Almost two decades after David Phillips noticed a disturbing trend of young, lean people who were under-nourished as children showing up at clinics in northern Ethiopia with diabetes, the unusual form of the disease is finally getting a name.
Type 5 diabetes affects about 25 million people, mostly in poorer countries, and has been neglected and under-researched, a group of experts wrote in The Lancet Global Health on Thursday, calling for the development of diagnostic criteria and treatment guidelines.
The patients’ profile is so unusual that, in a country short on health-care resources like Ethiopia, “there are people who die in a corner of their house because nobody ever thought about them having diabetes,” Phillips, an emeritus professor at the University of Southampton’s MRC Lifecourse Epidemiology Center, said in an interview.
Phillips first delved into the topic in 2008, when he spent time at diabetic clinics in rural locations in northern Ethiopia. He and colleague Liz Trimble of Queen’s University Belfast teamed up with local diabetologist Shitaye Alemu Balcha to study patients who didn’t fit the diabetes parameters seen elsewhere.
Diabetes is booming across the globe, but most cases are so-called type 2, in which sedentary lifestyles and excess weight cause the pancreas to become resistant to insulin and eventually struggle to produce enough of the vital hormone. The patients Phillips saw instead were often lean 30-year-olds from poor communities with a history of a severe lack of food as a fetus or in critical early childhood.
The World Health Organization classified the disease in 1985, calling it malnutrition-related diabetes, before scrapping that in 1999 amid disagreement over the role played by the lack of nutrition.
The diabetes community must “formally recognize this neglected entity, which likely affects the quality and length of life of millions of people worldwide,” experts led by Pradnyashree Wadivkar of the Albert Einstein College of Medicine’s Global Diabetes Institute in New York and Felix Jebasingh of the Christian Medical College’s department of endocrinology, diabetes and metabolism in Vellore, India, wrote in the opinion piece.
The proposal was backed by more than 30 scientists including Phillips after a meeting in Vellore earlier this year.
They cited evidence from countries including Bangladesh, Rwanda and Indonesia, among others. Most people with type 5 diabetes live in countries that tend to have strained health-care systems and are most at risk for climate change.
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Published on September 18, 2025
