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Objective: To assess the magnitude of diabetic health literacy (DHL) and associated factors among diabetes patients attending follow-up at public hospitals in Northeastern Ethiopia., Design: An institution-based cross-sectional study was conducted from 24 May to 24 June 2022., Setting: Diabetic clinics of four public hospitals in Northeastern Ethiopia., Participants: 611 adult diabetes patients who have been undergoing follow-up care for at least 6 months were systematically selected. Patients who were unable to communicate, were critically ill and with gestational diabetes mellitus were excluded from the study., Outcomes: DHL was assessed using a 15-item tool developed from existing literature., Results: Of all the participants, 300 (49.1%) had low, 174 (28.5%) moderate and 137 (22.4%) had high DHL levels. The significant factors impacting DHL included age ( < 40 years old: AOR=3.48, 95% CI=2.11-5.77; 40-60 years: AOR=2.79, 95% CI=1.75-4.46), low education (AOR=0.29, 95% CI=0.16-0.56 for those who can't read and write; AOR=0.41, 95% CI=0.23-0.74 for those who can read and write; AOR=0.45, 95% CI=0.27-0.76 for primary education), exposure to diabetic education (AOR=1.84, 95% CI=1.31-2.58), having ≥2 information sources (AOR=2.28, 95% CI=1.57-3.32), moderate social support (AOR=1.94, 95% CI=1.32-2.87), strong social support (AOR=2.73, 95% CI=1.75-4.26) and urban residence (AOR=1.65, 95% CI=1.14-2.39)., Conclusion: The study showed that less than a quarter of the patients have high DHL, with almost half having low levels of DHL. Tailoring health education programmes to diverse educational levels, incorporating multiple information sources and fostering social support networks could enhance DHL., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)