OBJECTIVES: To elicit type 2 diabetes mellitus (T2DM) patients’ perception regarding the factors influencing medication adherence together with the strategies aimed to improve it. METHODS: An observational, cross-sectional study was conducted. An electronic self-administered questionnaire containing 11 questions (5-likert scale) was designed in order to address the importance given by patients to different factors and strategies associated with medication adherence. In addition, patient’s adherence (Morisky-green) along with sociodemographic and clinical variables were collected. A multiple multinomial logistic regression was performed to assess explanatory variables. RESULTS: A total of 963 T2DM patients participated in the study (49.9% female; mean age 60.4 years). To achieve good medication adherence, the majority of patients considered “important” or “very important” their knowledge about disease (92.2%) and treatment (91.4%) and the treatment information provided by doctor (94%). Moreover, most subjects placed a great importance to disease features such as the chronicity (86.8%), presence of comorbidities (82.4%) or complications (80.5%). A lesser percentage of patients (55.4%), perceived that environmental characteristics such as “family member or friend having the condition” or medication features like “complexity of medication container” (57.2%) were relevant to adherence. Related to the strategies aimed to improve adherence, nearly half of participants (43%) agreed that to adjust treatment regimen to activities of daily living was the best strategy to reduce therapeutic complexity, while the use of weekly and daily pill dispensers were considered the most effective technique to improve their adherence (71.3 and 71.2%, respectively). Compared to non-adherent (p<0,005), adherent patient considered more important their treatment confidence and knowledge about disease (p=0,003), treatment (p=0,002) and adherence consequences as factors that determine their adherence. CONCLUSIONS: This information may help to incorporate a greater patient centeredness and guide medical decision-making in order to improve T2DM patient’s adherence and clinical outcomes.