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To explore diabetes-related knowledge levels among patients with type 2 diabetes mellitus (T2DM) and the influencing factors, correlations and paths of patients' mental and emotional status based on a structural equation model. A total of 1512 patients with T2DM in 18 tertiary general hospitals in Hunan Province. A descriptive correlational study. The study was conducted and surveyed with the general information questionnaires, including the Audit of Diabetes Knowledge (AD knowl), the Problem Areas in Diabetes 5 scale (PAID-5) and the World Health Organization Five-Item Well-Being Index (WHO-5). The structural equation model showed that PAID-5 and WHO-5 scores (P < 0.05) were affected by diabetes self-management, medical history/treatment and knowledge. According to the model, the common risk factors affecting the mental and emotional status of diabetic patients were general demographic characteristics (less exercise time and greater economic burden), medical history/treatment of diabetes (longer course of disease, more hospitalizations due to diabetes, and more acute or chronic complications), and lower levels of diabetes-related knowledge. In addition, solitude was also a risk factor for low levels of happiness. The diabetes-related knowledge levels of T2DM patients are very low, and these patients generally experience emotional disorders, which deserves close attention. The structural equation model can be used to explore the influencing factors and correlations of the psychological and emotional status of diabetic patients. [ABSTRACT FROM AUTHOR]