Epidemiology and the medical burden of diabetic foot ulcers especially in patients with infection : a population-based analysis from Germany

Abstract

Due to limited data on the epidemiology of diabetic foot ulcers (DFU) in Germany, especially for those infected, the study determined the prevalence and incidence of DFU and the associated medical burden. Anonymised claims data of 3.3 million insured lives were sourced from a statutory health insurance fund. Patients with DFU between 04/01/2016 and 12/31/2019 were selected (n = 7764) and divided into patients with/without infection/with prophylactic use of antibiotics. Outcome variables were described categorically. Two-sided t-tests and chi-squared tests (p < 0.05) were performed. The prevalence and incidence in patients with DFU was 4.6% and 2.1%, respectively. The mean Charlson Comorbidity Index was 7.9, significantly higher in those infected than in those uninfected (8.1% vs. 7.2%, p < 0.0001). Amputations occurred significantly more often in DFU patients with infection than in those without (minor 25.4% vs. 3.0%, p < 0.0001; major 6.7% vs. 1.2%, p < 0.0001). The 5-year mortality rate was significantly higher in patients with infection than in those without (64.0% vs. 51.3%, p < 0.0001). The occurrence of comorbidities and complications associated with DFU, in particular the high overall medical burden and mortality rate—especially in DFU patients with infections—underscores the importance of prevention and early, appropriate treatment.