Recognizing Type 5 Diabetes: A Distinct and Urgent Clinical Challenge

Abstract

The recent recognition of a fifth type of diabetes (Type 5 diabetes) by the International Diabetes Federation represents a meaningful step forward in identifying a new and historically undefined type of diabetes largely consisting of malnutrition-related diabetes in low- and middle-income countries. Type 5 diabetes has been described as aberrant insulin secretion without insulin resistance, of which both pancreatic atrophy and renal cysts may be present and display differential mutation-dependent characteristics based on HNF1B mutations, which represents a very large proportion of malnutrition-related diabetes reported primarily in lower-income regions. For too long, Type 5 diabetes, has been misrepresented or misdiagnosed as Type 1 diabetes, including incorrect treatment with insulin therapy, which has been found to increase clinical complications. Emerging evidence, including responses to GLP-1 receptor agonists such as liraglutide, continue to build support for better health determinants through more accurate diagnosis and tailored and individual treatment possibilities. This letter seeks to promote increased awareness, screening and testing for Type 5 diabetes, and ultimately the development of country specific clinical guidelines which takes into consideration the clinical and ethical implications associated with witnessing the unfolding of Type 5 diabetes, particularly in low-income and middle-income geographic regions.