Medication non-adherence is a significant challenge in chronic diseases such as type 2 diabetes mellitus (T2DM), particularly among elderly patients, leading to increased healthcare costs and adverse outcomes. This study aimed to assess the impact of pharmacist-led counselling and short message service (SMS) reminders on medication adherence and clinical outcomes in newly diagnosed elderly patients with T2DM. A 12-month prospective, open-label, randomized controlled study was conducted at an outpatient diabetic clinic, with 340 participants randomly assigned to either the Diaβcare or usual care groups. The Diaβcare group received pharmacist counselling sessions and SMS reminders, while the usual care group received standard care. Medication adherence and clinical outcomes, including HbA1C, random blood sugar (RBS), fasting blood sugar (FBS), blood pressure (BP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and body mass index (BMI), were assessed. Statistical analysis used: Sociodemographic characteristics were compared using the Z-test, medication adherence was analysed using the Mann–Whitney test, and clinical outcomes were compared using the t-test (P < 0.05, IBM SPSS v21.0). The Diaβcare group demonstrated significantly improved medication adherence (12.2±7.1%) compared to the control group (0.75±10.2%) (P<0.001). Furthermore, significant reductions in HbA1C, systolic blood pressure (SBP), and LDL cholesterol levels were observed in the Diaβcare group compared to the usual care group (P<0.01). Pharmacist-led Diaβcare effectively enhanced medication adherence and improved clinical outcomes in elderly patients with T2DM. Collaborative efforts among healthcare providers, policymakers, and technologists are essential for scaling up such interventions to enhance global health outcomes.