Einstein research leads to designation of new type of diabetes

APRIL 8, 2025—(BRONX, NY)— Malnutrition-related diabetes—typically affecting lean, malnourished teens and young adults in low- and middle-income countries—is now officially recognized as a distinct form of the disease, known as type 5 diabetes. The new designation, made today by the International Diabetes Federation (IDF), stems largely from the research and advocacy of Meredith Hawkins, M.D., M.S., professor of medicine, the Harold and Muriel Block Chair in Medicine, and founding director of the Global Diabetes Institute at Albert Einstein College of Medicine. 

“Malnutrition-related diabetes has historically been vastly under-diagnosed and poorly understood,” said Dr. Hawkins. “The IDF’s recognition of it as type 5 diabetes is an important step toward raising awareness of a health problem that is so devastating to so many people."

Diabetes that is caused by obesity, known as type 2 diabetes, accounts for the majority of diabetes cases in developing countries. But increasingly, said Dr. Hawkins, young people are being diagnosed with diabetes caused not by too much food but by too little—by malnutrition, in other words. Type 5 diabetes is estimated to affect 20-to-25 million people worldwide, mainly in Asia and Africa. “Doctors are still unsure how to treat these patients, who often don’t live for more than a year after diagnosis,” she said. 

Malnutrition-related diabetes was first described 70 years ago, with several studies later finding a high incidence of the disease in impoverished nations. Responding to those reports, the World Health Organization (WHO) recognized malnutrition-related diabetes as a distinct form of the disease in 1985. However, WHO removed this designation in 1999, due to a lack of follow-up studies and supporting evidence.  

Dr. Hawkins first learned of malnutrition-related diabetes in 2005 while teaching at global health meetings. “Doctors from various countries told me they were seeing many patients with an unusual form of diabetes,” she said. “The patients were young and thin, which suggested that they had type 1 diabetes, which can be managed with insulin injections to regulate blood sugar levels. But insulin didn’t help these patients and in some cases caused dangerously low blood sugar. Nor did these patients seem to have type 2 diabetes, which is typically associated with obesity. It was very confusing.” 

In 2010, Dr. Hawkins founded Einstein’s Global Diabetes Institute, which began leading international efforts to uncover the underlying metabolic defects that lead to malnutrition-related diabetes—a crucial step towards finding effective treatments.  

In a 2022 study published in Diabetes Care, Dr. Hawkins and her colleagues at Christian Medical College in Vellore, India, demonstrated that malnutrition-related diabetes is fundamentally different from types 1 and 2. Earlier findings had suggested that malnutrition-related diabetes stemmed from insulin resistance. “But it turns out that people with this form of diabetes have a profound defect in the capacity to secrete insulin, which wasn’t recognized before. This finding has revolutionized how we think about this condition and how we should treat it,” said Dr. Hawkins. 

In January of this year, Dr. Hawkins and her colleagues at Christian Medical College convened an international meeting in India to discuss the classification, diagnosis, and management of malnutrition-related diabetes as well as to advocate for global awareness and research. Investigators from several countries presented findings to a panel of diabetes experts, including the heads of the IDF and the American Diabetes Association. The attendees voted unanimously that malnutrition-related diabetes should be considered a distinct form of the disease—a decision that was endorsed today at the IDF World Diabetes Congress 2025, in Bangkok, Thailand. 

In announcing the organization’s formal recognition of type 5 diabetes, IDF president Peter Schwarz, Ph.D., also noted the formation of a type 5 diabetes working group, to be co-chaired by Dr. Hawkins. The group has been tasked to develop formal diagnostic and therapeutic guidelines for type 5 diabetes over the next two years. 

“Malnutrition-related diabetes is more common than tuberculosis and nearly as common as HIV/AIDS, but the lack of an official name has hindered efforts to diagnose patients or find effective therapies,” Dr. Hawkins says. “I’m hopeful that this formal recognition as type 5 diabetes will lead to progress against this long-neglected disease that severely debilitates people and is often fatal.” 

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About Albert Einstein College of Medicine  
Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2024-25 academic year, Einstein is home to 712 M.D. students, 226 Ph.D. students, 112 students in the combined M.D./Ph.D. program, and approximately 250 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2024, Einstein received more than $192 million in awards from the National Institutes of Health. This includes the funding of major research centers at Einstein in cancer, aging, intellectual development disorders, diabetes, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. For more information, please visit einsteinmed.edu, follow us on Twitter, Facebook, Instagram, LinkedIn, and view us on YouTube.