The International Diabetes Federation (IDF) has officially recognized a fifth type of diabetes after decades of debate.
The condition was first identified in Jamaica in 1955, but was largely ignored for many years. Although the World Health Organisation acknowledged it in the 1980s, the diagnosis remained controversial. Scientists have argued for nearly 70 years over whether type 5 diabetes truly exists. In 1999, the WHO removed it from its classifications due to a lack of strong evidence.
Type 5 diabetes potentially affects up to 25 million people worldwide, mainly in people in low- and middle-income countries, where access to healthcare is often limited. It was earlier known as malnutrition-related diabetes mellitus (MRDM), as it is related to poor nutrition issues.
Notably, there is no clear agreement on how to diagnose or treat it because insulin resistance does not seem to be the main problem in Type 5 diabetes. Standard diabetes treatments may not work for these patients and could even cause harm.
For years, endocrinologist Meredith Hawkins of the Albert Einstein College of Medicine's Global Diabetes Institute has pushed for global recognition of type 5 diabetes. In a 2022 study, Hawkins and her team were the first to show that this form of diabetes has a distinct metabolic pattern. In a small study in southern India, they found that people with MRDM produce less insulin, similar to those with type 1 diabetes, but not as severely. Also, unlike people with type 2 diabetes, they remain sensitive to insulin rather than resistant to it.
"Inappropriate insulin treatment could induce hypoglycaemia, which can be a particular risk in settings with food insecurity and where glucose monitoring might not be affordable," Hawkins explained in a review.
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