Objective: To explore the diagnostic value of real-time ultrasound elastography and power Doppler ultrasound in the diagnosis of abnormal Achilles tendon changes in T2DM patients with different courses. Methods: 135 patients with T2DM were selected as the research objects. The study period was from February 2017 to February 2020. According to different disease courses, they were divided into group A (disease course <5 years), group B (disease course 5-10 years), and group C (>10 years), 45 cases in each; among them, 10 cases were diagnosed as abnormal Achilles tendon changes in group A by MRI, 14 cases were diagnosed as abnormal Achilles tendon changes in group B by MRI, and group C was diagnosed as abnormal Achilles tendon changes by MRI A total of 17 cases.Real-time ultrasound elastography technology and power Doppler ultrasound detection were performed to evaluate the detection rate, cut-off value, Youden index, sensitivity and specificity after detection, and analyze ROC curve. Results: After power Doppler ultrasound detection in group A, there were 3 cases in grade I (6.67%), 0 cases in grade II, 0 cases in grade III, and 42 cases in grade 0 (93.33%). Compared with the gold standard, there was significant Difference (P＜0.05);In group B, 5 cases (11.11%) of grade I, 1 case of grade II (4.44%), 0 cases of grade III, and 39 cases of grade 0 (86.67%) were tested in group B. Compared with the gold standard, there are significant differences. (P＜0.05);In group C, 6 cases (13.33%) of grade I, 2 cases of grade II (4.44%), 0 cases of grade III, and 37 cases of grade 0 (82.22%) were tested in group C. Compared with the gold standard, there are significant differences. (P<0.05).After being tested by real-time ultrasound elastography technology, group A had 8 cases (17.78%) in grade 3, 31 cases in grade 1 (67.39%), and 6 cases in grade 2 (13.33%). Compared with the gold standard, there was no significant difference ( P>0.05); After the detection of group B, there were 12 cases (26.67%) in grade 3, 26 cases (57.78%) in grade 1, and 7 cases in grade 3 (15.56%). Compared with the gold standard, there was no significant difference ( P>0.05); after the detection of group C, there were 15 cases (33.33%) in grade 3, 23 cases in grade 1 (51.11%), and 7 cases in grade 2 (15.56%). Compared with the gold standard, there was no significant difference ( P>0.05).The ratio of RTE strain rate in group C was significantly higher than that of group A and B (P<0.05); the ratio of RTE strain rate in group B was significantly higher than that of group A (P<0.05).ROC curve analysis showed that the AUC of energy Doppler ultrasound, elastography classification method, and RTE strain rate ratio were (0.707, 0.927, 0.541, P＜0.05), sensitivity (41.50%, 85.40%, 22.00%), specific Degree (100.00%, 100.00%, 86.20%), Youden Index (0.415, 0.854, 0.082).Conclusion: Compared with power Doppler ultrasound, the real-time ultrasound elastography technique has a higher diagnosis rate.