# Sex based disparities in glycemic control and hospitalization outcomes of medical patients with diabetes mellitus—a historical cohort study

## TL;DR

This study finds that men with diabetes in hospitals have worse blood sugar control and higher rehospitalization rates compared to women.

## Contribution

The study reveals sex-based disparities in inpatient diabetes management and outcomes, which were previously less understood.

## Key findings

- Men had higher rates of hyperglycemia and severe hyperglycemia compared to women.
- Men were more likely to be rehospitalized within 30 days than women.
- Men were more frequently treated with chronic aspirin therapy than women.

## Abstract

While sex differences in type 2 diabetes mellitus (T2DM) are well-documented in outpatient settings, data on inpatient disparities remain limited. This study examines the relationship between sex and glycemic control, chronic treatment patterns, and hospitalization outcomes in patients with T2DM. A historical cohort of 5,133 adult T2DM patients hospitalized for > 24 h at a tertiary Israeli medical center in 2023 was analyzed. Outcomes included hypoglycemia, hyperglycemia, length of stay, 30-day readmission, and mortality. Propensity score matching and multivariable regression were applied to adjust for confounding variables. Men were more frequently treated with chronic aspirin therapy than women (35.8% vs. 29.4%; p < 0.001), a difference that remained significant after multivariable adjustment (aOR 1.31; 95% CI: 1.13–1.52; p < 0.001). Male sex was also associated with higher rates of hyperglycemia (76.4% vs. 73.3%; p = 0.009) and severe hyperglycemia (48.6% vs. 43.7%; p < 0.001), with these associations persisting after adjustment (hyperglycemia: aOR 1.23; 95% CI: 1.03–1.46; p = 0.02; severe hyperglycemia: aOR 1.28; 95% CI: 1.09–1.49; p = 0.002) and confirmed in propensity score-matched analyses. One-month rehospitalization rates were also higher in men (12.7% vs. 11.1%; p = 0.088), reaching statistical significance after multivariable adjustment (aOR 1.27; 95% CI: 1.03–1.55; p = 0.02). Sex-based disparities persist in inpatient glycemic control and chronic treatment patterns. Men are more prone to hyperglycemia and rehospitalization, while women are less likely to receive guideline-recommended cardioprotective therapies. A sex-specific approach may improve inpatient diabetes management and long-term outcomes.

The online version contains supplementary material available at 10.1007/s11739-025-04170-4.