〔Abstract〕 Objective To observe the effect of dexmedetomidine in elderly patients with intertrochanteric femoral fracture (IFF) complicated with diabetes. Methods A total of 50 elderly patients with IFF complicated with diabetes who were admitted to Zhangzhou Zhengxing Hospital from January 2020 to December 2020 were selected as the research objects, and were divided into a control group and an observation group according to random number table method, with 25 cases in each group. The patients in the control group received general anesthesia, and the patients in the observation group were combined with dexmedetomidine on the basis of general anesthesia. The comprehensive indexes of operation, heart rate and mean arterial pressure at different times, stress response before and 7 days after operation, mini-mental state examination (MMSE) score at 1, 3 and 7 days after operation, postoperative complications and postoperative delirium were compared between the two groups. Results There was no significant difference in operation time between the two groups (P > 0.05). The postoperative hospitalization time, ambulation time and extubation time in the observation group were shorter than those in the control group, and the differences were statistically significant (P < 0.05). There was no significant difference in heart rate and mean arterial pressure between the two groups 5 min before anesthesia (T0) (P > 0.05). At 15 min after anesthesia (T1), 45 min after anesthesia (T2), and after surgery (T3), the heart rate of the observation group was lower than that of the control group, and the mean arterial pressure was higher than that of the control group, with statistically significant differences (P < 0.05). Postoperative superoxide dismutase (SOD) in the observation group was higher than that of the control group, malondialdehyde (MDA), angiotensinⅡ (AngⅡ), norepinephrine (NE) were lower than those of the control group, the differences were statistically significant (P < 0.05). MMSE score of the observation group was higher than that of the control group on day 1, 3 and 7 after operation, the difference was statistically significant (P < 0.05). There was no significant difference in postoperative complication between the two groups (P > 0.05). The postoperative delirium in the observation group was lower than that in the control group (P < 0.05). Conclusion Dexmedetomidine has a good sedative effect in elderly patients with IFF complicated with diabetes under general anesthesia, and can improve hemodynamic indexes, postoperative cognitive function, reduce stress response, and reduce the risk of delirium.