Amidst the myriad challenges faced by individuals managing diabetes, medication non-adherence emerges as a critical barrier to achieving optimal health outcomes. Against this backdrop, the aim of this study is twofold. First, we seek to evaluate therapeutic compliance in elderly diabetics. Second, we delve into the intricate web of factors associated with poor compliance. We conducted a descriptive cross-sectional study at the endocrinology department of Hedi Chaker University Hospital in Sfax from January to March 2023. The study included patients aged 65 years and older who had been diagnosed with either type 1 or type 2 diabetes and had been receiving treatment with oral antidiabetic medications and/or insulin for at least three months. This study included a sample of 137 elderly patients, with a mean age of 71.49 years (±6.2), ranging from 65 to 90 years old. A female predominance (51.8%) was observed. Regarding therapeutic adherence, 77 patients were found to have poor medication adherence, representing a prevalence of 56.2%. In contrast, moderate adherence was observed in 38 patients (27.7%), while 22 patients (16.1%) exhibited good adherence.. Individuals who do not adhere to prescribed treatments, as instructed by their healthcare provider, are more prone to non-adherence [OR = 4.644; 95% CI (1.457-14.804), p = 0.009] compared to those who follow their prescriptions. Thus, the absence of self-monitoring of blood glucose [OR = 2.987; 95% CI (1.295-6.889), p = 0.01] and irregular medical visits [OR = 5.383; 95% CI (1.353-21.419), p = 0.017] was associated with a higher likelihood of non-adherence compared to those who actively monitored their diabetes and had regular medical visits, respectively. Moreover, individuals with diabetes who have high HbA1C levels (>7%) had a higher propensity for non-adherence [OR = 3.008; 95% CI (1.194-7,580), p = 0.02] than their counterparts. People diagnosed with diabetic retinopathy were also more likely to be non-adherent [OR = 2.987; 95% CI (1.327-6.725), p = 0.008] than those without this condition.