Purpose <p>Effective diabetes management requires a patient-centered approach. Research has shown mixed results regarding the impact of patient satisfaction on outcomes. This study examines the associations between different aspects of patient satisfaction, glycemic control, and diabetes complications.</p> Methods <p>This cross-sectional study used data from the National Program for Prevention and Control of Diabetes in Iran from 2018 to 2021. Satisfaction was assessed across: (1) treatment and follow-up interventions, (2) physical health and management of complications, (3) personal and social relationships, and (4) participation and education on health improvement. Statistical analyses were performed using SPSS version 26.</p> Results <p>Satisfaction with treatment showed associations with increased prevalence of obesity (AOR: 1.146), lipid disorders (AOR: 1.100), ischemic heart disease (AOR: 1.129), and microvascular complications. Conversely, higher satisfaction with physical health was associated with lower rates of complications. Satisfaction with social relationships was associated with lower odds of several complications but higher diabetic foot risk. Participation and education satisfaction were associated with improved glycemic control but had mixed associations with complications.</p> Conclusion <p>While patient satisfaction is generally associated with better glycemic control, it does not always lead to better long-term health outcomes. Future interventions should consider the alignment of treatment satisfaction and clinical effectiveness in diabetes control.</p> Trial Registration <p>Not Applicable.</p>