The elderly with type 2 diabetes (T2D) suffer from multiple comorbid conditions in addition to diabetes, which can lead to numerous medication use or polypharmacy. This review aims to evaluate the benefits and risks associated with polypharmacy in elderly people with T2D. A literature review was conducted using the following databases (PubMed and Cochrane Library) to provide a comprehensive evaluation of the existing literature and a comprehensive assessment of the Benefit-risk of polypharmacy in elderly with T2D. Polypharmacy can increase the risk of adverse clinical outcomes. These risks associated with Polypharmacy can be a key driver of medication-related harm. Unfortunately, elderly people with T2D are more prone to harm from polypharmacy. This review emphasizes the importance of routine benefit-risk assessment of polypharmacy in this vulnerable population. The benefit-risk evaluation of polypharmacy in elderly people with T2D is a challenging issue, regular evaluation of the efficacy and safety of each medication can identify potential risks associated with polypharmacy, allowing for tailored treatment plans that prioritize the individual needs and preferences of patients.