A newly recognized form of diabetes, known as Type 5 diabetes, has been identified in Uganda. Unlike the more familiar Type 2 diabetes, which is often linked to obesity, Type 5 diabetes stems from chronic undernutrition, particularly in childhood and adolescence.
According to the 2023 Uganda STEPS Survey, about 40% of diabetes cases in Uganda fall under this category. The survey, involving over 4,300 adults, also reported an increase in national diabetes prevalence from 1.4% to 2.5%. Affected individuals are typically thin and underweight, challenging the common belief that diabetes primarily affects those who are overweight.
Dr. Silver Bahendeka, senior consultant at St. Francis Hospital Nsambya and lead survey investigator, explained that the condition is most common in rural, impoverished communities. Malnourished mothers often give birth to babies with underdeveloped insulin-producing beta cells, increasing the risk of diabetes as the children grow.
“Many patients with Type 5 diabetes are unaware they have it because they don’t fit the typical profile,” said Bahendeka. He emphasized that insulin therapy, not standard Type 2 medications, is a more effective treatment, although dosage must be carefully managed to prevent hypoglycemia.
Type 5 diabetes was officially recognized by the International Diabetes Federation in April 2025. It typically affects malnourished adolescents and young adults in low- and middle-income countries.
Genetic mutations affecting pancreatic function and insulin production are believed to be the underlying cause. Symptoms include mild to moderate high blood sugar, frequent urination, fatigue, unintended weight loss, and a strong family history of diabetes.
Although once acknowledged by the World Health Organization in 1985 as diet-related diabetes, this classification was dropped in 1999 due to insufficient evidence. Recent findings, including those presented at the 7th East Africa Diabetes Study Group (EADSG) Congress in Munyonyo, have renewed calls for recognition and targeted interventions.
Experts at the congress, themed “Diabetes Care in Resource-Limited Settings: A Comprehensive Approach”, stressed the urgent need for research, education, and community-based programs, especially for underserved populations.
Globally, 149 million children under five are affected by undernutrition. In Uganda, about 10% of children are underweight. Regions such as Karamoja, northern, and parts of central and eastern Uganda are seen as potential hotspots for Type 5 diabetes.
The number of people with diabetes worldwide has soared from 200 million in 1990 to 830 million in 2022. The disease can lead to blindness, kidney failure, stroke, heart attacks, and amputations. In 2021, over 2 million deaths were linked to diabetes and related kidney disease, with 11% of cardiovascular deaths attributed to high blood glucose.
Dr. Michael Mungoma of Mulago Hospital explained that Type 1 diabetes results from the pancreas producing little or no insulin and typically appears in adolescence. Type 2 diabetes is linked to lifestyle and obesity. Type 3 diabetes, a rare form, shows insulin resistance in the brain and is associated with Alzheimer’s disease. Type 4 diabetes affects older, non-obese adults with insulin resistance.
Professor Meredith Hawkins of the Global Diabetes Institute emphasized the importance of recognizing Type 5 diabetes to address a health crisis affecting vulnerable communities. “Raising awareness of this overlooked condition is essential,” she said.
Diabetes is a significant public health concern in Uganda, with an estimated 716,000 adults living with the condition, and a large proportion remaining undiagnosed.
