SUN-842 - Validating the Nutritional Status of Patients with "Type 5 Diabetes"

Introduction:
In April 2025, the International Diabetes Federation proposed the term “Type 5 diabetes” (T5D) to represent a form of diabetes affecting lean individuals (BMI≤19 kg/m2) in low-resource settings (PMID: 40975084). This form of diabetes is characterized by moderate insulin deficiency, severe hyperglycemia, negative autoimmune markers, ketosis resistance, and insulin sensitivity. While the WHO previously classified this condition as Malnutrition-Related Diabetes Mellitus, this name was removed in 1999 due to a lack of evidence for an association with malnutrition.

Methods:
This study utilized the Global Leadership Initiative on Malnutrition (GLIM) consensus-based criteria (BMI, fat/muscle mass, food intake) to determine the nutritional status of a cohort of well-phenotyped T5D patients (PMID: 35522035). A cross-sectional comparison of adult T5D subjects (n=20) with lean controls (LC; n=16) and well-nourished controls (WNC; n=9) was conducted in South India. Body composition was quantified with DEXA and bioimpedance analysis. Dietary intake was assessed via 24-hour dietary recall using a standardized questionnaire. Statistical analyses used Mann-Whitney U tests; descriptive values were listed as median±interquartile range.

Results:
The BMI of T5D subjects (18.4±1.6 kg/m2) was comparable to LC (18.7±3.9 kg/m2, p=0.48) but significantly lower than WNC (25.1±2.0 kg/m2, p< 0.001). T5D subjects exhibited significantly lower lean body mass (39.8±6.5 kg) compared to both WNC (50.7±7.6 kg, p< 0.0001) and LC (43.2±9.0 kg, p=0.002). While T5D total fat mass (9.6±3.5 kg) was significantly lower than WNC (16.4±4.7 kg, p< 0.0001), it was comparable to LC (8.0±4.2 kg, p=0.71). Collectively, these findings suggest extreme leanness and sarcopenia.
Dietary analysis of the T5D group indicated compromised nutritional intake. T5D subjects exhibited significantly lower caloric intake (1795±156 kcal) compared to WNC (2078±553 kcal p=0.032), though the deficit compared to LC was not significant (1843±447 kcal, p=0.29). While fat and carbohydrate intake were similar across all groups, T5D subjects consumed significantly less protein (35.7±14.3 g) than both the WNC (49.4±20.2 g, p=0.005) and LC (42.1±14.4 g, p=0.012) groups.

Conclusion:
Our T5D subjects satisfy the GLIM consensus criteria for malnutrition, distinguished by low BMI and fat mass, severe sarcopenia, and reduced protein-energy intake compared to healthy controls. These findings help validate the classification of Type 5 Diabetes as a malnutrition-associated clinical entity. Limitations of this study include the cross-sectional design, which precludes establishing temporality between malnutrition and T5D onset, limited sample size, and potential reporting bias from the 24-hour dietary recall. Further research is critical to develop new therapeutic strategies to treat this unique form of diabetes mellitus.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*