Malnutrition-related diabetes mellitus (MRDM), also known as Type 5 diabetes, is a type of diabetes mellitus characterized by reduced insulin production (similar to Type 1 diabetes). However, in MRDM, the insulin deficiency is primarily linked to malnutrition rather than autoimmune damage to the pancreatic beta cells. Unlike Type 1 diabetes, patients with Type 5 diabetes do not develop ketonuria or ketosis.

History

Type 5 diabetes was first described in Jamaica in 1955. It's most commonly seen in young men in low- and middle-income countries who have a body mass index (BMI) below 19. They are often mistakenly diagnosed with Type 1 diabetes, but these patients don't develop ketonuria or ketosis, despite high blood glucose levels and a need for insulin. In 1985, the

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

(WHO) officially classified "malnutrition-related diabetes mellitus" as a distinct type of diabetes. However, in 1999, this category was abolished, with the WHO citing a lack of evidence that malnutrition or protein deficiency directly causes diabetes. Nevertheless, on April 8, 2025, a vote to support this category took place in Bangkok, Thailand, during the World Diabetes Congress of the

International Diabetes Federation The International Diabetes Federation (IDF) is an umbrella organisation of over 240 national diabetes associations in more than 161 countries and territories. It is headquartered in Brussels, Belgium. Organization IDF is divided into seven reg ...

(IDF).

Diagnosis

Diagnostic criteria for Type 5 diabetes are currently under development. In the spring of 2025, the International Diabetes Federation (IDF) tasked a working group, which includes Meredith Hawkins, a Professor of Medicine at Albert Einstein College of Medicine (Bronx, New York), with developing official diagnostic and therapeutic guidelines for Type 5 diabetes.

Management

As of July 2025, there are no clear guidelines for treating Type 5 diabetes. Some evidence suggests that very small amounts of insulin combined with oral medications may be most effective. It's crucial to differentiate Type 5 diabetes from Type 1 diabetes, as administering too much

insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...

can quickly be fatal. The diet for patients should include significantly higher amounts of protein and fewer carbohydrates, with special attention paid to correcting micronutrient deficiencies.

References

{{Diabetes Diabetes Malnutrition