Objective: To investigate the effects of switching to either Prandilin 25R monotherapy or Prandilin 25R combined with alogliptin and canagliflozin tablets after short-term intensive insulin pump therapy during hospitalization in elderly patients with type 2 diabetes mellitus on glycemic control, glycometabolic indicators, and cardiovascular risk factors, and to evaluate the safety of the two regimens. Methods: A total of 78 elderly patients with type 2 diabetes mellitus admitted to our hospital from January 2025 to September 2025 were selected and randomly divided into a control group and an observation group, with 39 cases in each group. The control group received monotherapy with insulin lispro protamine recombinant injection (Prandilin 25R) after intensive insulin pump therapy, while the observation group received Prandilin 25R combined with alogliptin and canagliflozin tablets. Continuous glucose monitoring (CGM) was performed for 14 days during the intensive insulin pump therapy phase in the hospital, followed by routine fingertip blood glucose monitoring after 14 days. Glycemic control indicators, glycometabolic indicators, and the incidence of adverse reactions were compared between the two groups. Results: After treatment, the mean amplitude of glycemic excursions and the 24-hour blood glucose standard deviation were significantly lower in the observation group than in the control group, while the time spent within the target blood glucose range was significantly higher (p < 0.05). The levels of glycated hemoglobin, fasting blood glucose, and 2-hour postprandial blood glucose were better in the observation group than in the control group; moreover, the body mass index, systolic blood pressure, and blood lipid levels improved more significantly in the observation group than in the control group (p < 0.05). There was no statistically significant difference in the incidence of hypoglycemia between the two groups. Conclusion: Combination therapy with alogliptin and canagliflozin tablets after short-term intensive insulin pump therapy can effectively improve glycemic variability in elderly patients with type 2 diabetes mellitus, with good safety. This suggests that alogliptin and canagliflozin tablets have a hypoglycemic advantage in the combination regimen and possess high clinical promotional value.