Diabetes Complications and Burden in a Metropolitan Environment: Correlates and Costs of Diabetic Foot Disorders

Background: Diabetes is a chronic disease of complications, and of which diabetic foot ulceration (DFU) and consequences can be devastating.

Aim: Identify and analyze the economic costs related to DFU upon the Saudi diabetic population.

Methods: Direct costs related to treatment of DFU illness episodes in patients enrolled in healthcare plans with major health insurance agencies in Saudi Arabia between 2012 and 2015 were studied. Patient demographic characteristics, treatment and intervention level, and cost of illness (COI) were analyzed.

Results: The enrollees’ age averaged 54.33 ±4.76y (range 41-to-72=31y). Out of 229 diabetic patients surveyed, 158 (68.9%) were male; 162 (71%) were Saudis and 67 (29%) were non-Saudis. Least frequently needed intervention for DFU conditions was conservative treatment alone (12%, n=28), mostly needed was debridement (43.2%, n=99), and in-between was either minor lower extremity amputation (LEA) (26.2%, n=60) - or major LEA (18.3%, n=42). Further, amputation increased by age, 1.7% minor LEA for DFU patients <50 years old and 0.9% LEA for ≥50y old peers (Fisher’s exact=27.5, p<0.0001). Also, amputation was more frequent among Saudi DFU patients compared to non-Saudi peers (23.6% vs. 2.6% minor LEA, and 14.4% vs. 3.9% major LEA, respectively) [Fisher’s exact 17.3, p=0.0015]. The enrollees’ mean COI accounted SR35,934.4±15,065.1 (range 141,204, 11,032 -to- 15,2236) (1SR=USD267) per DFU event, which significantly varied by the level of intervention [F(df 3, 225)=426.9, p<0.001]. Saudi DFU patients significantly incurred higher COI [t(df 214.8)= 9.7, p<0.001].

Conclusions: Among DFU patients, amputation rates and related COI increased both by patients’ age and having Saudi nationality. An ongoing update on the prevalence and costs of DFU disorders should be among the community health research priorities in Saudi Arabia. Prevention and close monitoring save limbs and assure better quality of life of Saudi diabetic patients.