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

Year: 2026

Type: article

Abstract: Background Diabetes mellitus increases the risk of severe COVID-19 and persistent post-infection symptoms, 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 a reduced number of daily health complaints in COVID-19 survivors with diabetes in Indonesia. Methods This cross-sectional study was conducted in 45 community health centres ( Puskesmas ) in Yogyakarta Province, Indonesia, from March to August 2024. Eligible participants were adults (aged≥15 years), diagnosed with 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. 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. Results 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 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 protective. Vaccination following infection was not significantly beneficial for the index infection (IRR = 1.06; 95% CI 0.90–1.26). Conclusions Pre-infection COVID-19 vaccination is associated with substantially fewer persistent daily health complaints in diabetic patients. Integrating vaccination promotions into routine chronic disease management at the primary care level in LMICs may reduce long-term morbidity. Future prospective studies with uninfected control groups are needed to confirm causality.

Source: BMC Public Health

DOI: 10.1186/s12889-026-30043-2

Authors: Putri Bungsu Machmud, Husnul Khatimah, Renti Mahkota, Jessica Veronica, Arie Wahyu Wijayanto

Institutions: University of Indonesia, Kementerian Kesehatan Republik Indonesia, Politeknik Statistika STIS

Language: English

Topic: Long-Term Effects of COVID-19

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,290