Objective: To investigate the efficacy and influencing factors of pharmacological mydriasis in type 2 diabetic patients undergoing cataract surgery. Methods: The study used a single-arm clinical trial design. Patients with type 2 diabetes who underdoing cataract surgery in the Second Affiliated Hospital, Zhejiang University School of Medicine from April to July 2024 were selected using convenience sampling method. The pupil diameter and compliance rate were observed at eight time points: 20 min (T1), 30 min (T2), 40 min (T3), 50 min (T4), 60 min (T5), 70 min (T6), 80 min (T7) and 90 min (T8) after mydriasis with compound tropicamide before cataract surgery. Multivariate logistic regression was used to analyze the influencing factors of preoperative mydriasis. Results: A total of 404 patients aged (58±11) years were included, with 185 males and 219 females. The pupil diameters at T1-T8 were (5.05±1.02) mm, (5.41±1.31) mm, (6.10±1.29) mm, (6.67±1.52) mm, (7.30±1.56) mm, (7.31±1.53) mm, (7.33±1.58) mm, (7.34±1.57) mm, respectively. The compliance rate of preoperative mydriasis was 23.3% (94/404), 30.7% (124/404), 50.7% (205/404), 62.1% (251/404), 77.2% (312/404), 78.7% (318/404), 79.0% (319/404) and 79.5% (321/404), respectively. One-way repeated measures analysis of variance showed that there was a statistically significant difference in pupil diameter among T1-T8 (F=705.195, P<0.001). Bonferroni multiple comparison results showed that there were statistically significant differences in pupil diameter among T1-T5 (all P<0.001 8). With the prolongation of time, pupil diameter gradually increased. There were no significant differences in pupil diameter at T5-T8 (all P>0.001 8). Multivariate logistic regression analysis showed that high level of glycosylated hemoglobin (HbA1c) (OR=1.47, 95%CI: 1.20-1.80, P<0.001), low body mass index (BMI) (OR=0.77, 95%CI: 0.69-0.86, P<0.001), and long duration of diabetes (OR=1.08, 95%CI: 1.04-1.12, P<0.001) were related factors for non-compliance of preoperative mydriasis. Conclusions: The compliance rate of pupil diameter within 60 min after pharmacological mydriasis before cataract surgery in patients with type 2 diabetes increased significantly with time, and the expansion effect tended to be stable after 60 min. The duration of diabetes, HbA1c levels, and BMI were factors affecting mydriasis achievement in patients with type 2 diabetes.