Comparison of clinical characteristics and medical costs of patients with diabetic foot ulcer in some provinces of China

Abstract

Objective To compare and analyze clinical data, ulcer characteristics, prognosis and hospitalization expenses in the patients with diabetic foot ulcer in 2004 and 2012 in China. Methods Diabetic foot disease data from 14 great three A hospitals from 10 provinces or cities in 2004 and 15 great three A hospitals from 11 provinces or cities in 2012 in China were collected and analyzed, including the medical history, physical and biochemical examinations, demographic characteristics, prognosis and hospitalization expenses. The classification, stage and risk factors of diabetic foot ulcer were also compared between two groups. The t, χ2 and u tests were used for comparing between two groups of data. Hospitalization expenses of diabetic foot disease was corrected with consumer price index. Results 386 cases in 2004 and 682 cases in 2012 were recruited. No significant differences in age, educational level, duration of diabetes, waist hip ratio, glycosylated hemoglobin A1c, triglyceride, high density lipoprotein cholesterol, uric acid, prevalence of dyslipidemia, cerebrovascular, peripheral artery disease, diabetic peripheral neuropathy, ischemic foot ulcer, and hospitalization expenses between two groups (all P>0.05). Compared with the patients in 2004, duration of diabetic foot (1(1-6) vs 6(1-16) m, u=-7.955, P<0.05) was shorter, more men(65.2% vs 58.5%, χ2=4.738, P<0.05), more patients with smoking(45.8% vs 39.0%, χ2=4.602, P<0.05) and/or drinking(41.1% vs 19.1%, χ2=51.179, P<0.05), lower fasting and postprandial blood glucose, total cholesterol and low density lipoprotein cholesterol in 2012(t=-2.987, -2.855, -4.910, -3.748, all P<0.05). The higher prevalence of hypertension, coronary heart disease, diabetic kidney disease, diabetic retinopathy(χ2 =47.572, 13.297, 9.638, 4.329; all P<0.05), and more patients with infectious foot ulcer, more patients with severe foot disease whose foot ulcer classified as Wagner 3 and above or Texas D (χ2 = 6.787, 40.880, 11.028, all P<0.05). There were significantly lower major amputation rate, higher ulcer healing rate(χ2 = 8.838, 8.908, 107.773, all P<0.05), shorter hospital stay (18(12-32) vs 21(15-32)d, u=-3.349, P<0.05). Conclusions The patients with diabetic foot disease in 2004 and 2012 were older, with more men, low educational level, long duration of diabetes, poor control of hyperglycemia, high hospitalization expenses and with more cardiovascular risk factors and diabetic complications. Compared with the patients in 2004, patients with diabetic foot disease in 2012 had more concomitant diseases and complications, with more severe foot ulcers and infections, higher total amputation rate, but lower major amputation rate, higher ulcer healing rate, and shorter hospital stay. Key words: Diabetes; Diabetic foot; Amputation; Hospitalization expenses