OBJECTIVES: To assess the association of adherence to treatment with gylcemic control and patient experience of hypoglycemic symptoms in adult T2DM patients, who added a sulfonyurea(SU) or glitazone(PPAR) to metformin(MF) monotherapy. METHODS: A retrospective clinical chart review and patient survey during physician visit (June'06-Feb'07) was conducted in 7 countries(Finland, France, Germany, Norway, Poland, Spain, UK). Patients recruited(aged 30 years) added SU or PPARƒ× to MF. A1C refers to the most recent measurement within a year prior to enrollment. Glycemic control was defined according to the IDF(2005) recommendations as A1C<6.5%. Questionnaires were used to ascertain experience of hypoglycemia and adherence to treatment. A questionnaire published by Grant et al. (2003), was modified and used to measure patient reported adherence to OHA RESULTS: A total of 1709 patients were included in this analysis. Average age 63(SD=11) years, 45% female, and 50% were diagnosed with diabetes > than 7 years. The mean A1C was 7.1%(SD=1.1), while 28%(477 patients) had adequate glycemic control. IN all, 652(38%) reported hypoglycemic symptoms. Sixty-nine percent reported that they always take their diabetes medications exactly as prescribed. Reported barriers to adherence were: 1) being unable to follow plan for diabetes(45.5%); 2) bothered by adverse effects(40.9%); 3) being unsure about physician instructions(32.9%); and 4) having difficulty filling prescriptions(23.6%). Experience of hypoglycemic symptoms was associated with higher odds of reporting: a barrier due to adverse effects (Odds Ratio(OR):2.54; 95%CI:2.1-3.1); unsure of doctor's instructions(OR:1.34; 95%CI:1.1-1.7); unable to follow plan for diabetes(OR:1.3; 95%CI:1.1-1.6); having difficulty filling prescriptions(OR:1.4; 95%CI:1.1-1.7). Patients always taking medications exactly as prescribed had higher odds of having adequate glycemic control(OR:1.3; 95%CI:1.05-1.68). CONCLUSION: Adequate glycemic control was found in 28% of patients and 38% of all patients experienced hypoglycemic symptoms. Experience of hypoglycemic symptoms was associated with barriers to adherence, while adherence to therapy improved the odds of having adequate glycemic control.