Background: Diabetes is a non communicable disease and today the world is experiencing a silent pandemic. Its complications negatively impact the patient’s quality of life, caregivers and society. Evidence based medicine suggests good Glycaemic control is required to restrict the complications of diabetes. Many factors play a significant role in poor glycaemic control. This study aims to identify the factors affecting glycemic control in patients with type 2 diabetes. Methods: A prospective observational study was conducted on 175 patients with diabetes mellitus having HbA1c more than 7g% from April 2022 to September 2022. A pre-tested, semi-structured questionnaire was used to collect the socio-demographic details, history and reasons for not taking insulin after obtaining informed consent. Results: 56% were between 41-60 years. The mean Hba1c was 11.3% with no significant differences between genders, socio-economic status and place of residence. 82.9% did not take insulin due to a patient related factor. Fear of injection being the most important (37.7%) which was seen more in male (32%) than females (23%). 13.1 % were not advised by their doctor. Conclusion: Proper adherence to treatment plays a pivotal role in preventing complications. Patient factors which are major cause of non adherence to insulin usage and doctors inertia to advice insulin therapy at appropriate time, need to be addressed. Patients and caregivers have to be counselled on the need for insulin therapy in management of the condition and preventing complications