Objective To investigate the difference of blood glucose fluctuation between type 2 diabetic patients with positive and negative insulin autoantibodies (IAA), and to analyze risk factors which would influence the productions of IAA. Methods Sixty-two hospitalized patients receiving IAA assay and glycemic excursions monitoring with continuous glucose monitoring system (CGMS) in Department of Endocrinology and Metabolism, West China Hospital from May 2009 to March 2012 were recruited. IAA was detected by enzyme-linked immunosorbent assay (ELISA). According to the results of IAA assay, the patients were divided into IAA positive group (n=31) and IAA negative group (n=31). The glucose excursions were assessed by the following parameters obtained from CGMS for 72h: the mean blood glucose (MBG) and its standard deviation (SD), the mean amplitude of glycemic excursion (MAGE), the mean of daily differences (MODD), the postprandial amplitude of glycemic excursion after breakfast (PPGEAB), the postprandial amplitude of glycemic excursion after lunch (PPGEAL), the postprandial amplitude of glycemic excursion after supper (PPGEAS), the mean amplitude of postprandial blood glycemic excursion (MPPGE), the large amplitude of glycemic excursion (LAGE). Glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) in two groups were also determined. Difference of glucose excursion between two groups was evaluated. The relation of age, sex, choice of therapy, body mass index(BMI) and histories of hypertension and hyperlipidemia with the production of IAA were also evaluated, and multiple logistic regression analysis was performed to analyze risk factors influencing the productions of IAA. Results LN(SD), MAGE, LAGE, PPGEAL in IAA positive patients were statistically significantly higher than those in IAA negative patients(P=0.031, P=0.010, P=0.021, and P=0.030; respectively). Multiple stepwise regression showed that choice of treatment was related to the production of IAA. Conclusion The inner daily glucose excursions was larger in patients with IAA positive than IAA negative, and no difference was found in inter daily excursions. Usage of exogenous insulin was positively related to the production of IAA, and the risk was 5.525 times in patients using subcutaneous insulin therapy than patients taking oral hypoglycemic agents.