ABSTRACT Aim Older adults living with type 2 diabetes represent a particularly vulnerable population. We investigated which continuous glucose monitoring (CGM)-derived targets are associated with all-cause mortality in this population. Methods HYPOAGE is prospective multicenter study including 141 insulin-treated older adults living with type 2 diabetes aged 75 and older, under insulin therapy for at least 6 months. All participants underwent standardized geriatric and diabetic assessments and wore an ambulatory blinded CGM (FreeStyle Libre Pro®) for 28 consecutive days. In this ancillary study, multivariable cox regressions were performed to identify factors associated with mortality after adjustment for age, sex, HbA 1c , kidney function, geriatric status, and metformin use. Results At baseline, participants were 81.5 years old on average. After a median follow-up of 44 months, 58 of 141 patients had died. In adjusted model, higher percentages of level 1 time below range (TBR), level 2 TBR and glycemic variability assessed by the coefficient of variation (CV) were independently associated with an increased mortality risk (hazard ratio 95% CI 1.51 1.11; 2.06, 1.25 1.02; 1.53, and 1.76 1.21; 2.56 for an interquartile range (IQR)% increase of each parameter, respectively). When recommended CGM targets were considered, only glycemic variability (CV ≤ 36%), remained significantly associated with a lower risk of mortality (hazard ratio 0.57 0.32; 0.99), whereas TIR > 50% and TBR ≤ 1% were not. Conclusion Among insulin-treated older adults living with type 2 diabetes, glycemic variability was independently associated with all-cause mortality, highlighting its potential relevance for clinical management in geriatric diabetes care.
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