A new form of diabetes has been officially recognized. It affects millions of people globally
The International Diabetes Federation (IDF) has officially recognized a fifth form of diabetes after decades of controversy. The organization is now calling on other health authorities, such as the World Health Organization (WHO), to do the same.
Type 5 diabetes has been officially recognized PHOTO Shutterstock
Type 5 diabetes is rarely discussed or researched, but it is estimated to affect up to 25 million people globally, especially in low- and middle-income countries where access to health care is limited, writes the journal Science Alert.
It was first described in 1955 in Jamaica, then it was forgotten for many years. Even after it was recognized by the WHO in the 1980s, the diagnosis was controversial.
For nearly seven decades, scientists have debated whether type 5 diabetes really exists, and in 1999 the WHO withdrew the classification due to a lack of evidence. To date, there is no consensus on how to diagnose or treat type 5 diabetes.
Type 5 diabetes is not related to obesity
Unlike type 1, 2, 3c and gestational diabetes, type 5 diabetes is not associated with obesity, lifestyle, pregnancy or the immune system. Instead, it appears to be based on malnutrition.
Formerly known as diabetes mellitus associated with malnutrition, this form of diabetes is frequently misdiagnosed as another type.
However, because insulin resistance does not appear to be the main cause of type 5 diabetes, existing treatments may not be effective. Moreover, they can even be harmful.
“Understanding the specific type of diabetes a person has is essential to providing the correct treatment”explained Craig Beall, a diabetes researcher at the University of Exeter, in May.
Diabetes associated with malnutrition
For years, Meredith Hawkins, an endocrinologist at the Global Diabetes Institute at the Albert Einstein College of Medicine, has been calling for worldwide recognition of type 5 diabetes, which typically affects people in Asia and Africa facing severe food insecurity.
“Diabetes associated with malnutrition is more common than tuberculosis and almost as widespread as HIV/AIDS, but the lack of an official name has hampered efforts to diagnose patients and identify effective therapies”Hawkins said earlier this year. “I hope that this official recognition as type 5 diabetes will lead to progress in the fight against this long-neglected disease that causes severe suffering and is often fatal.”
In recent years, numerous animal and human studies have shown that chronic nutrient deficiencies can have lifelong effects on the pancreas, affecting its ability to secrete insulin and maintain blood glucose balance.
Hawkins' own research, published in 2022, is the first to establish a distinct metabolic profile for diabetes associated with malnutrition. She and her colleagues conducted a small study in southern India that showed that people with this type of diabetes have an insulin deficiency similar to that found in type 1 diabetes, but not to the same extent, and remain insulin sensitive, unlike people with type 2 diabetes, who develop insulin resistance.
“Type 5 diabetes is distinguished by a unique mechanism of onset, which is believed to involve poor development of the pancreas caused by prolonged periods of insufficient nutritional intake”Rahul Garg, a physician at FH Medical College and Hospital in India, recently wrote in an expert review.
What is the treatment
Some say that the number of patients with type 5 diabetes is increasing, others say that the prevalence is decreasing. In any case, it all depends on how the condition is diagnosed and recognized.
Without an official name and recognition, it is difficult to obtain funding for research, and without further evidence it is impossible to establish a standard diagnosis or estimate how many people are affected.
The distinct metabolic profile of type 5 diabetes means that doctors must be extremely careful in managing patients' insulin levels.
People with type 5 diabetes may need only minimal amounts of supplemental insulin or alternative approaches to stimulate insulin secretion to avoid dangerous dips or spikes in insulin levels.
“Inadequate insulin treatment can cause hypoglycemia, low blood sugar, which is a particular risk in areas affected by food insecurity and where blood glucose monitoring may not be accessible”Hawkins and colleagues explained earlier this year in a review published after type 5 diabetes was officially recognized.
