Trends in diabetes-related foot disease in a tertiary health service in Australia: a 10-year retrospective study.

Abstract

Background and aims: Despite being a major cause of hospitalisations, there is limited literature on the trends in diabetes-related foot disease (DFD) in Victoria, Australia. The aim of this study was to assess the incidence of DFD admissions and outcomes in inpatients with DM at a major Victorian health service.

Methods: Inpatients aged >18 years with DM and DFD between 2013 and 2022 were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. Admission, demographic and mortality data were extracted from the hospital electronic database. Prevalence and incidence of DM, DFD and amputations were analysed. Independent t tests, Mann-Whitney U tests and χ² tests were used to compare groups. Linear regression models were used to explore trends, with logistic and Poisson regression for analysis of 5-year mortality and length of stay.

Results: Over 10 years, 37 561 patients with DM required 110 736 admissions at Western Health. DFD prevalence was 17% (n = 6397). An increasing burden of annual DM admissions was observed (6855 to 12 182), with increased rates of DFD admissions (β = 0.480, P < 0.001). Minor amputation rates increased (β = 0.028, P = 0.001), whilst major amputation rates remained stable. DFD cohorts experienced longer admissions (median 4.11 (interquartile range 1.74-9.06) vs 1.83 (interquartile range 0.28-4.50) days, P < 0.001), higher re-admissions (76% vs 47%, P < 0.001) and 5-year mortality (23.4% vs 12.7%, P < 0.001).

Conclusion: This large retrospective audit demonstrated an increasing burden of inpatient DM and DFD at Western Health, Victoria in Australia, with greater morbidity and mortality in DFD patients. Health networks need to be prepared for greater health service utilisation required by DFD cohorts, and further funding to prevent DFD is of particular importance to avoid overwhelming health services.