Overview

• An opinion published Sept 18 in The Lancet Global Health, backed by an International Diabetes Federation consensus, calls for formal recognition plus diagnostic criteria and care guidelines for a distinct diabetes phenotype.
• Researchers estimate 20–25 million people are affected worldwide, largely in Asia and Africa, with Indian experts suggesting roughly six million cases in India alone.
• Cases typically involve teenagers and young adults who are very lean with histories of early-life undernutrition, showing insulin sensitivity, lower insulin secretion than type 2, absence of islet autoantibodies, and little ketoacidosis.
• Experts warn misdiagnosis as type 1 or type 2 can cause harm, including severe hypoglycaemia from high insulin doses or worsening undernutrition from weight-loss medications.
• Authors urge pairing clinical guidance with poverty and food-security measures such as affordable protein- and complex carbohydrate-rich staples, noting WHO dropped a prior malnutrition-related diabetes category in 1999.