Objective To analyze in elderly type 2 diabetes (diabetes mellitus type 2, T2DM) combined high homocysteine levels (Hyperhomocysteinemia, HHcy) clinical characteristics and dietary factors, provide theoretical basis for T2DM combined HHcy patient's diagnosis and treatment. Methods A total of 186 elderly T2DM patients admitted to our hospital from January 2020 to June 2022 were selected and divided into control group (without HHcy) and observation group (with HHcy) according to whether the patients were complicated with HHcy. The age, gender, body mass index (BMI), mean course of disease, SBP, fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) levels, whether complicated with carotid plaque were compared between the two groups. Univariate analysis and logistic regression analysis were used to analyze the dietary factors affecting HHcy in T2DM patients. Results Among the 186 T2DM patients, 47 (25.27%) had HHcy. The serum Hcy level in the experimental group was significantly higher than that in the control group (P<0.05). The age, mean disease duration, levels of FPG, HbA1c, LDL-C and the proportion of carotid plaque in the experimental group were significantly higher than those in the control group(P<0.05). There were no significant differences in gender, BMI, TG, SBP and visceral fat area between the two groups(P>0.05). In terms of dietary factors , there were significant differences between the two groups in daily vegetable intake, daily meat intake, daily quantity of soy products (P<0.05). Daily vegetable intake <400g (OR=2.873) and weekly meat intake <560 or >1050g (OR=3.652) were dietary independent risk factors for HHcy in T2DM patients (P<0.05). Conclusion The elderly T2DM patients are at high risk of HHcy, especially those with daily vegetable intake <400g and weekly meat intake <560 or >1050 g. Dietary adjustment should be actively adopted to reduce the risk of HHcy in T2DM patients.