Sex-based differences in glycaemic variability and clinical outcomes among older inpatients with type 2 diabetes: insights from the GLIMPACT study

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Abstract Background Glycaemic variability (GV) has emerged as a potential marker of adverse outcomes in hospitalised patients with diabetes, yet its clinical impact in older adults and the role of sex differences remain unclear. Aims To evaluate the association between in-hospital GV and length of stay (LOS) and one- and two-year all-cause mortality in older adults with type 2 diabetes, and to explore sex-specific patterns. Methods Retrospective observational study of patients aged ≥ 65 years with type 2 diabetes admitted to a geriatric unit (2018–2020). GV was assessed using the coefficient of variation (CV) of point-of-care glucose measurements (POCT). Multivariable linear regression and Cox proportional hazards models were applied, adjusting for relevant confounders, with analyses stratified by sex. Results A total of 283 patients (59.7% female, mean age 84.9 ± 6.9 years) were included. Higher GV was independently associated with longer LOS in the overall cohort (β = 0.194, 95% CI 0.078–0.310, p = 0.001) and in females, but not in males. Higher GV was associated with increased one-year mortality in females (HR = 1.02, 95% CI 1.00–1.04, p = 0.019), while an inverse association was observed in males. At two years, GV remained associated with mortality only in females. Discussion Sex differences in insulin sensitivity and counter-regulatory responses may partly explain these findings. The inverse association in males should be interpreted cautiously, possibly reflecting residual confounding from a higher prevalence of SARS-CoV-2 infection. Conclusion In-hospital GV was associated with longer hospital stay and higher mortality in older adults with type 2 diabetes, particularly among females, suggesting it may represent a potential marker of clinical vulnerability warranting sex-specific approaches to glycaemic management.

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