Beyond the pandemic declaration: daily health complaints in diabetic COVID-19 survivors and the association with prior vaccination in Indonesian primary care

Diabetes mellitus increases the risk of severe COVID-19 and daily health complaints following infection, yet evidence from low- and middle-income country (LMIC) primary care settings remains limited. We assessed the association of pre-infection COVID-19 vaccination with the number of daily health complaints in COVID-19 survivors with diabetes in Indonesia. This was a cross-sectional study with retrospective assessment of vaccination and infection history, as all data were collected at a single time point. The study was conducted from March to August 2024 in DI Yogyakarta Province, Indonesia. Eligible participants were individuals aged≥15 years with diagnosed diabetes mellitus and self-reported history of COVID-19 infection. Trained enumerators administered a structured 25-item checklist of daily health complaints (range 0–25) during face-to-face interviews lasting approximately 20–30 min. The checklist was grouped into three domains: sensory function/ pain, body system function, and activity participation. Vaccination status was verified by electronic records ( SatuSehat ) and physical cards. The count outcomes were modelled with negative binomial regression adjusted for sociodemographic and clinical variables. Missing data were handled using K-nearest neighbours’ imputation (k = 5), yielding an analytic sample of 420 participants. Of 420 participants (median age 60 years, 70.2% female), 36.2% had prior vaccination before COVID-19 infection. The most prevalent complaints were joint/muscle pain (46.0%), visual impairment (43.1%), and fatigue (24.3%). In multivariable analysis, never-vaccinated individuals had a 45% higher rate of total daily health complaints than individuals vaccinated before infection (incidence rate ratio [IRR] = 1.45; 95% CI 1.10–1.91). Higher complaints rate was associated with female sex (IRR = 1.25; 95% CI 1.02–1.53), while secondary education (IRR = 0.66 for body system dysfunction) and absence of other comorbidities (IRR = 0.84 for sensory/pain complaints) were associated with lower rates. Vaccination following infection was not significantly beneficial for the index infection (IRR = 1.06; 95% CI 0.90–1.26). Pre-infection COVID-19 vaccination is associated with substantially fewer daily health complaints in diabetic patients. Integrating vaccination promotions into routine chronic disease management at the primary care level in LMICs may be associated with reduced long-term morbidity. Future prospective studies with uninfected control groups are needed to confirm causality.