OBJECTIVES: Diabetes has been increasing worldwide and the treatment of type 2 diabetes is based on lifestyle modification and pharmacological therapy. Appropriate self-care practices including lifestyle modifications and medication compliance are critical to satisfactory control and manage diabetes and to prevent from comorbidities. The objective of this study was to assess current treatment patterns, treatment compliance and reasons for noncompliance for patients with type 2 diabetes in Pakistan. METHODS: A cross-sectional study was conducted to collect data through structured interviews based on pre-tested questionnaire. Total 211 patients including 46% males and 54% females from the ages 25 and over were randomly selected for the study from a population of patients attending 5 primary care diabetes centers throughout Karachi. Information was collected on socio-demographic characteristics, diabetes duration and compliance to physician’s advices. RESULTS: Overall, median age for male subjects was 53 years, significantly older (p=0.008) than females (46 years). The mean duration of diabetes among respondents was 9.2±3.8 years. Of the total, majority of patients were treated with oral medication (61%). Only 27% reported full compliance as per physician’s advice for timely medication, routine exercise, timely lab investigation and follow up for next visit.  About 45% of the subjects were taking medication for diabetes related complications. Lack of financial resources, knowledge and supportive services and fear of needle were the main reasons for noncompliance. We also found that people with low literacy levels were less likely to manage their condition effectively compared to people with higher educational level (p<0.001). CONCLUSIONS: To manage the diabetes both physicians and patients should attempt to improve compliance, which could lead to better disease management. Based on the findings, a public health intervention and information campaign is needed to change behaviours of persons with diabetes. Further, physicians can also educate patients by identifying potential risks of non-compliance and educate them accordingly.