Background: Understanding and addressing the concerns of vaccine-hesitant individuals, including those with chronic diseases, is key to increasing vaccine acceptance and uptake. However, in Ethiopia, there is limited evidence on the COVID-19 vaccine hesitancy and predictor variables among diabetic patients. Hence, the study aimed to assess Covid-19 Vaccine Hesitancy and Predictor variables among Diabetic Patients on Follow-Up at Public Hospitals in Nekemte Town, Western Ethiopia. Method: Facility based cross sectional study was conducted among 422 diabetic patients attending public hospitals at Nekemte Town, Western Ethiopia between January, to February, 2023. Study participants were recruited by systematic random sampling. The data were collected interviewee administered pre-tested structured survey questioner. The collected data were entered and cleaned using Epi-Data software 4.6 version. The cleaned data were analyzed using SPSS. 25.0 Statical software. Descriptive statistics like frequency, mean and percentage, and binary logistic regression was applied to identify independent predictors of Covid-19 vaccine hesitancy and association between variables were declared at p-value of 0.05. Result: The overall magnitude of COVID-19 vaccine hesitancy was 15.2% (95% CI: 11.6–18.7). The top three listed reasons for the COVID-19 vaccine hesitancy were: negative information about the vaccine (32.90%), lack of enough information (21.80%), and vaccine safety concern (19.40%). The hesitancy of the COVID-19 vaccination uptake among diabetes patients was independently influenced by age between 40–49 (Adjusted Odd Ratio [AOR] = 4.52(1.04–19.66)), having vaccine awareness (AOR = 0.029(0.001–0.86)), having a great deal of trust on vaccine development (AOR = 0.028(0.002–0.52)), and a fear amount trust (AOR = 0.05(0.003–0.79)) on the vaccine preparation, vaccinated for COVID-19 (AOR = 0.13(0.04–0.51)), perceived exposure to COVID-19 infection after having the vaccine as strongly agree/agree (AOR = 0.03(0.01–0.17))and neither agree nor disagree (AOR = 0.07(0.02–0.30)). Conclusion: COVID-19 vaccine hesitancy among diabetic patients was relatively low. The identified independent predictors were age, vaccine awareness, COVID-19 vaccination history, awareness on vaccine preparation and exposure status to COVID-19 infection. The relevant agency should focus on efforts to translating these high levels of vaccine acceptance into actual uptake, through targeting identifying predictor variables and vaccine availability for a high-risk diabetes patient. [ABSTRACT FROM AUTHOR]