Diabetes mellitus is a major global public health challenge. Insulin adherence is crucial to prevent complications, yet poor adherence remains common. This study assessed insulin adherence and associated factors among diabetic patients in Wolaita Zone Hospitals, Southern Ethiopia.

A multicenter cross-sectional study was conducted from November 2023 to January 2024 among 394 diabetic patients. Participants were selected using proportional allocation and systematic random sampling. Logistic regression was used to identify factors associated with insulin adherence, with results reported as adjusted odds ratios (AORs) and 95 % confidence intervals (CIs).

The prevalence of insulin adherence was 40.1 % (95 % CI: 35.5–44.9 %). Higher adherence was associated with college education or above (AOR=3.03; 95 % CI: 1.36–7.18), owning a glucometer (AOR=2.79; 95 % CI: 1.35–5.75), good knowledge (AOR=3.14; 95 % CI: 1.71–5.77), positive attitude toward insulin (AOR=6.12; 95 % CI: 3.38–11.09), and regular monthly follow-up (AOR=3.81; 95 % CI: 1.73–8.40). Conversely, having comorbidities (AOR=0.42; 95 % CI: 0.23–0.77) and diabetes duration ≥15 years (AOR=0.27; 95 % CI: 0.11–0.67) were negatively associated with adherence.

Insulin adherence was low. Patient-centered interventions focusing on education, attitude improvement, and promote regular follow-up are vital to enhance adherence and reduce complications.