Background: The effect of combination therapy with liraglutide and acarbose vs. acarbose monotherapy in obese patients with type 2 diabetes mellitus (T2DM) is unknown. In this systematic review and meta-analysis, we compared the clinical efficacy and safety of liraglutide plus acarbose versus acarbose in obese patients with T2DM. Methods: Up until November 2024, searches were done online for relevant publications in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, and Wanfang Database. We obtained randomized controlled trials (RCTs) evaluating the efficacy of liraglutide and acarbose combination therapy versus acarbose monotherapy in obese T2DM. Weighted mean differences (WMDs) and 95% confidence intervals (CI) were pooled using either the random-effect models or the fixed-effect models. Results: Fifteen RCTs (n=1605) were included. Compared with acarbose alone, the addition of liraglutide reduced body mass index (WMD = -2.96, 95% CI: [−3.53,-2.40], p＜0.00001) and blood lipid related indicators: total cholesterol (WMD = -0.98, 95% CI: [−1.47,-0.50], p<0.0001) and triglycerides (WMD = -0.73, 95% CI: [−1.18,-0.29], p=0.001). At the same time, the combination therapy also significantly reduced blood glucose related indexes and insulin resistance related indicators in the patients. In addition, there was no increased risk of gastrointestinal adverse reactions, hypoglycemia, or pruritus. Conclusions: The addition of liraglutide can reduce body mass index (BMI) in obese patients with T2DM compared to acarbose alone. There is no significant difference in the incidence of adverse events between the combination and acarbose alone.