Complicated foot ulcers and high treatment costs in rural type 2 diabetic patients in vietnam: impact of infections on hospital stays

This study aims to describe the clinical characteristics and assess treatment expenditures among patients with type 2 diabetes mellitus (T2DM) who developed foot ulcers in Vietnam. A cross-sectional, hospital-based study was conducted among 283 inpatients. Data collected included demographic information, medical history, glucose and HbA1c levels, ulcer severity, bacterial culture results, and direct medical costs. The mean fasting plasma glucose, random glucose, and HbA1c were 8.87 mmol/L, 14.41 mmol/L, and 8.94%, respectively. Patients from rural areas had marginally higher treatment costs than those from urban areas (VND 10,154,000 vs. 9,444,300), though the difference was not statistically significant. The average direct medical cost per patient was approximately VND 10.5 million, with antibiotic therapy and hospitalization being the major contributors. Higher ulcer severity (Wagner grade ≥ 3) and infections—particularly with Acinetobacter baumannii and Pseudomonas aeruginosa—were significantly associated with increased costs. Multivariate analysis confirmed that ulcer grade (p = 0.038) and bacterial infection (p = 0.002) were independent predictors of higher cost. Poor glycemic control and infection are key factors increasing the economic burden of diabetic foot ulcers. Interventions targeting infection prevention and early management of ulcer severity may reduce treatment costs, particularly in resource-constrained settings.