Abstract Aims/Introduction We analyzed patient‐reported outcomes of people with type 2 diabetes to better understand perceptions and experiences contributing to treatment adherence. Materials and Methods In the ongoing International Diabetes Management Practices Study, we collected patient‐reported outcomes data from structured questionnaires (chronic treatment acceptance questionnaire and Diabetes Self‐Management Questionnaire) and free‐text answers to open‐ended questions to assess perceptions of treatment value and side‐effects, as well as barriers to, and enablers for, adherence and self‐management. Free‐text answers were analyzed by natural language processing. Results In 2018–2020, we recruited 2,475 patients with type 2 diabetes (43.3% insulin‐treated, glycated hemoglobin (HbA 1c ) 8.0 ± 1.8%; 30.9% with HbA 1c <7%) from 13 countries across Africa, the Middle East, Europe, Latin America and Asia. Mean ± standard deviation scores of chronic treatment acceptance questionnaire (acceptance of medication, rated out of 100) and Diabetes Self‐Management Questionnaire (self‐management, rated out of 10) were 87.8 ± 24.5 and 3.3 ± 0.9, respectively. Based on free‐text analysis and coded responses, one in three patients reported treatment non‐adherence. Overall, although most patients accepted treatment values and side‐effects, self‐management was suboptimal. Treatment duration, regimen complexity and disruption of daily routines were major barriers to adherence, whereas habit formation was a key enabler. Treatment‐adherent patients were older (60 ± 11.6 vs 55 ± 11.7 years, P < 0.001), and more likely to have longer disease duration (12 ± 8.6 vs 10 ± 7.7 years, P < 0.001), exposure to diabetes education (73.1% vs 67.8%, P < 0.05), lower HbA 1c (7.9 ± 1.8% vs 8.3 ± 1.9%, P < 0.001) and attainment of HbA 1c <7% (29.7% vs 23.3%, P < 0.01). Conclusions Patient perceptions/experiences influence treatment adherence and self‐management. Patient‐centered education and support programs that consider patient‐reported outcomes aimed at promoting empowerment and developing new routines might improve glycemic control.