Objectives: In the elderly population, hyperglycemia is associated with increased rates of infections, length of hospital stay (LOS) and mortality. However, there is a lack of informative studies addressing the drivers of hyperglycemia. We hypothesized that central obesity has an effect on hyperglycemia. Therefore, our objective is to investigate whether central obesity predicts hyperglycemia within the first 48 hours of admission in elderly trauma patients admitted to the ICU. Methods: Our trauma registry was queried for all trauma patients aged 65 and older from 2012 to 2018 with an intensive care unit (ICU) LOS of at least 3 days. CT scan images were reviewed for visceral fat area, waist circumference to height ratio (WCHR), waist circumference to hip ratio (WHR) and the presence of sarcopenia, which has been implicated in adverse outcomes of trauma, in the presence or absence of obesity. Results: Of 320 elderly patients, 7% developed infections, 3% developed stroke, 52% had an increased ICU LOS >6 days, and 48% had an increased total hospital LOS >14 d. The prevalence of sarcopenia was 26%, increased visceral fat area >200 cm2 was 87%, WCHR >0.65 was 25%, and WHR >1 was 54% All of these factors except sarcopenia were significant predictors of hyperglycemia >140 mg/dL (OR: 4.0, 95% CI: 2.53–6.46), (OR: 2.45, 95% CI: 1.47–4.16) and (OR: 3.1, 95% CI: 1.93–4.9) respectively. A total of 143 patients (45%) had an average glucose >140 mg/dL within the first 48 hours after admission and this was independently associated with infections (OR: 2.64, 95% CI: 1.06–7.13), stroke (OR: 5.88, 95% CI: 1.48–38.96), increased ICU LOS (OR: 1.87, 95% CI: 1.20–2.94) and increased hospital LOS (OR: 1.59, 95% CI: 1.02–2.48). Conclusions: Central obesity independently predicts hyperglycemia in geriatric trauma patients. The influence of metabolic stressors related to adiposity may drive elevated glucose levels and could represent a novel target for future outcomes studies in geriatric critical illness Funding Sources: None.