Type 5 Diabetes — The WHO/IDF Consensus for Lean Undernutrition-Related Diabetes

Key finding

The WHO/IDF consensus meeting in Vellore, January 2025, formally proposed Type 5 Diabetes as a distinct classification for lean undernutrition-related diabetes. Diagnostic criteria: BMI <18.5, age <30 at onset, history of undernutrition, substantial beta-cell secretory impairment, normal insulin sensitivity, negative diabetes autoantibodies (GAD, IA-2, ZnT8), and no ketoacidosis tendency. This condition affects tens of millions across South Asia, Sub-Saharan Africa, and the Caribbean — populations systematically excluded from the Type 1 / Type 2 binary. The Vellore consensus is a landmark reclassification event: for the first time, a formal international body has acknowledged that lean individuals with developmentally programmed beta-cell insufficiency have a distinct disease entity that demands distinct management. ---

Framework connections: The Fragile Engine, The Overflow Tank

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