body mass index (BMI) is less than 19.
To the best of our knowledge, the WHO created a separate classification for malnutrition-related diabetes as a type in 1985. Yet, this classification was removed in 1999 for lack of evidence connecting malnutrition and protein deficiency as a direct cause of diabetes. Type 5 diabetes has received new attention in recent weeks. All of this is happening as clinicians are increasingly recognizing that diagnosing and treating diabetes may not be as straightforward across diverse populations.
Studies have shown that type 5 diabetes is frequently misdiagnosed as type 1 diabetes, leading to inappropriate treatment for these patients. People with type 5 diabetes do not have ketonuria or ketosis. This holds even when their blood glucose levels are high and their insulin needs are increased. This important distinction can’t be overstated – it reveals the growing importance of tailored approaches to diagnosis and treatment.
As a result, a working group has been established. Over the next two years, they will develop official diagnostic and therapeutic guidelines for type 5 diabetes. Despite this, clear evidence-based treatment protocols have not been established. Early data indicate that high long-term immunity with very small doses of insulin combined with oral agents can yield the best outcomes for controlling this serious condition.
Recent research has surfaced a more nuanced understanding of type 5 diabetes. In 2022, Meredith Hawkins and her team administered state-of-the-art metabolic tests to 73 Asian Indian men. Of those 20, 20 had been diagnosed with a rare type 5 diabetes. Their results revealed distinct difference in insulin secretion between the type 5 group and T2Ds. More importantly, they illustrated unique differences in glucose metabolism between these two groups.
Their study showed that participants with type 5 diabetes had lower total insulin secretion and a significantly lower endogenous glucose production than individuals with type 2 diabetes. As a downside, they had increased glucose uptake as well. Furthermore, the type 5 group had less visceral adipose tissue and hepatocellular lipids than their T2D counterparts.
Keynote speaker, the AIM-HI initiative’s own Dr. Meredith Hawkins, emphasized the urgency of addressing the nutritional needs of those with type 5 diabetes. She suggested that a high-protein, low-carb diet and an emphasis on important micronutrients would go a long way. She emphasized the need for more rigorous research, with this new global momentum and an official mandate from the International Diabetes Federation to take such a step.
The official acknowledgement of type 5 diabetes is a watershed moment for these international efforts toward improving health. Hawkins brought attention to diabetes caused by malnutrition, which has been historically underdiagnosed and misinterpreted. He hailed the IDF’s recognition of it as “type 5 diabetes” as a key step towards increasing awareness of this life-changing and devastating health condition that affects millions of people.
As healthcare professionals begin to confront this issue more actively, there is optimism for change in how this condition is understood and treated. Hawkins was the first to clearly document that people with this form of diabetes have a marked defect in their capacity to secrete insulin, demonstrating something often missed by doctors. This landmark finding has changed our understanding of the disease and how we need to treat it.
An international expert panel will meet in India in January 2025. From these discussions, they will write a consensus statement on type 5 diabetes, which will then be published soon after. Today’s meeting is an impressive bipartisan, collaborative acknowledgment that there is a need for clearer guidelines that could change the treatment landscape for this awful condition.
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