Globally, the prevalence of diabetes remains high despite enhanced sensitization and management strategies. In Sub-Saharan Africa, the diabetes prevalence is thought to be under-estimated. Busia County a rural setup in Kenya is estimated to have about 20,000 persons diagnosed with diabetes. Despite the high prevalence which eventually results in increased hospitalization, the driving factors of hospitalization are barely understood. This study determined factors associated with hospitalization among diabetes patients at Busia County Referral Hospital (BCRH). The study adopted a hospital-based analytical cross-sectional design. Data was collected using close-ended structured questionnaires. Systematic sampling was used to select the 155 participants among diabetes patients seeking health care services at BCRH. Pearson’s Chi-square test of association, bivariate and multivariate logistic regression were used for data analysis using STATA version 16. More than one-half of the participants, 89 (57.4%) were female. More than half (52.9%) had been admitted at least once within six months. Those who had routine clinic visits with no admission to the hospital were 47.1%. Participants aged over 60 years were 16.07 (AOR=16.07, 95% CI= 4.47-57.72, p-value<0.001) and 7.30 times more likely to have both routine clinic visits and admission, respectively, compared to the participants aged 20-39 years old (AOR=7.30, 95% CI= 2.35-22.62, p-value<0.010) after adjusting for possible confounders. Participants taking alcohol were more likely to be admitted to the hospital as compared to those who were not taking alcohol (AOR=2.73, 95%CI=1.03- 7.27, p-value=0.044). HIV status was significantly associated with clinic visits (p-value=0.005). Counseling on the diagnosis day was significantly associated with hospital admission (OR=2.30, 95%CI=1.10-4.81, p -value=0.026). This study revealed that: age, alcohol consumption, HIV-diabetes comorbidity, and counseling on diagnosis are significant factors associated with hospitalization among diabetes patients at BCRH. The study therefore recommends strengthening of policy on education and diabetes management strategies in line with the significant factors.