title: Effects of foot complications in patients with Type 2 diabetes mellitus on public healthcare: An analysis based on the Korea National Diabetes Program Cohort.
abstract: OBJECTIVE
  Diabetes mellitus (DM) patients are susceptible to foot injury or foot diseases such as diabetic foot and peripheral arterial disease. Although these conditions are considered important, few studies have investigated them in detail. Therefore, we investigated the epidemiology of diabetic foot complications (DFC) with respect to the effects on the public healthcare system.
  
  
  METHODS
  We evaluated the incidence, clinical characteristics, health service utilization frequency and medical expenses of DFC in type 2 DM patients in the Korea National Diabetes Program (KNDP), the largest multi-center, prospective cohort in Korea (n=4405). To determine precise outcomes, we used national representative databases, including claims data from the Health Insurance Review & Assessment Service of Korea.
  
  
  RESULTS
  During a median follow-up period of 3.30years, 528 patients (12.0%) were newly diagnosed with DFC at an incidence rate of 43.02 cases per 1000 person-years. The patients with DFC were significantly older than patients without DFC, but other clinical characteristics were similar between the two groups. The patients with DFC had more hospital visits (p<0.001), longer duration of hospitalization (p<0.001), and increased expenses (p<0.001) compared to patients without DFC. After multiple adjustments, the differences in number of hospital visits and medical expenses were consistent. In a before and after comparison within the DFC group, all three variables increased significantly after the onset of DFC (p<0.001).
  
  
  CONCLUSIONS
  DFC were significantly associated with poor clinical outcomes and caused a substantial burden to the national healthcare system in Korea. Therefore, intervention to prevent DFC is important.
authors.affiliation: Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Sang Youl
authors.initials: SY
authors.lastname: Rhee
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Suk
authors.initials: S
authors.lastname: Chon
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Kyu Jeung
authors.initials: KJ
authors.lastname: Ahn
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Cheil General Hospital and Women's Healthcare Center, College of Medicine, Dankook University, Seoul, Republic of Korea.
authors.forename: Sung-Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine,Korea University, Seoul, Republic of Korea.
authors.forename: Sei Hyun
authors.initials: SH
authors.lastname: Baik
authors.affiliation: Department of Internal Medicine, College of Medicine, Hanyang University, Guri, Republic of Korea.
authors.forename: Yongsoo
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, College of Medicine, Inha University, Incheon, Republic of Korea.
authors.forename: Moon Suk
authors.initials: MS
authors.lastname: Nam
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, Ajou University, Suwon, Republic of Korea.
authors.forename: Kwan Woo
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Jeong-Taek
authors.initials: JT
authors.lastname: Woo
authors.affiliation: Department of Preventive Medicine and Public Health Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Ki Hong
authors.initials: KH
authors.lastname: Chun
authors.affiliation: Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Republic of Korea. Electronic address: kimys@khmc.or.kr.
authors.forename: Young Seol
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D017721:Hospital Costs; D006779:Hospitals, Public; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D013222:State Medicine
keywords: Diabetes complications; Diabetes mellitus, type 2; Epidemiology; Korea; Peripheral vascular diseases; Risk factors