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Given the high prevalence of type 2 diabetes and its significant renal complications, which can ultimately lead to renal failure and require patients to undergo hemodialysis, this study was designed and conducted to examine the association between health literacy and hemodialysis in diabetic patients. This case-control study examined 291 patients: 97 were diabetic hemodialysis patients, and 194 were non-hemodialysis diabetic patients. Data were collected using a standard adult health literacy questionnaire. Additionally, a 19-item demographic questionnaire was used to collect information on the patients' personal characteristics. Independent t-tests and analyses of variance at the 95% level of statistical significance were used to compare mean health literacy scores based on demographic variables. A multivariable logistic regression model at a 5% significance level was used to determine the relationship between health literacy scores and factors associated with type 2 diabetes requiring hemodialysis. All analyses were performed using Stata 17 statistical software. The mean age of the patients in this study was 62.3 ± 9.72 years. Health literacy had an inverse association with hemodialysis outcomes for diabetic patients, and for each unit increase in health literacy score, the odds of hemodialysis for diabetic patients (HFDP) decreased by 15% (OR = 0.85, 95% CI: 0.82, 0.88, P-value < 0.01).Income level also had an inverse association with hemodialysis outcomes in diabetic patients; those with middle socioeconomic status had 77% lower odds of requiring hemodialysis compared to those from low socioeconomic backgrounds (odds ratio: 0.23, 95% CI: 0.09, 0.56, p = 0.001). Physical activity was also inversely associated with hemodialysis outcomes, i.e. as weekly physical activity increased, the odds of HFDP decreased by 23%. (Odds Ratio: 0.77, 95% CI: 0.64, 0.94, p = 0.011). The results indicated that health literacy, income level, and physical activity are inversely associated with hemodialysis dependence. In addition, underlying health conditions are a contributing factor to the increased likelihood of diabetic patients requiring hemodialysis.