Objective To investigate the quality of life in the elderly patients with diabetic peripheral neuropathy (DPN) and the influencing factors. Methods A total of 156 elderly T2DM patients with DPN admitted to Tunchang People′ s Hospital from January 2019 to December 2022 were included in the observation group, and 263 elderly T2DM patients without DPN in the control group. The quality of life was investigated by diabetes specific quality of life scale (DSQL), the fear of disease progression by the fear of progression questionnaire-short form (FoP-Q-SF), the anxiety status of patients by the Hamilton anxiety scale (HAMA), and the severity of neuropathy in patients by the Michigan neuropathy screening instrument (MNSI). SPSS 23.0 was used for data processing, and multivariate linear regression analysis was used to analyze the factors affecting the quality of life of patients in the observation group. Results The DSQL scores of each dimension and the total score in the observation group were higher than those in the control group, the proportions of patients with FoP-Q-SF score ≥ 34, psychological dysfunction and anxiety were higher than those in control group; the total MNSI score was also higher in the control group, and the differences were statistically significant (P<0.05). Multivariate linear regression analysis suggested that having regular caregivers (β=-0.633; P<0.001), age (β=0.287; P<0.001), self-rated economic burden of disease (β=0.226; P<0.001), fear of disease progression (β=0.648; P<0.001), anxiety (β=0.513; P<0.001), MNSI questionnaire score (β=0.578; P<0.001) and painful DPN (β=0.715; P<0.001) were factors affecting DSQL score in the observation group, which jointly explained 62.50% of the variation in quality of life. Conclusion The quality of life in the elderly T2DM patients with DPN is generally lower than that of the patients without complications. In addition to age, self-rated economic burden of disease, severity of neuropathy and painful DPN, psychological disorders such as fear of disease progression and anxiety can also affect the patients′ quality of life. Additionally, patients with regular caregivers have a higher quality of life.