| Objective:1.To investigate the clinical characteristic of diabetic foot in patients with type 2 diabetic mellitus(T2DM).2.To evaluate the risk factors for diabetic foot.3. To analyse the medical cost of diabetic foot patients in in-patient facilities.Methods:1.A total of 1016 inpatients with diabetic foot in the Foot department of the Metabolic Disease Hospital of Tianjin Medical University from January,2001 to June,2008 were enrolled.Their clinical data were collected,including demographic data,correlation factors of diabetic foot,laboratory data,medical cost and so on.2. 561 out of 1016 inpatients had the complete laboratory data(exclude Wagner 0 patients),which were divided into two groups according to Wagner's Classification: mild group with 156 Wagner 1-2 patients and severe group with 405 Wagner 3-5 patients.3.812 out of 1016 inpatients had the complete data about the medical cost. Among them,519 cases from 2003 to 2006 were divided into three groups: amputation group(35 cases),toe amputation group(95 cases) and Control Group (389 cases).The medical cost and hospital day of three group patients were compared. The tendency of medical cost from 2001 to 2007 was analysised.4.The statistical analysis was executed by SPSS 13.0 software.Results:1.The investigation showed the proportion of diabetic foot inpatients with T2DM was 4.74%and the ratio of male and female was 1.6/1.Foot problems most frequently occurred in the elderly diabetic patients of 71-80 years old and diabetic duration of 6-10 years.Trauma(18.87%) was main motivation of diabetic foot problems.61.71%of the ulcers were at the Wagner stage 3 or 4.There were 53.03% ulcers with neuropathy combined with peripheral artery disease.The location of ulcers was mainly toe.The blood glucose control of diabetic foot patients was worse. Lipid metabolism disorder was mainly Hypertriglyceridemia.The average mean of Packed cell volum,Fibrinogen,Prothrombin timeand,High-sensitivity C-reactive protein were above the normal levels.Most of these patients had diabetic complications or related affection,including neuropathy(90.06%),coronary heart disease(67.52%),Peripheral vascular disease(64.37%),hypertension(61.52%) and so on.44.83%patients with diabetic foot infection had the typical clinical symptom, and the other(55.1%) had the atypical clinical symptom.The pathogenic bacteria were mainly Gram-positive bacteria.The therapeutic results of diabetic foot ulcers included cicatrize(500 cases),amelioration(345 cases),decease(16 cases),disunion and autokinetic discharge(110 cases),toe amputation(301 cases),amputation(above ankle,47 cases) and amputation in other hospital(45 cases).The toe amputation rate was 29.63%and the amputation rate was 9.06%.2.Results from Non-conditional logistic regression analysis showed that severity of the foot problems was associated with peripheral vascular disease,diabetic nephropathy,fibrinogen,high-sensitivity C-reactive protein,white blood cell and Albumin(P<0.05).3.Results from analysing the medical cost and hospital day can be briefly stated as follows.(1) The average hospital day was 38 days.The average direct medical cost and day cost in hospital were 18 913 yuan and 498 yuan respectively.The medical cost was mainly western medicine cost,then treating cost,chemical examination,bed cost and nursing cost.(2) The medical cost from 2001 to 2007 was increasing year by year,especially from 2005 to 2007.(3) There were significant difference among three groups about the hospital days(P<0.05);There were significant difference among three groups,control group and toe amputation group,control group and amputation group about the medical cost(P<0.017).There were no significant difference between toe amputation group and amputation group about the medical cost(P>0.017).Conclution:Foot problems most frequently occurred in the diabetic patients with advanced age,long diabetic duration or more diabetic complications.The location of ulcers was mainly toe.The more ulcers suffered from neuropathy combined with peripheral artery disease and were complicated with atypical infection.Severity of the foot problems was associated with peripheral vascular disease,diabetic nephropathy, fibrinogen,high-sensitivity C-reactive protein,white blood cell and albumin.The medical cost of diabetic foot was expensive.Through enhancing protection and treatment,the diabetic foot ulcers can be effectively controlled,which was very singificant to improve the quality of life of patients and reduce medical cost.
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