The link between malnutrition and type 5 diabetes: What you need to know
Dr. Meredith Hawkins, the founding director of the Global Diabetes Institute at Albert Einstein College of Medicine and co-chair of the IDF working group on type 5 diabetes, noted that type 5 diabetes could also impact certain populations in the United States, including children in foster care or migrants who have faced food insecurity.
Diabetes in all its forms impacts the body's ability to process glucose, a critical energy source for cells. Without proper regulation, glucose accumulates in the bloodstream, potentially causing damage to vital organs, including the eyes, kidneys, nerves, and heart.
Type 1 diabetes occurs when the immune system destroys the insulin-producing cells in the pancreas, resulting in little or no insulin to help cells absorb glucose. In type 2 diabetes, the body either does not use insulin effectively or doesn't produce enough, and obesity is a significant risk factor. However, type 5 diabetes arises from childhood undernutrition, which can impair pancreatic development and reduce insulin production, according to Dr. Hawkins.
Although experts have recognized type 5 diabetes for decades, it was often misclassified as either type 1 or type 2 diabetes. Dr. Hawkins explained that individuals with type 5 diabetes typically require very small amounts of insulin or oral medication, as standard insulin doses can dangerously lower blood sugar and lead to severe complications, even death. She first noticed these treatment failures while treating young patients in Africa years ago.
Currently, the American Diabetes Association (ADA) recognizes type 1, type 2, and gestational diabetes, as well as other types that are caused by specific conditions such as cystic fibrosis, pancreatic disease, organ transplant, steroid therapy, or genetic factors. Other medical organizations acknowledge additional forms of diabetes, such as type 3, which links insulin resistance to Alzheimer's disease, and type 4, which is age-related and found in lean, older adults.
Despite advances in diabetes classification, there is no specific blood test to diagnose type 5 diabetes. Dr. Hawkins explained that the diagnosis is largely based on assessing the clinical picture, particularly the patient's history of childhood malnutrition.
While malnutrition is the primary factor defining type 5 diabetes, Dr. Hawkins believes that awareness of this condition may also benefit individuals in higher-income countries who experience significant weight loss, such as those who undergo bariatric surgery or use GLP-1 medications. Concerns about this issue were raised by colleagues in Japan, who observed young women intentionally starving themselves and displaying a clinical profile similar to that of individuals with type 5 diabetes. However, Dr. Hawkins emphasized that more research is needed to understand whether extreme weight loss can actually lead to type 5 diabetes.
Significant weight loss can reduce muscle mass, which, in turn, affects how the body processes glucose. As skeletal muscle is the body's largest insulin-sensitive tissue and accounts for much of its glucose uptake, losing muscle mass can result in insulin resistance—a condition where cells do not properly respond to insulin, leading to elevated blood sugar levels.
While the American Diabetes Association has not yet classified type 5 diabetes, experts believe that the delay is likely due to the time required for internal review and consensus within the organization. Dr. Hawkins anticipates that the ADA will formally address the condition soon.
Dr. Rozalina McCoy, an associate professor of medicine at the University of Maryland School of Medicine, suggested that there may already be cases of type 5 diabetes in the US that have gone unrecognized by healthcare providers. "It is important to consider this unique type of diabetes and treat it carefully, not only in those who have a childhood history of malnutrition, but also in those who have lost significant weight or are malnourished for other reasons, such as an eating disorder or weight loss treatment, either surgical or medical," McCoy said.
As more attention is brought to type 5 diabetes, healthcare providers are urged to recognize and properly treat this condition, especially for individuals with a history of childhood malnutrition or significant weight loss.
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