Objective To investigate the prevalence of microvascular complications in elderly patients with diabetes mellitus, and analyze the risk factors of microvascular diseases. Methods A retrospective analysis was conducted on the clinical data of 495 elderly diabetic patients admitted to Peking Union Medical College Hospital from January 2020 to December 2022. Their baseline information and biochemical indicators were collected, and the incidences of microvascular complications such as diabetic retinopathy, diabetic nephropathy and peripheral neuropathy were recorded. According to the type of microvascular complications, the patients were divided into diabetic retinopathy group (n=107), diabetic nephropathy group (n=81), peripheral neuropathy group (n=169) and non-complication group (n=138). SPSS statistics 22.0 was used for data analysis. Based on different data type, one-way ANOVA or Chi-squared test was employed for intergroup comparison. Multivariate logistic regression analysis was applied to determine the related risk factors leading to diabetes microvascular disease. Results Among the 495 elderly patients with diabetes mellitus, 357 had microvascular complications, with a total prevalence rate of 72.12%, including 21.62% (107/495) of diabetes retinopathy, 16.36% (81/495) of diabetes nephropathy, and 34.14% (169/495) of peripheral neuropathy. Compared with the patients of the non-complication group, those of the diabetic retinopathy group had a longer course of diabetes mellitus, higher systolic blood pressure (SBP) and glycosylated hemoglobin A1c (HbA1c), and lower low-density lipoprotein cholesterol (LDL-C) level; those of the diabetic nephropathy group had longer course of diabetes mellitus and higher TG and 24-hour urine albumin excretion rate (UAER); and those with peripheral neuropathy had higher levels of SBP, diastolic blood pressure (DBP), HbA1c, total cholesterol (TC) and triglyceride (TG) (all P<0.05). Multivariate logistic regression analysis showed that the long duration of diabetes mellitus (OR=3.013, 95%CI 1.206-7.526; P=0.019), high SBP (OR=2.445, 95%CI 1.105-5.408; P=0.028) and high HbA1c (OR=3.093, 95%CI 1.112-8.606; P=0.031) were independent risk factors for diabetic retinopathy. Long duration of diabetes mellitus (OR=2.404, 95%CI 1.185-4.877; P=0.016), high TG (OR=2.654, 95%CI 1.241-5.677; P=0.012) and high UAER (OR=3.432, 95%CI 1.303-9.036; P=0.013) were independent risk factors for diabetic nephropathy. High SBP (OR=2.020, 95%CI 1.228-3.323; P=0.006), high DBP (OR=2.560, 95%CI 1.109-5.912; P=0.028), high HbA1c (OR=2.382, 95%CI 1.321-4.297; P=0.004), high TC (OR=2.779, 95%CI 1.057-7.303; P=0.039) and high TG (OR=2.266, 95%CI 1.237-4.152; P=0.008) were independent risk factors for peripheral neuropathy. Conclusion Elderly diabetes patients have a higher prevalence of microvascular complications. Long duration of diabetes mellitus, high SBP, DBP, HbA1c, TC, TG and UAER are risk factors for the aforementioned complications, and attention should be paid to these factors.