Representational file image.
| Photo Credit: B. Velankanni Raj
At the International Diabetes Federation’s (IDF) World Diabetes Congress held in Bangkok last week, an epoch-making decision was taken, nearly 75 years after a particular type of diabetes was first recorded. Peter Schwarz, president of IDF, announced the inauguration of the Type 5 Diabetes Working Group, turning attention to malnutrition-induced diabetes.
While Type 2 diabetes, where the global numbers are largest, can arise out of unregulated intake of food, and consequently, excess weight, Type 5 diabetes is at the polar end of the weight and nutrition spectrum, understood to be associated with undernutrition and even low weight. It was first reported in Jamaica in 1955, and then defined as J-type diabetes, and the WHO classified it in 1985 as malnutrition-related diabetes mellitus, only to remove that in 1999, citing lack of evidence of causal association with malnutrition.
However, other nations, including India, Sri Lanka, Bangladesh, Uganda, Ethiopia, Rwanda and Korea, started reporting such cases and it is estimated that today, there are about 25 million people globally living with Type 5 diabetes. “Until this working group was formed at the IDF Congress, this form of diabetes has been largely understudied and misdiagnosed,” says Nihal Thomas, senior professor, department of endocrinology, diabetes and metabolism, Christian Medical College, Vellore.
Dr. Thomas has been collaborating, since 2008, with Meredith Hawkins, director, Global Diabetes Institute, Albert Einstein College of Medicine, New York, who has been at the forefront of research on how early-life undernutrition is a potential risk factor for development of diabetes in adult life. Both of them are chairs of the IDF Working Group. He says an initial consensus meeting to lay the path towards the IDF Working Group, was held in CMC Vellore in January 2025, organised along with colleague Felix Jebasingh. Here, 42 participants from across the world signed the Vellore Declaration, to promote more research and increase awareness about Type 5 diabetes among clinicians and researchers globally. “In fact, it was here that Prof. Schwarz suggested the name Type 5 diabetes to distinguish it from other forms,” Dr. Thomas adds.
The results of a study published in 2022 among patients at CMC Vellore established Type 5 diabetes as a distinct metabolic entity. People with this form of ‘lean diabetes’ have a history of malnutrition in utero and continue to have a low BMI into adulthood, drawing in the thrifty gene theory of diabetes, Riddhi Dasgupta, a co-author on the paper, told The Hindu then.
Prof. Hawkins explained that because of the programming in utero, these people have actually accumulated more fat than planned for by the gene, leading to the ‘thin-fat’ phenomenon. These individuals never catch up with nutritional requirements, and remain nutritionally challenged as adults.
The Working Group has been tasked with defining diagnostic criteria for Type 5 diabetes, diagnostic and management guidelines, establishing a global registry to facilitate global research collaborations, promoting research on the pathophysiology and management and develop education modules to train healthcare professionals worldwide.
Published – April 13, 2025 12:54 am IST
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