OBJECTIVES: To examine whether risk preferences are associated with adherence to oral hypoglycemic agents (OHA). METHODS:  We performed a cross-sectional study among patients with type 2 diabetes (n=308) aged 21–70 presenting for routine visits in the diabetes clinic at a university medical center. We used validated questionnaires to estimate: risk preferences, motivation, self-efficacy, impulsivity, perception about the disease and about the interpersonal process of care, and demographic and socio-economic characteristics, in addition to computerized patient medical records for retrieval of clinical indicators to estimate disease severity and a computerized database for retrieval of medication adherence one-year before the interview. Adherence was estimated using prescription-based measures of proportion of days covered (PDC). Concurrent adherence was calculated in three ways: PDC with ≥1 OHA; average PDC; PDC of ≥80% for all OHA. We classified patients into one of three groups using standard thresholds: ≥80%, 40-79%, and <40%. Multivariable ordered logit and logistic models were specified to estimate predictors of adherence to each of the adherence measures. RESULTS: Multivariable analyses revealed that compared to others, risk-seeking patients had lower PDC with ≥1 OHA (β = -0.50, p≤0.1). Specifically, compared to the rest of study population, risk-seeking patients were 11.2 percentage points less likely to have ≥80% of the follow-up period covered with ≥1 OHA available (p≤0.1). In addition, risk-seeking patients had lower average PDC (β = -0.85, p≤0.05). Specifically, compared to others, risk-seeking patients were 19.5 percentage points less likely to have an average PDC of ≥80% (p≤0.05). Finally, risk-seeking was associated with lower probability to have PDC of ≥80% for all OHA in the follow-up period (OR; 90% CI: 0.59; 0.35 – 0.97). CONCLUSIONS: Risk seekers are less adherent to OHA. Identifying these patients may enable practitioners to proactively tailor strategies to improve their adherence and health outcomes.