not-yet-known not-yet-known not-yet-known unknown Abstract Few studies have investigated blood glucose levels and complication management in elderly patients with type 2 diabetes (T2D) at community hospitals in China. The objective of this study was to investigate the factors influencing blood glucose control in elderly patients with T2D and assess the adherence of doctors in community hospitals to the latest diabetes guidelines regarding the use of glucose-lowering medications. This study involved 1150 elderly patients (age≥65 years) with diabetes to assess blood glucose control, complications management, and adherence of medication according to the guidelines of American Diabetes Association. To evaluate blood glucose control, different glycated haemoglobin targets were assigned according to patient characteristics and health status (including comorbidities and cognitive status). Univariate and multivariate logistic regression analyses were used to investigate the factors affecting glucose control. Among the 1150 participants, 351 (30.52%) had poor glucose control. Frailty (odds ratio [OR]:0.393; 95% confidence interval [CI]:0.195-0.789; P=0.009), male sex (OR:1.472; 95% CI:1.131-1.915, P=0.004), and insulin treatment (OR:4.364; 95% CI:3.151-6.042; P<0.001) were significantly associated with poor blood glucose control in patients treated with glucose-lowering medications. The proportion of patients without frailty with poor control was higher than those with frailty (31.28% vs. 17.46%, respectively). In conclusion, blood glucose control in elderly Chinese patients with T2D is poor and influenced by frailty, sex, and insulin treatment. Hence, it is crucial to enhance the implementation of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in Chinese community hospitals and strengthen the differentiation of updated guidelines within these healthcare settings.