BackgroundDiabetes prevalence among adults has risen globally from 4.6% (151 million) in 2000 to 10.5% (537 million) in 2021, with projections reaching 11.3% (643 million) by 2030. This study aimed to assess the prevalence and determinants of poor Self-Monitoring of Blood Glucose (SMBG) among Type 2 Diabetes patients at Kigeme District Hospital's NCD clinic. MethodsA cross-sectional study was conducted with 217 patients, selected using the Yamane formula. Data were collected through researcher-administered questionnaires and analyzed in SPSS v22. Univariate, bivariate (Fisher’s exact test), and multivariate (binary logistic regression) analyses were used to identify associations. Ethical standards, including confidentiality, were maintained. Findings aim to guide targeted interventions and policies. ResultsPoor SMBG was reported in 89.1% of patients; only 10.9% practiced it adequately. Females had higher odds of poor SMBG (AoR = 3.761, 95% CI: 1.568–7.930, p = 0.08). Lack of physical activity showed a strong association (AoR = 6.900, 95% CI: 4.508 10.646). Farmers and traders were at greater risk (AoR = 8.338, 95% CI: 2.026–21.766). Low knowledge of SMBG was another key factor (AoR = 11.645, 95% CI: 3.992–21.117). ConclusionMost Type 2 Diabetes patients at Kigeme exhibited poor SMBG. Key associated factors included female gender, inactivity, poor glucose control, rural occupations, limited knowledge, and equipment barriers. The study recommends expanding diabetes education and ensuring access to testing supplies to improve SMBG adherence