Type 5 diabetes in low-income populations with early malnutrition is underdiagnosed and needs standardized care

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Frontiers in Medicine Published June 5, 2026 Medically reviewed June 5, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider Type 5 diabetes in malnourished populations; standardized classification and protocols are urgently needed.

This narrative review addresses Type 5 diabetes mellitus, a form of diabetes linked to early-life malnutrition, particularly in low-income and middle-income populations in resource-constrained settings. The authors synthesize available literature to characterize this underrecognized condition.

Key findings include that Type 5 diabetes remains underdiagnosed and poorly understood, with no standardized classification or management protocols. The review emphasizes the need for research collaborations and region-specific approaches to improve diagnosis and care.

Limitations acknowledged include the overall poor understanding of the condition and the lack of robust data. The review does not report specific study populations, sample sizes, interventions, or outcomes, reflecting the nascent state of evidence.

For practice, the review suggests that clinicians in resource-constrained settings should consider Type 5 diabetes in patients with a history of early malnutrition, but standardized guidelines are lacking. Further research is needed to establish clear diagnostic criteria and treatment strategies.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

This review advocates for the formal recognition of Type 5 Diabetes Mellitus, a distinct, neglected form of non-autoimmune, lean diabetes predominantly affecting low-income and middle-income populations with a history of early-life malnutrition. Characterized by impaired insulin secretion amid preserved insulin sensitivity, this phenotype exhibits unique microarchitectural alterations within pancreatic islets and is strongly linked to malnutrition-induced epigenetic reprogramming and gut microbiota dysbiosis. Recent advancements in spatial omics technologies have illuminated region-specific gene expression, inflammatory pathways, and cellular remodeling in pancreatic tissue, offering novel insights into its pathophysiology. Despite its global prevalence, especially in resource-constrained settings, Type 5 diabetes remains underdiagnosed and poorly understood, hindering the development of tailored diagnostic criteria and therapeutic strategies. This review synthesizes current epidemiological, mechanistic, and molecular evidence, emphasizing the imperative for establishing standardized classification, research collaborations—including the formation of the IDF Type 5 Diabetes Working Group—and region-specific management protocols. Recognizing this disease entity is critical for advancing health equity, improving clinical outcomes, and guiding future research in metabolic disease frameworks.