Abstract: Background　A systematic understanding of the disease not only helps patients establish a scientific health belief but also promotes their self-management behaviors, thereby effectively controlling disease progression. Currently, for the specific population of retired elderly patients with type 2 diabetes, there is still a lack of in-depth quantitative research exploring the relationship between their level of knowledge mastery and both glycemic control and the occurrence of complications. Objective　To investigate the levels of disease-related knowledge, glycemic control, and diabetes complications among retired patients with type 2 diabetes, and analyze the influencing factors of glycemic control and complication management using structural equation modeling.Methods　A cross-sectional survey was conducted among elderly patients with type 2 diabetes in 12 retirement homes in Beijing from January to June 2024 using convenience sampling. General clinical data of the patients were collected, and their disease knowledge level was investigated using the Michigan Diabetes Knowledge Test (DKT). The association between each dimension of the DKT and glycated hemoglobin (HbA1c) and the occurrence of complications was analyzed using structural equation modeling. Results　A total of 210 elderly patients with type 2 diabetes were included, with an average age of (75.36 ± 8.78) years, including 180 males and 30 females. There were 100 patients (47.62%) with a disease duration of more than 10 years, and the mean HbA1c was (8.189 ± 2.38) mmol/L. There were 144 patients (68.6%) with HbA1c ＞ 6.5% (poorly controlled). The median number of diabetes complications was 1 (range: 1-2), and 171 patients (81.4%) had ≥ 1 complication. The mean DKT score was (13.69 ± 4.01) points, which was at a medium level. The score for dietary management was (3.93 ± 1.66) points, the median for exercise management was 1 (range: 0-1), the median for foot care was 0 (range: 0-1), the score for insulin management was (5.19 ± 1.84) points, and the score for diabetes complication management was (3.48 ± 1.10) points. The structural equation model showed that dietary management (β =-0.232, P＜0.001), exercise management (β =-0.25, P＜0.001), and insulin management (β =-0.214, P＜0.001) had significant effects on HbA1c; while dietary management (β=-0.14, P＜0.05), exercise management (β=-0.158, P＜0.05), diabetes complication management (β=-0.177, P＜0.01), and foot care (β=-0.164, P＜0.05) had significant effects on the number of complications. The model fit results showed that the overall fit of the structural equation model was good, with a good degree of fit. Conclusion　The current blood glucose control status of retired patients with type 2 diabetes is not optimistic, and their disease knowledge level is at a medium level. The structural equation model clarified the causal influence path of diabetes knowledge level on disease outcomes - dietary, exercise, and insulin management directly affect HbA1c, while dietary, exercise, complication management, and foot care directly affect the occurrence of complications. Medical staff should carry out targeted health education on disease knowledge based on the individual characteristics of patients to improve their disease awareness, promote behavioral improvement in blood glucose control, and enhance their quality of life.