The relationship between clinic symptoms and cost of treatment in patients with diabetic foot injury

Background and aim: The diabetic foot is one of the chronic complications of diabetes, which requires hospitalization the most and for the longest duration. Diabetic foot significantly reduces quality of life of the patients. Diabetic foot has become one of the most important public health problems of today, due to the high cost, mortality and morbidity. Diabetic foot treatment is a highly complicated and demanding subject. With a multidisciplinary approach, it is possible to perform diabetic foot treatment successfully and reduce treatment cost. The aim of our study is to determine the effect of each factor on total cost by investigating the relationship between clinical findings and cost of treatment in patients who are followed up due to diabetic foot injury. Materials and methods: Between January 2012 and May 2018, total in 300 male and female patients with type 2 diabetes mellitus who were older than 18 years of age due to diabetic foot injury were included in Gaziantep University Faculty of Medicine Endocrinology and Metabolism service. Age, gender, hemoglobin A1c. Wagner stage, length of hospitalization, cost of vacuum wound treatment, cost of diagnostic imaging, cost of daily dressing and wound care, cost of antibiotic treatment, cost of insulin treatment, cost of amputation treatment, cost of hospitalization and total cost examined as retrospective study. The effect of each factor on total cost is determined. Results: Three hundred patients were included in the study. The male to female ratio is detected as 1.94. The mean age of the patients revealed as 62.6±11. The mean hemoglobin A1c level is determined as 9.5± 2.4. Mean duration of hospitalization is detected as 17.8±12.9 days. Diabetic foot wound was stage 1 (% 12.33) in 37 patients, stage 2 (% 20.33) in 61 patients, stage 3 (% 36.67) in 110 patients, stage 4 (% 17.33) in 52 patients and stage 5 (% 13.33) in 40 patients. The average cost of treatment of patients with diabetic foot injury was significantly higher compared to diabetic patients without diabetic foot complications (p<0.05). When the contribution of the factors involved in the treatment of diabetic foot to the total cost was examined as ratio, antibiotic treatment was the largest contributor with a 30.8% share. When cost analysis of diabetic foot ulcers is performed; The effect of antibiotic treatment on total cost was detected less in patients with stage 1 and stage 2 depending on whether the antibiotic treatment was used less or not used at all. Because the cost of hospitalization was calculated for each patient and the duration of hospitalization of the patients was long, the hospitalization cost was effecting the total cost the most according to cost analysis results (r=3.24). After the cost of hospitalization, factors effecting the total cost most were diagnostic imaging (r = 2.52) and amputation therapy (r = 2.14) respectively. Conclusions: Prevention of diabetic foot formation is important both socially and economically. With a multidisciplinary approach it is possible to treat diabetic foot wound successfully and reduce treatment costs. Reducing hospitalization and length of staying by detecting and treating early stage lesions in diabetic foot ulcers will be effective in reducing the cost of treatment of the disease. Keywords: Diabetes mellitus, Diabetic foot, cost of treatment, multidisciplinary approach.