Objective To observe the effects of Weitang grain diet on leptin and adiponectin in type 2 diabetes mellitus, and provide a basis for its clinical application. Methods A total of 180 patients with type 2 diabetes mellitus who visited the outpatient and inpatient departments from January 1, 2023 to December 31, 2024 were selected as the study subjects, and they were divided into the control group (90 cases) and the Weisanggu diet group (90 cases), according to the random number table method. The original hypoglycemic regimen remained unchanged between the two groups. The control group was treated with ordinary diabetic diet, and Weitang grain diet group was treated with Weisanggu diet (replacing the staple food at lunch and dinner) for a period of 12 weeks. The clinical symptom score, total effective rate, adiponectin (ADPN), leptin (LP), fasting blood glucose (FBG), hemoglobin a1c (HbA1c), alanine aminotransferase (ALT), ddverse reactions of aspartate aminotransferase (AST), urea nitrogen (UREA), creatinine (CREA), and hypoglycemia were compared between the two groups before and after treatment. Results After 12 weeks of intervention, the total effective rate of the Weisanggu diet group was 87.7%, and that of the control group was 81.1%. After intervention, the clinical symptom score, FBG, HbA1c, ADPN and LP of the Weitang grain diet group were better than those of the control group(P<0.05), and there was no significant difference in ALT, AST, CREA and UREA between the two groups before and after intervention and were within the normal range(P>0.05). There were no adverse reactions of hypoglycemia in either group. Conclusion Weitang grain diet can effectively improve the clinical symptoms and blood glucose, improve the indexes of leptin and adiponectin, alleviate insulin resistance, and have no liver and kidney function damage and hypoglycemia adverse reactions, which has significant advantages compared with ordinary diabetes diet