Abstract： Objective To recognize the risk factors and provide evidence for prevention and intervention of type 2 diabetes mellitus in the elderly. Methods A frequency matched case-control study based on hospital involving 65 new diagnosed type 2 diabetics mellitus cases in the elderly and 71 control cases without.type 2 diabetes mellitus was carried out in Xuzhou City, Jiangsu Province. In addition, 67 healthy people in this district were also randomly selected as controls. Results family history of diabetes mellitus (OR=5. 48 ), WHR (OR=2. 33 ), high carbohydrate food intake (OR=2. 86), usually meat intake (OR=2. 61 ), hypertension (OR=4. 83) and number of pregnancies (OR =4. 46) were significantly associated with type 2 diabetes mellitus after adjustment for all other risk factors. Leisure time physical activity (OR=0. 43) were inversely associated with type 2 diabetes mellitus. Conclusion The results indicated that family history of diabetes mellitus, obesity, dietary factors (contain high total energy), hypertension and number of pregnancies might be risk factors of type 2 diabetes mellitus in the elderly. Physical activity might be protective factors of type 2 diabetes mellitus. Healthy lifestyle intervention may provide an effective program for prevention of type 2 diabetes mellitus in the elderly.