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DM4 is not recognized by any of the main medical classification systems, including the ADA, WHO and ICD However, DM4 is used informally in new scientific publications to refer to a rare form of insulin resistance (IR) In 2022, researchers Ronald Evans and Ye Zheng, who study IR in old age, proposed the name type 4 diabetes [12] for IR that occurs in lean elderly patients without autoimmune diabetes and/or obesity DM4 is estimated to be present in 20% of patients who are newly diagnosed with diabetes and aged over 65 years, amounting to 2 million patients in the US [12]

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