Hyderabad: Long-held beliefs about who is at risk are being called into question by a recently identified kind of diabetes. This type manifests in people who are frequently extremely underweight, in contrast to those that are typically linked to excess weight or lifestyle choices.
In some areas where childhood undernutrition is still common, blood sugar levels might be elevated even when calorie intake is consistently low.
Malnutrition-related diabetes, which is different from type 1 and type 2, was formally recognized as “type 5 diabetes” by the International Diabetes Federation (IDF) on April 8 of this year.
A panel convened in India in January 2025 to develop a consensus statement regarding the disease, which is thought to impact millions of people worldwide yet frequently eludes standard diagnosis.
Severe insulin-deficient diabetes (SIDD), often known as type 5 diabetes, is characterized by high insulin deficiency levels and inadequate metabolic regulation. Chronic undernutrition, particularly in infancy or adolescence, is the main cause of this condition, which is sometimes referred to as malnutrition-related diabetes.
In India, where almost 10 crore individuals have diabetes, a sizable portion may unintentionally fall into this group, particularly in areas where early nutrition provision is restricted. Accurately recognizing it is becoming as important as controlling it, since its therapeutic pathway is still being discovered.
An explanation of a lesser-known diabetic
Chronic malnutrition is causing a distinct type of diabetes that is starting to differentiate from other forms in places where food insecurity is still a daily occurrence. This variety, often referred to as severe insulin-deficient diabetes or malnutrition-related diabetes, differs from the more well-known varieties in that it is not caused by autoimmune diseases or obesity.
The autoimmune destruction of cells that produce insulin is the cause of type 1 diabetes. The incapacity of the body to utilize the insulin it produces is a hallmark of type 2 diabetes. Diabetes type 5 is unique. According to IDF, it is thought to result from compromised pancreatic development brought on by chronic dietary deficits.
Dr. Jimmy Prabhakaran, Senior Consultant in Internal Medicine and Diabetology at Rela Hospital in Chennai, told South First that the condition occurs when the pancreatic cells that produce insulin do not fully grow throughout adolescence as a result of a protracted dietary deficit. “This results in decreased insulin production because these cells were underdeveloped from the beginning, not because the body kills them,” he continued.
Malnutrition-related diabetes arises from direct structural and functional damage brought on by early-life protein-energy malnutrition, whereas type 1 diabetes is characterized by insulin resistance and type 2 diabetes includes the autoimmune death of pancreas cells.
According to Dr. Prabhakaran, “it’s most commonly observed in people with very low BMI, usually under 18, and is linked to deficiencies in protein, zinc, vitamin A, chromium, and other micronutrients.”
“It is mostly a socioeconomic issue,” he stated, highlighting the underlying cause, hunger. Although this was documented as early as the 20th century, other prevailing conditions prevented it from receiving much attention.
When diabetes is brought on by inadequate nutrition
Early adolescence or adulthood is when this type of diabetes usually manifests, especially in people from low-income families. He pointed out that it is frequently misinterpreted as either type 1 or type 2 diabetes, or even as MODY [Maturity Onset Diabetes of the Young]. “But it has distinctive characteristics; these people are lean, typically stunted, and exhibit elevated blood sugar levels not due to insulin resistance or autoimmunity, but rather because they don’t make enough insulin initially.”
Regarding therapy, Dr. Prabhakaran clarified that many individuals might not need insulin right away. “To improve insulin secretion, we can start with a good balance of nutritional support and oral medication,” he stated. He stated that autoantibody testing must be used to rule out other types of diabetes, such as type 1, and that insulin is only explored when the patient does not react to initial treatment.
He emphasized that promoting the diet of children and adolescents is the key to prevention. The pancreas is still evolving, especially during adolescence. It’s a crucial window,” he said.
He emphasized the importance of dietary discipline and early nutritional intervention, saying, “We need to ensure balanced, protein-rich diets and avoid junk food.” It is crucial to raise public understanding of healthy eating practices and the long-term significance of nutrition. The pancreas just cannot develop to its maximum capacity otherwise.
Understanding this less well-known type of diabetes necessitates changing our perspective on the condition. It’s about what kids eat, when they eat it, and how it affects their bodies for the rest of their lives, not simply about sugar or weight.
Early identification and nutritional intervention can have a long-lasting impact in areas where undernutrition is prevalent. Raising awareness and going past the typical symptoms could be the first practical step in tackling this hidden burden as research continues.
