A long-overlooked type of diabetes, characterized by unique symptoms, finally receives its official designation, shedding light on a pressing health issue. In light of the escalating malnutrition crises affecting numerous nations, experts predict that cases of this newly recognized Type 5 diabetes will significantly increase. A patient undergoes a blood glucose evaluation as part of a door-to-door screening initiative in Haryana, India.
In the 1950s, a British doctor named Philip Hugh-Jones encountered a puzzling situation when 13 patients arrived at his diabetes clinic near Kingston, Jamaica. At that time, the medical community predominantly recognized two types of diabetes, now referred to as Type 1 and Type 2. Interestingly, Hugh-Jones himself was responsible for coining these terms in a comprehensive study published in 1955, which examined hundreds of patients.
While the majority of his patients fit neatly into these two categories, this specific group of 13 did not conform to either classification, as explained by endocrinologist Michael Boyne from the University of the West Indies.
"These individuals were relatively young, slim, and appeared undernourished," Boyne noted. Under usual circumstances, such appearances would be indicative of Type 1 diabetes, a condition in which individuals are incapable of producing insulin and often end up underweight.
However, there was a significant deviation from Type 1 symptoms in these patients; they never experienced ketoacidosis, a dangerous condition that arises when the body depletes its insulin supply and resorts to burning fat for energy, leading to dangerously acidic blood levels. "Despite their slender physiques, they never developed ketoacidosis," Boyne remarked, seemingly dismissing the possibility of them being Type 1 diabetics. Conversely, they also did not fall into the Type 2 category, which typically includes individuals who are overweight.
"So, he thought, 'These folks are something else. They don't belong to Type 1 or Type 2,'" Boyne recounted. This led Hugh-Jones to label them Type J, with the 'J' originating from Jamaica. However, this name did not gain traction, nor did multiple subsequent labels that emerged over the years. Cases of this unusual diabetes were still reported, primarily in regions suffering from malnutrition. Now, seven decades later, a collaborative international research team is advocating for the formal adoption of the term Type 5 diabetes.
Dr. Meredith Hawkins, a diabetes researcher at Albert Einstein College of Medicine, asserted, "The timing is perfect to acknowledge this condition, which may affect up to 25 million individuals." In April, the International Diabetes Federation officially recognized the new designation. Following this, Hawkins and her international collaborators have called for other influential organizations, including the World Health Organization, to endorse the term as well.
Hawkins emphasized the importance of naming this condition from a scientific standpoint. "This recognition is crucial, as patients stand to gain significantly from it," she explained, noting that some are currently receiving treatments that might be fatal.
Why does a name matter?
After Hugh-Jones's publication in 1955, researchers across the globe began to encounter similar cases that did not align with Type 1 or Type 2 classifications. "Over the years, this condition has gone by various names, but they've all generally tried to describe the same phenomenon," Boyne shared. Particularly in Southeast Asia, India, and Africa, there has been a pronounced correlation with early-life malnutrition.
Hawkins first observed this atypical type of diabetes while working in Uganda in the early 2000s. "Many impoverished patients arriving from rural backgrounds were strikingly thin, malnourished, yet presenting very high blood sugar levels," she recalled. These patients showed classic diabetes symptoms, such as frequent urination, constant thirst, and even nerve damage.
Initially, Hawkins and other medical professionals viewed these cases as typical Type 1 diabetes. The common treatment protocol was to send them home with substantial amounts of insulin. Unfortunately, they quickly discovered that this strategy could prove deadly. "Essentially, it was like giving them a death sentence due to low blood sugar if they didn't have enough food at home," Hawkins explained. Insulin is crucial for transporting sugar from the bloodstream into cells for energy use. Any excess insulin combined with insufficient food intake can lead to dangerously low blood sugar levels.
Hawkins expressed, "Witnessing the fatalities of young individuals due to low blood sugar resulting from improper treatment truly propelled our research forward."
What sets Type 5 diabetes apart?
Since those early days, Hawkins and fellow researchers have come to understand that individuals diagnosed with Type 5 diabetes exhibit physiological differences when compared to those with Type 1 or Type 2 diabetes. These variations appear to be deeply influenced by malnutrition.
"Individuals with Type 5 diabetes have typically been malnourished starting from the time they were in utero," Hawkins clarified. "They experience malnutrition during their toddler years, childhood, adolescence, and into adulthood. They are the ones who never catch up; they remain very thin, which differentiates them from other diabetes types."
One critical distinction lies in the pancreas, the organ responsible for insulin production. Evidence indicates that early-life malnutrition adversely affects the pancreas's ability to produce enough insulin.
"Their pancreas isn't completely dysfunctional, but it certainly isn't in good shape," Boyne described. Nonetheless, individuals with Type 5 diabetes find themselves in a complex position. They can produce some insulin, and their bodies respond to it, in contrast to those with Type 2 diabetes, who often exhibit insulin resistance. However, they are unable to generate sufficient insulin to effectively manage their blood sugar levels.
"We are convinced that if this represents a separate category of diabetes, it warrants a distinct treatment approach," Hawkins emphasized. Determining the optimal treatment will require further research, a course of study that she hopes the new name will stimulate.
A divide in opinion
Not everyone in the diabetes research community agrees on whether Type 5 diabetes constitutes its own unique category or merits a distinctive name. Anoop Misra, an endocrinologist from the Centre of Nutrition & Metabolic Research in New Delhi, pointed out that formal classification could inadvertently solidify what might actually be a spectrum of poorly defined Type 2 diabetes rather than a separate condition altogether. He argues that the current data is insufficient to conclusively affirm a unique form of diabetes.
Nonetheless, the International Diabetes Federation maintains a contrary perspective, having established a dedicated working group to enhance diagnostic criteria and treatment protocols for Type 5 diabetes. They opted for the name Type 5 to avoid contention, as there are ongoing initiatives to categorize other diabetes forms as Types 3 and 4. Advocates are hopeful that acknowledgment from other health authorities, such as the World Health Organization, will further bolster this endeavor, especially at a time when the incidence of Type 5 diabetes is anticipated to rise in various global regions.
Areas grappling with severe food crises, such as Gaza, Sudan, the Democratic Republic of Congo, Nigeria, and Yemen, could be creating a higher risk generation for Type 5 diabetes, according to Boyne. "It’s truly heartbreaking," he remarked. "This is a preventable condition—one that can be addressed through proper nutrition."
But here's the kicker: as we dive deeper into the implications of naming and understanding this neglected form of diabetes, how should we approach the treatment of such patients? Are new classifications necessary, or do we risk complicating existing diabetes categories? We welcome your thoughts—feel free to share your opinions in the comments.
