Background: Glycaemic control is crucial in managing Type 2 Diabetes Mellitus (T2DM) to prevent or delay complications. Inadequate medication adherence remains a significant barrier to achieving optimal glycaemic control, leading to increased morbidity, mortality, and healthcare costs. Identifying factors influencing poor treatment adherence can help develop targeted interventions. Methods: A descriptive cross-sectional study was conducted from November 2023 to October 2024 at a tertiary healthcare hospital in central India. A total of 250 adult T2DM patients were recruited using systematic random sampling. Data were collected through face-to-face interviews using structured questionnaires, including the Eight-Item Modified Morisky Adherence Scale and additional questions to assess socio-demographic, clinical, psychological, and healthcare-related factors. Data were analyzed using SPSS with descriptive and inferential statistics, considering p-values <0.05 as significant. Results: Among the 250 participants, 28% demonstrated high adherence, 42% medium adherence, and 30% low adherence. Significant associations were found between poor adherence and factors such as male gender (p=0.0001), younger age (p=0.00001), employment status (p=0.00001), lack of knowledge about medication side effects (p=0.02334), lack of assistance (p=0.00001), long waiting times (p=0.00001), and forgetfulness due to busy schedules (p=0.0061). Conclusion: The study revealed moderate adherence levels among T2DM patients. Factors influencing poor adherence include socio-demographic characteristics, healthcare system barriers, and patient-related issues. Enhancing patient education, improving healthcare communication, and simplifying medication regimens can significantly improve adherence.