Objective To investigate the status quo of diabetes distress in elderly diabetic patients and to analyze its influencing factors. Methods Diabetes Distress Scale (DDS), Social Support Rate Scale (SSRS), Medical Coping Modes Questionnaire (MCMQ), and self-made general information questionnaire were used as research tools to survey elderly diabetic patients who were hospitalized in a Grade-A Tertiary Hospital in Nanning from March to September 2022. Results Among the 321 elderly diabetic patients, 122(38.01%) patients had diabetes distress. There were statistically significant differences in diabetes distress of elderly diabetic patients with different ages, educational backgrounds, occupations, average personal monthly incomes, exercise, blood glucose monitoring, duration of illness, comorbidities, complications, treatments, social support levels, and coping modes (all P<0.05). The results of binary logistic regression analysis showed that old age, a long duration of illness, and a high social support level were protective factors for diabetes distress in elderly diabetic patients, and irregular blood glucose monitoring, being treated with oral drugs and insulin, and avoidance coping mode were risk factors for diabetes distress in elderly diabetic patients (all P<0.05). Conclusions The incidence of diabetes distress in elderly diabetic patients is high, and old age, a long duration of illness, and a high social support level are protective factors for diabetes distress, and irregular blood glucose monitoring, being treated with oral drugs and insulin, and avoidance coping mode are risk factors in elderly diabetic patients.