Predicted annual costs for inpatients with diabetes and foot ulcers in a developing country-a simulation of the current situation in Brazil

AIMS

The objective of this cost-of-illness analysis was to quantify the annual costs associated with hospital admission for people with diabetes and foot ulcers in Brazil.

METHODS

A hypothetical cohort was simulated using a decision tree model. Prevalence and incidence rates and clinical outcomes were estimated from published studies and applied to the general Brazilian population over 30 years. Costs were quoted in Brazilian real (BRL) and converted to US dollars ($US) at the 2008 currency exchange rate ($US1 = BRL 1.64). In the sensitivity analysis, we reduced and increased rates to assess the robustness of the cost estimates.

RESULTS

In this hypothetical cohort there are 6.48 million (95% confidence interval 4.47-7.12) Brazilians citizens with Type 2 diabetes. Each year, approximately 323,000 (89,500-484,500) of these people develop foot ulcers and almost 97,200 (17,900-169,600) require hospital admission as a result. Each year, almost 46,300 (8500-80,900) limb amputations and 12,400 (2300-21,700) deaths occur as a result of diabetic foot disease in Brazil. The annual cost associated with these hospital admissions is estimated to be almost $US264m ($US51m-461m). The estimated cost for patients with amputation is nearly $US128m ($US24.5m-222.3m).

CONCLUSIONS

Our model shows that the social and economic impact of diabetic foot disease in Brazil is high. Government decision makers should reflect on the current situation and provide organized foot care throughout the whole country.

[Autonomic neuropathy in patients with impaired glucose tolerance]

Impaired glucose tolerance (IGT) is a clinical situation characterized by mild hyperglycemia, which is estimated to afflict 7.8% of the Brazilian population. Diabetic neuropathy is the most common complication in diabetes mellitus and it is related to morbidity and lethality in this disease. The association between IGT and peripheral neuropathy is still a matter of great concern.

PURPOSE AND METHOD

In order to determine if IGT is associated with autonomic neuropathy a cross-sectional study in 44 patients with impaired glucose tolerance test (Group 1) was performed. The patients were compared to 43 control individuals (Group 2). Every patient in each group underwent anamnesis and standardized autonomic tests which consisted of heart frequency test, Valsalva maneuver, postural test and sinus arrhythmia. Routine hematologic exams as well as GTT were also made.

RESULTS

Patients in group 1 had more systemic arterial hypertension, centripetal obesity, fasting and post-feeding hyperglycemia and dyslipidemia when compared with group 2. When we analysed the autonomic tests, the sinus arrhythmia test was abnormal in 54.5% of the patients in group 1 and in 32.5% in group 2 (p = 0.0039) and the Valsalva maneuver was abnormal in 34.1% of group 1 and in 7% of group 2 (p = 0.004). The postural test was not different in both groups (p = 0.334).

CONCLUSION

Our results show that the involvement of the autonomic nervous system was more frequent in patients with IGT when compared to controls. These findings can explain the increased lethality due to vasculopathies observed in this group of patients and also alert physicians to care for patients with impaired glucose tolerance test.