In communities where food insecurity remains a daily reality, a unique form of diabetes shaped by chronic malnutrition is beginning to stand apart from conventional types.
Published Aug 07, 2025 | 3:55 PM ⚊ Updated Aug 07, 2025 | 3:55 PM
Diabetes. Representative Image. (iStock)
Synopsis: The International Diabetes Federation recently recognised malnutrition-related diabetes, distinct from both type 1 and type 2, as “type 5 diabetes”. This form, known as malnutrition-related diabetes or severe insulin-deficient diabetes, does not stem from obesity or autoimmune causes.
A newly recognised form of diabetes is challenging long-held assumptions about who is at risk. Unlike the types commonly associated with excess weight or lifestyle, this one shows up in people who are often severely underweight.
In some cases, blood sugar levels remain high even when calorie intake is chronically low, a pattern seen in certain regions where childhood undernutrition remains widespread.
On 8 April this year, the International Diabetes Federation (IDF) officially recognised malnutrition-related diabetes, distinct from both type 1 and type 2, as “type 5 diabetes”.
In January 2025, a panel met in India to draft a consensus statement about the condition, which is estimated to affect millions globally, yet it often slips through the cracks of standard diagnosis.
Type 5 diabetes refers to severe insulin-deficient diabetes (SIDD), characterised by elevated levels of insulin deficiency and poor metabolic control. Also known as malnutrition-related diabetes, it is primarily caused by chronic undernutrition, especially during childhood or adolescence.
In India, where approximately 10 crore people live with diabetes, a significant share may unknowingly belong to this category, especially in communities with limited access to nutrition in early life. As its treatment pathway is still being developed, identifying it correctly is becoming just as critical as managing it.
In communities where food insecurity remains a daily reality, a unique form of diabetes shaped by chronic malnutrition is beginning to stand apart from conventional types. Unlike the more familiar types, this form, known as malnutrition-related diabetes or severe insulin-deficient diabetes, does not stem from obesity or autoimmune causes.
“Type 1 diabetes is the result of autoimmune destruction of insulin-producing cells. Type 2 diabetes is characterised by the body’s inability to use the insulin it produces. Type 5 diabetes is distinct. It is believed to stem from impaired pancreatic development due to long-term nutrient deficiencies,” said IDF.
“It arises when the insulin-producing cells in the pancreas do not develop fully during adolescence due to prolonged nutritional deficiency,” Dr Jimmy Prabhakaran, Senior Consultant in Internal Medicine and Diabetology at Rela Hospital, Chennai, told South First. “This leads to reduced insulin production, not because the body destroys these cells, but because they were underdeveloped from the start,” he added.
While type 1 diabetes involves autoimmune destruction of pancreatic cells, and type 2 is marked by insulin resistance, malnutrition-related diabetes results from direct structural and functional damage due to early-life protein-energy malnutrition.
“It’s most often seen in individuals with very low BMI, typically under 18, and is associated with deficiencies in protein, zinc, vitamin A, chromium, and other micronutrients,” Dr Prabhakaran said.
Highlighting the root cause, malnutrition, he said, “It is mostly a socioeconomic issue. This was reported as early as the 20th century, but didn’t receive much attention due to other dominant factors.”
This form of diabetes typically presents in early adolescence or adulthood, particularly among those from low-income households. “It is often misdiagnosed as type 1 or type 2 diabetes or even as MODY [Maturity Onset Diabetes of the Young],” he noted. “But it has unique features; these individuals are lean, usually stunted, and present with high blood sugar not because of insulin resistance or autoimmunity, but simply because they don’t produce enough insulin in the first place.”
On treatment, Dr Prabhakaran explained that many patients may not require insulin immediately. “We can start with a good balance of nutritional support and oral medication to improve insulin secretion,” he said. Insulin is considered only when the patient does not respond to initial treatment, and other forms like type 1 diabetes must first be ruled out through autoantibody testing, he added.
The key to prevention, he stressed, lies in supporting childhood and adolescent nutrition. “Particularly during adolescence, the pancreas is still developing. That window is critical,” he mentioned.
Urging the need for early nutritional intervention and dietary discipline, he said, “We need to ensure balanced, protein-rich diets and avoid junk food. Public awareness about disciplined eating habits and the long-term importance of nutrition is essential. Otherwise, the pancreas simply cannot grow to its full potential.”
Recognising this lesser-known form of diabetes calls for a shift in how we think about the disease. It’s not just about sugar or weight; it’s about what children eat, when they eat it, and how that shapes their bodies for life.
In places where undernutrition is common, early detection and nutritional support can make a lasting difference. As research continues, spreading awareness and looking beyond the usual signs may be the first real step in addressing this hidden burden.
(Edited by Muhammed Fazil.)
