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Objectives: This study aimed to assess the prevalence of under-prescription among elderly type 2 diabetic patients in the primary care unit of a university hospital in southern Thailand and identify the associated factors.Material and Methods: A 1-year retrospective medical record review was conducted in elderly type 2 diabetic patients treated continuously in the primary care unit. Under-prescription was the primary outcome assessed from criteria developed from the START criteria (2015), Thailand’s clinical practice guideline for diabetes (2014), and for hypertension (2015).Results: This study included 458 medical records that fit our inclusion criteria. The median age was 69.1 years old and more than 80% of them had a comorbidity of dyslipidemia or hypertension. The prevalence of under-prescription in elderly type 2 diabetic patients was 84.5%. The most commonly omitted medication was aspirin for primary prevention of cardiovascular disease. An increased number of medications received and having cardiovascular disease was associated with a lower risk of under-prescription.Conclusion: The prevalence of the omission of beneficial medications in elderly type 2 diabetic patients in the primary care unit of a university hospital was high, especially under-prescription of aspirin for primary prevention of cardiovascular disease.