Background <p>Poor glycaemic control is common among adults with type 2 diabetes mellitus (T2DM) in low- and middle-income settings in South-Eastern Europe, yet patient-level data on its correlates from Albania are scarce. We examined the demographic, clinical and treatment-related factors associated with poor glycaemic control (HbA1c ≥ 7%) in Albanian adults with T2DM.</p> Methods <p>Cross-sectional study of 176 consecutive adults with T2DM attending a hospital-based outpatient diabetes service in northern Albania. Poor glycaemic control was defined a priori as HbA1c ≥ 7% (53 mmol/mol). Sociodemographic characteristics, diabetes duration, insulin therapy and physician-confirmed comorbidities were recorded. Associations were assessed using univariate and multivariable logistic regression, estimating odds ratios (OR) with 95% confidence intervals (CI); comorbidity was modelled both as individual conditions (primary model) and as a comorbidity-burden index (sensitivity model). Model calibration and discrimination were evaluated using the Hosmer–Lemeshow test and the area under the ROC curve.</p> Results <p>Mean age was 65 years, 51% were men and mean diabetes duration was 11 years. The prevalence of poor glycaemic control was 58.5% (95% CI 50.9–65.9%), and 54% were receiving insulin. In univariate analyses, poor control was more frequent with insulin therapy (OR 5.64, 95% CI 2.93–10.87), longer diabetes duration (OR 1.42 per 5 years, 1.09–1.85) and ischaemic heart disease (OR 2.10, 1.09–4.08). After mutual adjustment, insulin therapy was the only factor independently associated with poor control (adjusted OR 6.32, 95% CI 2.71–14.71); age, diabetes duration, hypertension, ischaemic heart disease and multimorbidity were not. Results were unchanged in the sensitivity model. The primary model was well calibrated (Hosmer–Lemeshow <i>p</i> = 0.96), with moderate discrimination (area under the ROC curve 0.74).</p> Conclusions <p>In this Albanian outpatient population, poor glycaemic control was common and insulin therapy was the only factor independently associated with it. This reflects confounding by indication rather than harm from insulin: insulin is initiated when oral therapy no longer maintains targets, so insulin-treated patients form a clinically identifiable subgroup with more advanced disease who warrant priority for structured treatment intensification and individualised follow-up. Prospective multicentre studies are needed to confirm these associations and their temporal direction.</p> Trial registration <p>Not applicable (observational, non-interventional study).</p>