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Here, we propose SAGE-DM (Senescence-Associated Gluco-Endocrinopathy Diabetes Mellitus), a novel conceptual framework that extends the definition of so-called type 4 diabetes. SAGE-DM is characterised by insulin resistance and glucose dysregulation in lean or olders with sarcopenic obesity individuals, arising from endocrine senescence, chronic low-grade inflammation, and immunemetabolic crosstalk