Objective To investigate the effect of englaglizin on ventricular remodeling after acute myocardial infarction (AMI) in elderly patients with type 2 diabetes mellitus (T2DM). Methods 110 T2DM patients with AMI admitted to our hospital from June 2022 to December 2024 were selected as the study objects. Percutaneous coronary intervention (PCI) was performed in both groups, followed by routine dual antiplatelet therapy. On this basis, the control group was given metformin hydrochloride sustained-release tablets for hypoglycemic treatment, and the observation group was given Englipzin tablets for hypoglycemic treatment. The blood glucose index [random blood glucose, hemoglobin a1C], inflammation index [hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)], coronary blood flow index [peak diastolic blood flow (DPV), peak systolic blood flow (SPV) and coronary blood flow velocity reserve (CFVR)], ventricular remodeling indicators [left ventricular end-systolic volume index (LVESVI), left ventricular mass index (LVMI), and left ventricular remodeling index (LVRI)] and the occurrence of adverse reactions of the two groups were analyzed and compared. Results After treatment, the levels of random blood glucose and HBA1c in both groups were significantly lower than those in admission, and the levels of random blood glucose and HBA1c in observation group were significantly lower than those in control group (P < 0.05). After treatment, the levels of hs-CRP, TNF-α and IL-6 in both groups were significantly lower than those in hospital admission, and the levels of hs-CRP, TNF-α and IL-6 in observation group were significantly lower than those in control group (P < 0.05). After treatment, the values of DPV, SPV and CFVR in both groups were significantly higher than those at admission, and the coronary blood flow indexes in the observation group were significantly higher than those in the control group (P < 0.05). After treatment, the values of LVESVI, LVMI and LVRI in both groups were significantly decreased compared with those at admission, and the ventricular remodeling indexes in the observation group were significantly decreased compared with the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion In elderly T2DM patients with AMI, the use of englaglizin can improve blood glucose control, reduce inflammation, promote the improvement of coronary blood perfusion, inhibit ventricular remodeling, and has high safety.