In the early 1950s, British physician Philip Hugh-Jones encountered a perplexing case at his diabetes clinic near Kingston, Jamaica. He observed 13 patients whose symptoms did not align with the known classifications of diabetes, which were broadly recognized as Type 1 and Type 2 at the time. Hugh-Jones, who later coined these terms in a 1955 study involving hundreds of patients, found that the unique characteristics of these 13 individuals defied categorization.
According to Michael Boyne, an endocrinologist at the University of the West Indies, these patients were relatively young, thin, and appeared malnourished. Typically, such traits suggest Type 1 diabetes, where individuals cannot produce their own insulin and may become underweight. However, these patients lacked a common symptom of Type 1—ketoacidosis—which occurs when the body runs out of insulin and begins using fat for energy, leading to dangerously acidic blood. This absence of ketoacidosis, coupled with their thinness, led Hugh-Jones to propose a new classification: Type J for Jamaica. Unfortunately, this name did not gain traction.
Fast forward 70 years, and a coalition of international researchers is advocating for the recognition of a new classification: Type 5 diabetes. Dr. Meredith Hawkins, a diabetes researcher at Albert Einstein College of Medicine, asserts that recognizing this condition is crucial, as it could potentially affect as many as 25 million people worldwide. Her efforts, alongside the International Diabetes Federation, aim to establish a formal name for this distinct form of diabetes.
Historically, since Hugh-Jones published his findings, similar cases of diabetes that do not conform to Type 1 or Type 2 classifications have surfaced globally. While various names were proposed over the years, they all described similar conditions, particularly in regions with high rates of malnutrition, such as Southeast Asia, India, and Africa. Dr. Hawkins first encountered this unusual diabetes form during her work in Uganda in the early 2000s, where she noted that many impoverished patients presented with high blood sugar levels yet appeared malnourished and thin.
Initially, these patients were often misdiagnosed as having Type 1 diabetes, leading to a standard treatment of insulin administration, which, in many cases, proved fatal due to the patients’ inability to maintain stable blood sugar levels without sufficient food. Hawkins emphasizes the dangers of this misclassification, stating that too much insulin without adequate nutrition can induce dangerously low blood sugar levels, essentially becoming a death sentence for those affected.
Research has since indicated that individuals with Type 5 diabetes exhibit physiological differences compared to those with Type 1 or Type 2 diabetes. These differences are believed to stem from chronic malnutrition, which can begin as early as in utero. Hawkins notes that these patients often remain thin throughout their lives, lacking the ability to catch up in weight, distinguishing them from other diabetic forms.
One significant physiological difference lies in the pancreas’ functionality. Evidence suggests that malnutrition during critical developmental stages can impair the pancreas's ability to produce insulin effectively. Boyne explains that while individuals with Type 5 diabetes can produce some insulin, it is insufficient to maintain normal blood sugar levels, setting them apart from those with Type 1 diabetes, who cannot produce insulin at all, and Type 2 diabetes patients, who often experience insulin resistance.
While some in the diabetes research community remain skeptical about the necessity of a distinct classification for Type 5 diabetes, the International Diabetes Federation has launched a working group committed to developing diagnostic criteria and treatment guidelines. This initiative emphasizes the urgency of recognizing Type 5 diabetes, particularly in light of increasing food crises in regions like Gaza, Sudan, and Yemen, which pose a heightened risk for future cases of this condition.
As Boyne poignantly remarks, the rise of Type 5 diabetes is preventable through improved access to food and nutrition. Advocates hope that broader recognition of this condition by health authorities, including the World Health Organization, will facilitate better treatment and support for those affected.
