Sex Differences in Failure to Achieve Geriatric-Adjusted Glycemic Targets Among Older Adults with Type 2 Diabetes in Vietnam

Background: Older adults with type 2 diabetes mellitus (T2DM) often face challenges in achieving glycemic targets due to geriatric conditions. However, evidence on sex differences in failure to achieve glycemic targets in low- and middle-income countries remains limited. Aim: To examine sex differences in the prevalence of failure to achieve individualized glycemic targets and to identify associated factors among older adults with T2DM in Vietnam. Methods: This cross-sectional study was conducted between September and December 2025 among outpatients aged ≥ 60 years with T2DM. Failure to achieve glycemic targets was defined based on individualized HbA1c targets according to geriatric conditions, including comorbidities, cognitive function, and functional status, in accordance with recommendations from the American Diabetes Association. Multivariable logistic regression analyses were performed in the overall population and stratified by sex. Results: Among 537 patients, 306 (57.0%) were male and 231 (43.0%) were female. Overall, 25.5% of patients failed to achieve their glycemic targets, with a similar prevalence in males (24.8%) and females (26.4%). In the overall population, polypharmacy (adjusted odds ratio [aOR] 1.98, 95% confidence interval [CI] 1.14– 3.44), limitations in instrumental activities of daily living (IADL) (aOR 1.72, 95% CI 1.14– 2.61), and diabetes duration ≥ 5 years (aOR 2.07, 95% CI 1.15– 3.75) were independently associated with failure to achieve glycemic targets. In sex-stratified analyses, diabetes duration ≥ 5 years was associated with failure to achieve glycemic targets among males (aOR 3.30, 95% CI 1.34– 8.13), whereas dependent income (aOR 3.60, 95% CI 1.18– 10.9), polypharmacy (aOR 2.46, 95% CI 1.02– 5.95), and limitations in IADL (aOR 2.39, 95% CI 1.28– 4.46) were significantly associated with failure to achieve glycemic targets among females. Conclusion: Failure to achieve glycemic targets remains common among older adults with T2DM in Vietnam, with sex-specific associated factors. These findings suggest that incorporating geriatric assessment and sex-sensitive approaches into outpatient diabetes management may be beneficial; however, they should be interpreted as hypothesis-generating and may not be generalizable to all settings.