Could a form of diabetes driven by childhood undernutrition change how clinicians treat millions worldwide?
At the IDF World Diabetes Congress in Bangkok, the International Diabetes Federation gave official recognition to a new classification linked to chronic undernutrition and impaired pancreatic growth. This announcement matters for public health in the United States and globally because it reframes care for many people who do not fit classic categories.
The condition affects an estimated 20–25 million people worldwide, largely in South and South‑East Asia and sub‑Saharan Africa. Affected adolescents and young adults often have low BMI and severe insulin deficiency without the insulin resistance seen in other forms.
Clinical urgency is clear: mislabeling these patients as other types can lead to wrong treatment either excessive insulin or missed nutritional support. A new Working Group will draft diagnostic criteria, therapy guidance, a global registry, and education over the next two years.
Key Takeaways
- The IDF’s formal recognition at the world diabetes congress marks a major public health update.
- This form links chronic undernutrition to impaired pancreatic development and insulin deficiency.
- About 20–25 million people worldwide may be affected, mainly in low‑resource regions.
- Correct classification can prevent inappropriate insulin regimens and improve outcomes.
- A dedicated Working Group will define diagnosis, treatment, and a global research registry.
IDF officially recognizes Type 5 diabetes at the World Diabetes Congress
The International Diabetes Federation used the 2025 world diabetes congress in Bangkok to place a malnutrition-linked form of diabetes on the global agenda.
International Diabetes Federation announcement and global impact
The announcement highlighted equity and science as top priorities. Professor Peter Schwarz framed the action as a step to save lives and close care gaps.
Our goal is to bring rigorous standards and fair access to people who have been overlooked, said Professor Peter Schwarz.
Type 5 Diabetes Working Group: leaders, mandate, and timeline
The diabetes working group is co-chaired by Dr Meredith Hawkins of the Global Diabetes Institute at Albert Einstein College of Medicine and Dr Nihal Thomas of Christian Medical College in Vellore.
The working group will draft formal diagnostic criteria, create therapeutic guidance, build a global research registry, and produce education modules within two years.
| Item | Lead | Timeline |
|---|---|---|
| Diagnostic criteria | Working Group | 24 months |
| Therapeutic guidelines | Hawkins Thomas | 24 months |
| Global registry | Global Diabetes Institute | Ongoing |
| Provider education | Christian Medical College | 24 months |
How many people are affected and why this matters
An estimated 20–25 million people are affected, mainly in South‑East Asia and sub‑Saharan Africa. Better criteria will cut misdiagnosis and unsafe insulin use.
What Newly Recognized Type 5 Diabetes is and how it differs from other types
Evidence shows a malnutrition-driven form of severe insulin deficiency with a distinct metabolic signature.
Pathophysiology: severe insulin-deficient diabetes linked to malnutrition
This condition arises when long-term undernutrition in childhood stalls pancreatic development. Impaired growth leaves fewer functional beta cells and a reduced insulin reserve, causing sustained high glucose levels.
Distinct from type 1 and type 2
Unlike autoimmune type 1, this form is non‑autoimmune and does not involve immune destruction of insulin-producing cells. Unlike type 2, the body usually remains sensitive to insulin the core problem is low insulin production rather than resistance.
Who is most affected
People most often present in adolescence or young adulthood. Many are lean, with a body mass index below 19 kg/m², and come from low- and middle-income countries across South‑East Asia and sub‑Saharan Africa.
- Early-life undernutrition and poor maternal nutrition impair organ development and later glucose control.
- Because insulin resistance is not dominant, some patients respond to targeted oral agents or low‑dose insulin plus nutritional rehabilitation.
- Fluctuating glucose levels and limited diagnostics in affected countries make accurate classification hard without standardized criteria.
Why accurate categorization matters
Correct labeling aligns therapy with biology, avoids unnecessary high-dose insulin, and prioritizes nutritional support alongside glucose control.
From oversight to action: history, diagnosis, and treatment implications
Observations from low‑resource clinics slowly formed a reproducible pattern over many years.
A brief history: early observations, WHO changes, and the 2025 update
Clinicians reported malnutrition-linked hyperglycemia beginning in the mid‑20th century. The WHO included a malnutrition-related class in 1985 but removed it in 1999 when follow‑up studies were scarce.
In January 2025 an expert panel in India voted to restore formal recognition type diabetes, and the International Diabetes Federation endorsed the move at the world diabetes meeting in Bangkok.
Diagnosis and misdiagnosis risks: why formal diagnostic criteria matter
Absence of standard diagnostic criteria has driven routine misdiagnosis as type 1 or type 2, especially in countries with limited labs.
Misclassification can lead to dangerous treatment decisions, including excessive insulin use when nutrition is the root problem.
- Misdiagnosis may trigger intensive insulin regimens that cause hypoglycemia and poor control.
- Lean phenotype and fluctuating glucose levels often mislead clinicians without clear criteria.
- Standardized diagnostic criteria will improve research, surveillance, and care pathways.
| Period | Action | Impact |
|---|---|---|
| Mid‑20th century | Case reports | Early clinical pattern noted |
| 1985–1999 | WHO classification added then removed | Confusion and lost continuity |
| 2025 | Panel vote and IDF endorsement | Working group to codify diagnostic criteria |
The IDF working group will translate years of research into practical guidance. That work aims to pair careful insulin use with targeted nutrition. Better understanding now helps protect people and reduce disability in later life.
Conclusion
The diabetes federation’s action in Bangkok accelerates steps toward clear diagnostic criteria and better patient care.
This formal move brings malnutrition-related diabetes into global diabetes conversations and matters for millions of people worldwide. Clear rules will help clinicians match therapy to biology, prioritizing nutritional rehabilitation and calibrated insulin when needed.
The diabetes working group, co-chaired by Dr. Meredith Hawkins Albert Einstein College of Medicine Global Diabetes Institute and Dr. Nihal Thomas Christian Medical College , will produce strong, collaborative leadership for formal diagnostic criteria, education, and a research registry over the next two years.
Recognizing a non‑autoimmune shortage of insulin-producing cells from disrupted childhood development advances care, equity, and patient safety across countries and health systems.
