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Type 5 diabetes is a newly recognized type of diabetes that develops from long-term undernutrition. It mainly affects people from low-income countries where malnutrition is common. Type 5 usually requires insulin as treatment. But researchers are looking into other ways to treat it, like with oral medications.
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Type 5 diabetes happens when a long-term lack of nutrition in childhood prevents your pancreas from growing properly. Because of this, your pancreas doesn’t make enough insulin (a hormone). It’s also known as malnutrition-related diabetes mellitus (MRDM). A lack of insulin results in high blood sugar levels (diabetes). This type usually develops before the age of 30.
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The International Diabetes Federation officially recognized Type 5 diabetes in 2025. Researchers estimate that it affects 20 to 25 million people worldwide. It mainly affects people in regions where malnutrition is common, like in parts of Asia and Africa. Researchers are actively studying how to better diagnose and treat this type of diabetes.
Type 5 diabetes symptoms can include:
Many classic symptoms of diabetes overlap with undernutrition signs, like weight loss, fatigue and hunger. Because of this, Type 5 may be difficult to recognize.
People with Type 5 diabetes typically have underweight — a body mass index (BMI) that’s less than 18.5. They may also have features of long-term (chronic) undernutrition, like:
Research is ongoing. But scientists think Type 5 diabetes happens when chronic undernutrition prevents your pancreas from fully developing.
A lack of nutrients over a long time can affect many parts of your body and health. This can include your pancreas. It’s the organ that makes insulin, a hormone that’s necessary to manage blood sugar levels.
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People with this type have a history of malnutrition in early childhood or during fetal development. Researchers think this affects the growth of their pancreases.
Type 5 diabetes can lead to the same complications as other types of diabetes, like:
The main test to help diagnose diabetes is usually a blood glucose test. This test checks the level of glucose (sugar) in your blood. People with diabetes often have a result of over 200 mg/dL.
In the U.S. and other high-income countries, healthcare providers use other tests to help identify the type of diabetes (like Type 1 or Type 2). These may include an A1C, urinalysis and antibody tests.
Due to limited access to these kinds of tests in low- and middle-income countries, providers often misdiagnose Type 5 diabetes as Type 1 diabetes.
A history of malnutrition in childhood, a low BMI and age younger than 30 years at diagnosis can all help distinguish Type 5 diabetes from Type 1, which it can be easily confused with. A unique feature of Type 5 is that people with it often don’t have ketones in their pee at diagnosis. It’s very common for people with Type 1 to have ketones at diagnosis.
Healthcare providers typically prescribe insulin injections to manage Type 5 (malnutrition-related diabetes). Researchers are studying the possibility of using oral diabetes medications to manage it.
Researchers and healthcare providers still have a lot to learn about Type 5 diabetes. It’s gone unrecognized for a long time. With ongoing research and advocacy, experts aim to better understand and treat Type 5 diabetes.
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Whether you’ve been living with diabetes for years or you’re newly diagnosed, you want experts you can trust. Our team at Cleveland Clinic is here to help.
Last reviewed on 07/30/2025.
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