Background: Type 2 diabetes mellitus remains a major public health problem due to its rising prevalence and the risk of chronic complications from poor blood glucose control. Socio-demographic characteristics, knowledge, access to health services, family support, and medication adherence are believed to influence glucose control. This study aimed to determine the factors associated with the control of random blood glucose levels among patients with type 2 diabetes mellitus in North Lampung Regency in 2025. Methods: This cross-sectional analytic study involved 382 respondents selected by proportional random sampling from 6,770 patients with type 2 diabetes mellitus in 27 public health centers in North Lampung Regency. Data were collected through structured questionnaires and medical records and analyzed using univariate, bivariate (Chi-square), and multivariate (logistic regression) analysis. Results: Age (p = 0.036), gender (p = 0.025), education (p = 0.040), knowledge (p = 0.001), access to health services (p = 0.031), family support (p = 0.037), health worker support (p = 0.039), perception of disease (p=0.039), and medication adherence (p = 0.000) were significantly associated with blood glucose control. Medication adherence was the most dominant factor (OR = 7.75). Conclusions: Medication adherence, knowledge, family support, and health worker support are the most significant factors associated with random blood glucose control. Strengthening patient education, access to health services, and family and health worker support is essential to improve adherence and achieve optimal glucose control.