Type 5 diabetes as a growing malnutrition driven health crisis in low and middle income countries

Type 5 diabetes mellitus (T5DM), recently redefined as malnutrition-related diabetes, represents a distinct form of severe insulin-deficient diabetes that arises from chronic undernutrition, particularly during childhood and adolescence. Unlike type 1 and type 2 diabetes, T5DM is neither autoimmune-mediated nor primarily driven by insulin resistance. Instead, it results from impaired pancreatic development and disrupted insulin signaling pathways due to prolonged nutritional deficiencies. This commentary proposes the formal adoption of "malnutrition-related diabetes" as the nomenclature for T5DM to more accurately reflect its etiology and clinical features. The condition is disproportionately prevalent in low and middle income countries, where malnutrition remains widespread and access to advanced diabetes care is limited. Accurate recognition and classification of T5DM are critical for developing appropriate diagnostic criteria, management strategies, and public health policies. Treatment typically focuses on nutritional rehabilitation and cost-effective oral antidiabetic therapies, rather than insulin dependence. Establishing malnutrition-related diabetes as a distinct category will support targeted research, improve patient outcomes, and raise awareness of its growing burden in vulnerable populations. This commentary urges the global health community to recognize malnutrition-related diabetes as a pressing metabolic disorder requiring urgent attention in low resource settings.

The online version contains supplementary material available at 10.1007/s40200-025-01674-w.