UP TO 25 million people across the world may have an “under-recognised and under-researched” form of diabetes.
People with the condition – known as type 5 diabetes – may be misdiagnosed or not treated properly due to “lack of evidence-based treatment guidelines”, researchers warn.
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Type 2 diabetes, the most common form of the disease, is often linked to obesity.
By contrast, type 5 diabetes tends to affect people who are very thin and suffered long-term undernutrition in childhood.
Undernutrition is a form of malnutrition where the body doesn’t get all the nutrients it needs to sustain it.
Type 5 diabetes is seen particularly in young adults under the age of 30 in low- and middle-income countries, including India, Pakistan, Bangladesh, Uganda, Ethiopia, Rwanda, Nigeria, and Indonesia.
Symptoms of type 5 diabetes can be similar to those caused by other types, such as feeling thirsty, peeing more often and slow-healing cuts.
But classic symptoms of diabetes can overlap with signs of undernutrition, like weight loss, fatigue and hunger, making type 5 hard to spot.
“We call upon the international diabetes community to
recognise this distinct form of the disease,” researchers wrote in the Lancet Global Health journal.
“This neglected entity […] likely affects the quality and length of life of millions of people worldwide,” they added.
Diabetes is a condition where blood sugar levels become too high because the body can’t make insulin, can’t make enough of it or doesn’t use it properly.
Insulin helps your body use glucose for energy. Without it, the level of glucose in the blood becomes too high.
Type 1 diabetes is usually caused by a problem with your immune system, while type 2 can be related to your weight, age, ethnicity and whether other people in your family have it.
“Diabetes is associated with an increasing public health burden worldwide, and the number of people living with the disease is expected to increase markedly in low- income and middle-income countries, which are facing a double burden of undernutrition and
overnutrition,” the report authors wrote.
In fact, a recent global study published in The Lancet Diabetes and Endocrinology found around 45 per cent of people with diabetes (type 1 and 2) worldwide do not know they have it.
“Although the growing burdens of obesity and population ageing are key risk factors for the increasing prevalence of type 2 diabetes, undernutrition also appears to contribute to the burden, since atypical forms of non-type-1 diabetes have been reported to occur
in young, lean individuals with a life course history of undernutrition,” researchers went on.
When was type 5 diabetes first established?
Type 5 diabetes was first introduced in 1955 as a condition seen in people who are underweight and have a history of early life malnutrition.
In 1985, was formally classified by the World Health Organization (WHO) as “malnutrition-related diabetes mellitus”.
But it was removed from the list of types of diabetes in 1999 due to disagreement as to whether malnutrition could in fact cause this type of diabetes.
Now, the report authors said decades of research using modern techniques now show that type 5 diabetes patients have distinct symptoms compared to type 1 and type 2 diabetes.
Type 1 vs type 2 diabetes
There are two main types of diabetes, which causes a person’s blood sugar level to become too high.
Type 1 diabetes is a lifelong condition where the body’s immune system attacks and destroys the cells that produce the hormone insulin.
It affects around 344,000 people in the UK.
Type 2 diabetes on the other hand is far more common, accounting for more than 90 per cent of the 4.4million adults with diabetes.
It occurs when the body doesn’t produce enough insulin, or the body’s cells don’t react to it properly.
There are no lifestyle changes you can make to lower your risk of type 1 diabetes.
But you may be at higher risk of type 2 diabetes if you are overweight or obese, eat unhealthily, have a family history of the condition, take certain medications for a long time, have high blood pressure, and have had gestational diabetes during pregnancy.
People of Asian, Black African or African Caribbean origin are also at increased risk.
Source: NHS and Diabetes UK
For example, people with type 5 diabetes don’t produce enough insulin, but their body still processes insulin normally.
They also typically don’t experience ketoacidosis – sudden onset of illness common in type 1 diabetes – and their immune systems don’t attack the pancreas.
The causes of type 5 diabetes aren’t yet completely understood.
But it’s thought that undernutrition in the womb, followed “persistent undernutrition during childhood and adolescence” can increase the risk, according to researchers.
While evidence suggests that at least 25 million people may be affected by type 5 diabetes, the report authors said it remains under-recognised and under-researched.
As a result, the number of type 5 diabetes patients is under-reported and people with the condition are misdiagnosed or don’t get the right treatment.
“Misdiagnosis and underdiagnosis are likely to have negatively impacted the clinical care and lives of millions of individuals worldwide,” the report noted.
The report authors also noted: “Incorrectly diagnosing these young, lean individuals with type 1 diabetes could lead to serious iatrogenic hypoglycaemia [low blood sugar caused by medical treatment].
“Individuals with type 5 diabetes might only need minimal amounts of insulin, or alternative approaches to stimulate insulin secretion, to manage hyperglycaemia and avoid hypoglycaemia [high and low blood sugar levels].”
They will also have specific nutritional needs to help them reach a healthy weight.
The International Diabetes Federation wants to change this by forming a new working group to set out a formal way of diagnosing type 5 diabetes.
It also hopes to encourage research the signs and treatment of type 5 diabetes, in the hopes of bettering the lives of millions of people worldwide.
Signs of type 5 diabetes
Common symptoms include:
- Very low body weight or trouble gaining weight
- Constant tiredness or weakness
- Excessive thirst
- Frequent urination
- Blurred vision
- Muscle loss
- Poor appetite or trouble digesting food
- No response — or bad reactions — to insulin treatment
The condition is often inherited — if one parent carries the gene, their child has a 50 per cent chance of developing it
People with type 5 diabetes are typically underweight, with a BMI of less than 18.5.
A healthy BMI is between 18 and 24.9, suggesting that those with type 5 diabetes tend to be on the thinner side of healthy.
Scientists think type 5 diabetes happens when chronic undernutrition prevents the pancreas from fully developing, making it harder to manage blood sugar, according to Cleveland Clinic.
Patients’ bodies can’t properly absorb and store nutrients, especially sugar and fat to put on any weight, or store muscle.
As a result, they often stay very thin, even if they’re eating enough.
