Objective To analyze the factors influencing compliance with lifestyle intervention in the elderly patients with newly-diagnosed type 2 diabetes mellitus (T2DM). Methods A retrospective analysis was made of the clinical data of 86 elderly patients with newly-diagnosed T2DM admitted to Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University, from January to June 2022. Their compliance with lifestyle intervention was assessed at follow-up visits 6 months later. The patients were divided into poor compliance group (n=41) and good compliance group (n=45). The two groups were compared in demographic characteristics, homeostasis model assessment-insulin resistance (HOMA-IR) and homeostasis model assessment-islet β cell function index (HOMA-β). SPSS statistics 23.0 was employed to process and analyze the data. According to the data type, t test,χ² test or continuous correctedχ² test was used for comparison between groups. Binary logistic regression analysis was used to analyze the factors influencing compliance with lifestyle intervention in the elderly patients with newly-diagnosed T2DM. Results HOMA-IR in both groups at follow-up visits was reduced compared with that at the first visit (P<0.05), and HOMA-IR in the good compliance group was lower than that in the poor compliance group (P<0.05). HOMA-β in both groups was enhanced compared with that at the first visit (P<0.05), and HOMA-β in the good compliance group was higher than that in the poor compliance group (P<0.05). Binary logistic regression analysis showed that divorced/widowed (OR=2.633,95%CI 1.513-4.581; P<0.05), living alone (OR=2.326,95%CI 1.218-4.442; P<0.05), and having a family history of diabetes mellitus (OR=0.655,95%CI 0.197-0.983; P<0.05) were contributing factors of poor compliance with lifestyle intervention in the elderly T2DM patients. Conclusion Among the elderly patients with newly-diagnosed T2DM, those with poor compliance with lifestyle intervention have poor islet β cell function and insulin resistance control, the divorced/widowed and the solitary are more likely to have a poor compliance with lifestyle intervention, and those with a family history of diabetes mellitus often have a good compliance.