Diabetes-related Kidney, Eye, and Foot Disease in Taiwan: an Analysis of the Nationwide Data for 2000-2009

Background/purpose: Diabetes is one of the leading causes of dialysis, blindness, and amputation worldwide. However, the prevalence of diabetes-related kidney, eye, and foot diseases has not been investigated in national surveys.

Methods: In this study, we reviewed data sets of the National Health Insurance claims for the years 2000-2009. In 2009, the total population of Taiwan was 23 million. We de-identified the data and then analyzed them on inpatients and outpatients with diabetes mellitus, kidney diseases, eye diseases, peripheral vascular diseases (PVDs), and diabetic foot according to the International Classification of Diseases, 9(th) Revision with Clinical Modification diagnosis codes.

Results: The prevalence of diabetic nephropathy increased from 13.32% in 2000 to 15.42% in 2009. The corresponding diabetes dialysis rate increased from 1.5% to 2.46% during the same period (p < 0.001). The prevalence rates of retinopathy and PVD also increased (from 6.17% to 8.91%; p = 0.002 and from 1.87 to 2.47; p < 0.001, respectively). More than 94% of the patients treated for diabetic foot in the hospital had an associated foot infection. The prevalence of in-hospital diabetic foot decreased from 1.68% to 1.02% during the years 2000-2009 (p < 0.001), while the rates of lower extremity amputation as the treatment outcome did not show improvement (mean amputation rate: 28.35%).

Conclusion: During the years 2000-2009, patients with diabetes in Taiwan had an increased risk for kidney, eye, and PVDs. Multidisciplinary teams need to be set up for the treatment of complications related to diabetic foot, and preventions programs that are specifically designed to target these complications should now be made mandatory.