Objective To explore the correlation between alexithymia and self-management in elderly patients with type 2 diabetes and the mediating effect of health empowerment on the relationship between the 2 variables. Methods Totally, 210 elderly patients with type 2 diabetes from 3 Grade A hospitals were investigated by using the Toronto Alexithymia Scale, the Health Empowerment Scale for Elderly Patients with Chronic Diseases and the Diabetes Self-Care Scale. Results The scores of self-management, alexithymia and health empowerment were （87.18±11.07）,（57.53±10.09） and （91.69±10.67）, respectively. Alexithymia was negatively correlated with health empowerment and self-management, while health empowerment was positively correlated with self-management （P＜0.01 for all）.Health empowerment played a partial mediating role between alexithymia and self-management, and the mediating effect accounted for 41.52% of the total effect. Conclusion Alexithymia, health empowerment and self-management are closely related in elderly patients with type 2 diabetes. Alexithymia can indirectly affect self-management through health empowerment. Nurses should enhance self-management of older patients with type 2 diabetes by reducing alexithymia while improving health empowerment.