Purpose: To explore and analyze the application effect of personalized guidance nursing model on patients in the process of nursing care for elderly patients with diabetes in the community. Methods: A total of 100 elderly patients with diabetes who were treated in our community from January 2024 to December 2025 were selected and divided into the conventional group and the observation group according to the lottery grouping method. There were 50 elderly patients with diabetes in each group. The blood sugar levels, self-management ability and satisfaction of the two groups of patients before and after care were compared. Results: Compared with the patients in the conventional group, the blood sugar level of the patients in the observation group was not statistically significant, P > 0.05; after different nursing models were applied to the two groups of elderly diabetic patients, the blood sugar levels of the patients in the observation group were significantly improved compared with those in the conventional group, P < 0.05; Compared with the patients in the conventional group, the self-management ability of the patients in the observation group in terms of diet control, exercise management, blood sugar monitoring and taking medicine on time has been significantly improved, P < 0.05; the overall satisfaction of the patients in the observation group with the nursing process was significantly higher than that of the patients in the conventional group, P < 0.05. Conclusion: Judging from the research results, the application of personalized guidance has a very significant application effect for middle-aged and elderly diabetic patients in the community. It not only effectively improves the patient's blood sugar level to a large extent and improves the patient's self-management ability, but also promotes the establishment of a friendly relationship between nurses and patients, and is worthy of promotion and application in clinical practice.