Sex Based Disparities in Glycemic Control and Hospitalization Outcomes of Medical Patients with Diabetes Mellitus - A Historical Cohort Study

Abstract Introduction 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. Methods A historical cohort of 5,133 adult T2DM patients hospitalized for > 24 hours 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. Results 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). Conclusions 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.