〔Abstract〕 Objective To analyze the therapeutic effect of acarbose and metformin on type 2 diabetes mellitus. Methods 82 patients with type 2 diabetes mellitus admitted to the Sanming First Hospital of Sangang Branch from July 2018 to June 2022 were retrospectively selected as the study subjects. According to different medication methods, they were divided into a control group and an observation group, with 41 cases in each group. The control group was treated with acarbose, and the observation group was treated with metformin. After one course of treatment, compare the blood glucose and lipid indicators of the two groups of patients before and after treatment, and calculate the adverse reactions of the two groups of patients during the treatment period. Results After treatment, the levels of fasting blood glucose, and glycated hemoglobin, and insulin resistance index of patients in the observation group were lower than those in the control group, and the levels of blood glucose 2 hours after meal was higher than that in the control group, the differences were statistically significant (P < 0.05). After treatment, the levels of triacylglycerol, total cholesterol, and low-density lipoprotein in the observation group were lower than those in the control group, the differences were statistically significant (P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (P > 0.05). Conclusion The mechanism of action of acarbose and metformin for type 2 diabetes mellitus is different, and the focus of treatment will also be different. Metformin is more suitable for type 2 diabetes mellitus patients with obesity, high blood lipids, and insulin resistance, while acarbose is more suitable for patients with high postprandial blood glucose.