Malnutrition-related diabetes, distinct from both Type 1 and Type 2, has now been officially recognized and named “Type 5 diabetes” at the International Diabetes Federation’s (IDF’s) World Diabetes Congress in Bangkok.
Malnutrition-related diabetes was first described in Jamaica in 1955 and is seen most commonly in young men in low- and middle-income countries (LMICs) who have a body mass index <19. They are often misdiagnosed as having Type 1 diabetes, but they do not develop ketonuria or ketosis, despite high blood glucose levels and high insulin requirements.
In 1985, the World Health Organization officially classified “malnutrition-related diabetes mellitus” as a distinct diabetes type, but then in 1999 dropped the category, citing a lack of evidence that malnutrition or protein deficiency causes diabetes.
However, in 2022, Meredith Hawkins, MD, professor of medicine at Albert Einstein College of Medicine, Bronx, New York, published findings from state-of-the-art metabolic testing in 73 Asian Indian men, including 20 with what is now called Type 5 diabetes following exclusion of all other known forms of diabetes by immunogenetic analysis. Among the findings were lower total insulin secretion in the Type 5 group and significantly higher glucose uptake, as well as significantly lower visceral adipose tissue and hepatocellular lipids.
These findings contradict the previous belief that malnutrition-associated diabetes was associated primarily with insulin resistance. Hawkins said, “It turns out people with this form of diabetes have a profound defect in the capacity to secrete insulin, which wasn’t recognized before. This finding has revolutionized how we think about this condition and how we should treat it… it’s important to differentiate Type 5 from Type 1 diabetes because giving too much insulin can rapidly prove fatal.”
Although there are no clear guidelines yet for treating Type 5, some data suggest that very small amounts of insulin combined with oral agents may be the most effective and that their nutrition should include much higher amounts of protein and lower amounts of carbohydrates.
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