Type 5 Diabetes: The New Classification For Malnutri-tion-Associated Diabetes

Type 5 diabetes mellitus (T5DM), officially recognized by the International Diabetes Federation in 2025, is an emerging form associated with caloric-protein malnutrition, prevalent in low- and middle-income countries such as Asia and Africa. T5DM differs from traditional classifications due to the absence of autoimmunity, partial insulin secretion, and lack of ketoacidosis. Through a narrative literature review, studies highlighting its clinical and metabolic characteristics were analyzed, focusing on two often-confused pancreatic diabetes subclassifications: protein-deficient pancreatic diabetes (PDPD) and fibrocalculous pancreatic diabetes (FCPD), based on historical studies by Ahuja (1980), Mohan (1985), and recent ones, using reliable databases like PubMed, WHO, and IDF. Malnutrition impairs beta and alpha pancreatic cell development, resulting in classic diabetes symptoms exacerbated by severe catabolism, alongside reduced insulin and glucagon secretion. Fictional clinical cases illustrate diagnostic differences between PDPD and FCPD involving pancreatic impacts. Challenges in resource-limited settings, hindering insulin therapy and glycemic monitoring, are still debated. T5DM’s reinstatement as an official classification by the IDF underscores the need for research on metabolic and epigenetic mechanisms to develop tailored management guidelines for vulnerable populations.