Dr. Ahmed Type 5 diabetes, also known as malnutrition-related diabetes mellitus (MRDM), is a distinct form of diabetes affecting lean adolescents and young adults, especially in low‑ and middle‑income countries.
First documented in Jamaica around 1955, it was formally recognized by the World Health Organization as MRDM in the 1980s, although this classification was later withdrawn due to limited evidence.
In April 2025, the International Diabetes Federation (IDF) officially designated it as Type 5 diabetes, thanks to pivotal research led by Dr. Meredith Hawkins and colleagues, highlighting its unique link to undernutrition and impaired pancreatic development. [Ref]
Who Is Affected—and Why
Type 5 diabetes or MRDM predominantly affects lean adolescents and young adults, often males, in regions where chronic undernutrition is common.
People with this condition typically have a BMI below 18.5, and many show signs of poor growth or muscle wasting, despite high blood sugar levels.
The root cause is early-life malnutrition, either in utero or during childhood. This greatly affects the development of the pancreas, particularly the insulin-producing β‑cells.
And without optimal nutrition in these critical developmental periods, the pancreas doesn’t grow to its full capacity, limiting the body’s ability to produce insulin effectively.
This form of insulin deficiency is not caused by autoimmune destruction (as in type 1), nor by insulin resistance (as in type 2), but by underdevelopment of the pancreas itself.
Estimates suggest that 25 million people worldwide may be living with Type 5 diabetes, most of whom are concentrated in South Asia, Africa, and other resource-limited settings. [Ref]
Symptoms
Type 5 diabetes symptoms overlap with those of other forms of diabetes:
- Excessive thirst
- Frequent urination
- Unexplained weight loss
- Fatigue
- Slow wound healing
- Recurrent infections
What makes Type 5 different is that the people who experience these symptoms are often underweight and lack other metabolic features typically associated with type 2 diabetes, such as high cholesterol, fatty liver, or hypertension.
They also don’t show autoimmune markers, which rules out type 1 diabetes. And despite having very high blood sugar, many do not develop diabetic ketoacidosis, which is unusual in severe insulin deficiency.
This is because these patients have both insulin and glucagon deficiency, as the condition affects both the exocrine and endocrine cells of the pancreas.
MRDM (Malnutrition-related Diabetes Mellitus): Definition, Criteria, Diet
How Type 5 Diabetes Differs from Other Types
Type 5 diabetes sits apart from other well-known forms:
- Type 1 diabetes is autoimmune, where the body’s immune system destroys its β‑cells, requiring lifelong insulin.
- Type 2 diabetes is primarily metabolic, driven by insulin resistance and often associated with obesity.
- Type 3 Diabetes is similar to Type 2 Diabetes with features of insulin resistance as well as insulin deficiency. However, patients with type 3 diabetes have dominant features of cognitive impairment as seen in neurodegenerative diseases like Alzheimer’s.
- Type 3 C Diabetes: It is a form of diabetes that develops after chronic pancreatitis, pancreatic cancer, or medical conditions affecting the pancreas, such as cystic fibrosis and hemochromatosis
- Type 4 Diabetes: It is not a formal or recognized form of diabetes. However, it is referred to as patients with mild age-related diabetes in elderly patients over 65 years of age.
- Type 5, however, is non-autoimmune and non-obesity-related. It is marked by insulin deficiency due to poor development of the pancreas caused by long-term undernutrition.
Quite frequently, patients diagnosed with Type 5 diabetes are regarded as patients with Type 1 diabetes, and they are prescribed a routine insulin regimen, which may be harmful for them.
Such patients are extremely sensitive to insulin and can develop a life-threatening condition of hypoglycemia with high doses.
Diabetes Types: The 5 Clusters of Type 2 Diabetes
Genetics and Type 5 Diabetes
While early-life malnutrition is the primary environmental driver of Type 5 diabetes, genetics also plays an important role.
Research has shown that certain individuals have a genetic predisposition to impaired insulin production, which becomes evident only when combined with early nutritional deprivation.
Studies, demonstrate that fetal malnutrition can alter gene expression, particularly genes involved in insulin secretion like IGF2BP2 and TCF7L2.
These genes are also implicated in type 2 diabetes, but in the context of Type 5, their effects are compounded by a failure of pancreatic development during the fetal and postnatal periods. [Ref]
Further evidence from India and sub-Saharan Africa has shown that people with Type 5 diabetes may share MODY-like features—a monogenic form of diabetes—suggesting that single-gene mutations affecting β-cell function could also play a part.
For example, variations in HNF1A and GCK have been seen in some lean, early-onset patients previously thought to have type 1 or 2 diabetes. [Ref]
In essence, Type 5 diabetes appears to result from a gene-environment interaction, where malnutrition unmasks or exacerbates underlying genetic weaknesses in insulin regulation.
However, genetic testing remains rare in low-income settings where the condition is most prevalent, meaning many cases remain misunderstood or unclassified.
NIDDM (Non-Insulin Dependent Diabetes Mellitus) – T2DM
Treatment: Nutrition First, Insulin Later
The most effective approach to managing Type 5 diabetes starts not with insulin or medication, but with nutrition.
Rehabilitation includes a high-protein, energy-rich diet with adequate micronutrient supplementation (especially zinc, magnesium, and B vitamins).
Weight restoration and repletion of missing nutrients are critical in improving pancreatic function and increasing insulin sensitivity.
Only when necessary and carefully monitored, should low-dose insulin therapy be introduced. These patients often require far less insulin than typical type 1 patients, and overtreatment can lead to severe hypoglycemia.
Some individuals respond to oral medications like sulfonylureas or metformin, particularly if residual β-cell function remains.
In specific cases, such as fibro-calculous pancreatic diabetes (a subtype of Type 5), enzyme replacement therapy is needed to support digestion and absorption due to exocrine insufficiency.
Classification of Diabetes: ADA 2023 Updates
Lifestyle Interventions and Type 5 Diabetes
Beyond medical and nutritional therapy, lifestyle changes can greatly help manage Type 5 diabetes. Because many patients are underweight and lack muscle mass, light to moderate exercise, once nutrition is stabilized, can improve insulin use and prevent complications.
Structured meal planning and consistent sleep patterns further reduce glucose variability and improve energy balance.
Preventing secondary infections, maintaining hygiene, and supporting mental health are also essential in these often marginalized populations.
Why Classifying Type 5 is Important?
Unfortunately, millions of people have been denied treatment or have received the wrong treatment due to a misidentified or undetected type of diabetes.
With official recognition:
- Public health systems can design appropriate screening tools
- Training guidelines can be developed for clinicians in rural or underserved areas
- Nutrition programs for at-risk children and pregnant women can become central to diabetes prevention
- Research and funding can flow into neglected regions that are disproportionately affected
Conclusion
Type 5 diabetes is a unique, biologically distinct form of diabetes born out of early-life malnutrition and influenced by genetics. Its main cause is insulin deficiency without the classic markers of type 1 or the obesity of type 2.
Now that it has a name, it also has a future—where diagnosis can be timely, treatment can be safer, and prevention can start early.
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