Objective To investigate the effect of acarbose on the plasma nesfatin-1, glucose and lipid metabolism in patients with type 2 diabetes mellitus. Methods 60 patients who met the inclusion criteria were selected. After dose adjustment for previous oral hypoglycemic, the fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG) of them reached 6-8mmol/L, 8-10mmol/L respectively. Then all of the patients were randomized into two groups. One group receive acarbose on the base of the initial hypoglycemic as the test group, and the other acted as the blank control group.The study lasted for 12 weeks. Results There was no statistically significant between the two groups at baseline (P>0.05). After 12-week treatment, the plasma nesfatin-1 level in the test group was significantly higher than before(P<0.01), but there was no significant change in the control group. FPG, 2hPG, glycosylated hemoglobin (HbA1c), body mass index(BMI), homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride(TG) and total cholesterol(TC) were all reduced obviously in the test group (P<0.01 or P<0.05). Only 2hPG decreased in the control group(P<0.01). Covariance analysis demonstrated that after treatment, the level of nesfatin1 was higher in the test group compared with that in the control group(P<0.05), FPG, 2hPG, HbA1c, fasting plasma insulin(FPI), HOMA-IR, TG and TC were significant lower in the test group(P<0.01 or P<0.05). Conclusion Acarbose is an effective medicine for increasing the level of plasma nesfatin-1and improving glucose and lipid metabolism in patients with type 2 diabetes mellitus.