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These findings affirm that none of the current diabetes classifications is able to fully account for the role of biological aging processes (independent of obesity) in the development of dysglycaemia in older adults In this regard we have proposed the term SAGE-DM (Senescence-Associated Gluco-Endocrinopathy Diabetes Mellitus) as a mechanistic (pathophysiological) interpretation of diabetes in the elderly rather than a new clinical subtype It is distinct from the cluster-defined, statistically derived phenotype mild age-related diabetes The two share relative metabolic mildness, but SAGE-DM is defined by its underlying biological mechanisms, associated with age-related endocrine dysfunction, rather than the clinical clustering of metabolic factors that characterizes mild age-related diabetes Ultimately on the basis of our results SAGE-DM could be considered as a mechanistic view of diabetes and used to adjust treatment for a selected population of the elderly non-overweight/obese and patients with other risk factors The aim of formulation of this construct is not to redefine diabetes but to provide a biologically plausible explanation for the dysglycaemia of aging based on mechanisms of -cell functional decline sarcopenia inflammaging and endocrine dysfunction during aging To clarify the conceptual and operational definitions SAGE-DM may be provisionally defined by the following clinical-operational criteria: diabetes diagnosed in those aged over 65 BMI 10 in subclinical hypothyroidism is always an indication for initiating l-thyroxine, initially at a low dose of 12.5 mcg with a slow increase of 12.5 mcg every few days [124]

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