Introduction: Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose due to insulin deficiency or resistance. Type 2 DM(T2DM) is the most common form and a growing public health concern in Saudi Arabia. The national prevalence rose from 15.8% in 2016 to 18.2% in 2021 and is expected to exceed 20% by 2026. Proper management of T2 DM requires consistent adherence to medications and lifestyle changes. However, non-adherence is a major challenge, leading to poor glycemic control and increased risk of complications such as nephropathy, retinopathy, and cardiovascular events. In Al-Ahsa, non-adherence rat 2021and 65% in primary care settings. This study utilizes the Adherence to Refills and Medications Scale (ARMS), validated in Arabic, to assess medication adherence among T2 DM patients in Al-Ahsa and explore contributing factors.

Methods: Study Design & Setting: A cross-sectional study was conducted from May to September 2024 among adults with T2DM who had attended primary healthcare centers (PHCs) in Al-Ahsa, Saudi Arabia, between October 2023 and March 2024. Sampling Technique: A stratified random sampling method was used. All PHCs were divided into four strata (Eastern, Middle, Northern, Southern), and participants were randomly selected from each stratum. Sample sizes were estimated using standard formula parameters (Z = 1.96, E = 0.05, P = 50%). Data Collection: Data were collected through structured phone interviews using the Arabic ARMS questionnaire, covering sociodemographic and clinical variables. Clinical data (weight, height, HbA1c) were retrieved from records. Assistance was provided to illiterate participants, and internal consistency was acceptable (Cronbach’s α = 0.74). Statistical Analysis and Ethical Considerations: Data were analyzed using SPSS v27, with logistic regression identifying predictors of medication non-adherence (p < 0.05). Ethical approval was obtained from the King Fahad Hospital-Al-Hofuf Ethics Committee (IRB-KFHH No. H-05-HS-065), and informed consent was secured in line with the Declaration of Helsinki.

Results: The study found that the adherence rate to medications and refills was 52.5%. Significant factors associated with adherence (p < 0.05) included income level, marital status, occupation, and area of residence. Among diabetes-related variables, adherence was significantly influenced by the age at diabetes onset, presence of diabetic complications, HbA1c level, frequency of blood glucose monitoring, and the presence of other comorbidities. Healthcare-related factors such as frequency of doctor visits, continuity of care with the same physician, and receiving medication-related information from physicians were also significantly associated with adherence.

Conclusion: Nearly half of patients with T2DM in Al Ahsa were non-adherent to medications and refills. Sociodemographic, clinical, and healthcare-related factors significantly influenced adherence. Targeted interventions to improve patient education, physician communication, and healthcare accessibility may enhance adherence and health outcomes.