Objective To follow up the progression of white matter hyperintensity(WMH)and cognitive impairment in elderly patients with type 2 diabetes mellitus,and to investigate the risk factors affecting the progression of white matter hyperintensity(WMH)in elderly patients with type 2 diabetes mellitus.Methods Seventy-six elderly patients with type 2 diabetes were followed up for 2 years.General clinical data were collected at baseline and 2 years after follow-up,brain MRI was improved,WMH severity was assessed by Fazekas scale.The Hamilton anxiety scale(HAMA)and the Hamilton depression scale(HAMD)assessed the mental state of the subjects.A series of cognitive function tests were performed.The cognitive function assessment tools used included MMSE,number span test(attention),word immediate and delayed memory(memory),Stroop color word interference test(executive function inhibitory control),verbal fluency test(cognitive flexibility),and clock drawing test(visuospatial structure ability).Results At baseline and after 2 years of follow-up,subcortical WMH(SC-WMH)[1.5(1,2)vs.2(1,3)]and total WMH score[3(2,4)vs.3(2,4)],number span inversion(6.32±1.59 vs.5.37±1.43),total number span score(14.71±2.61 vs.13.71±2.32),word delay memory(2.86±0.86 vs.2.14±0.99),Stroop color word interference test color response time[0.58(0.43,0.72)vs.0.61(0.53,0.79)],word response time[0.47(0.37,0.55)vs.0.51(0.42,0.65)],color word response time[0.98(0.95,1.05)vs.1.01(0.97,1.13)],clock test(8.09±1.48 vs.7.76±1.74)and verbal fluency test(4.42±0.82 vs.4.29±0.75)were compared,and the difference was significant(P<0.05).Age(OR=1.383,95%CI:1.094～1.748)and creatinine(OR=1.100,95%CI:1.004～1.205)were significantly associated with WMH progression(P<0.05).Conclusions After 2 years of follow-up,WMH and SC-WMH in the elderly patients with type 2 diabetes have exhibited certain progression.Attention,delayed memory,executive function,visuospatial structure,and cognitive flexibility are all impaired to varying degrees.Patients'age and creatinine are significantly correlated with the progression of WMH.