Diabetes-related foot complications and caregiver burden: insights from a cross-sectional study in multi-ethnic Asians

Background: Informal caregivers (unpaid family or friends) of individuals with type two diabetes mellitus (T2DM) may experience substantial subjective, time and financial burden, especially in the presence of diabetes-related lower extremity complications (DRLEC). However, evidence on caregiver burden in Asians is limited. Hence, we aimed to investigate the association between DRLEC and informal caregiver burden, quantify the caregiving time and costs attributable to DRLEC by comparing with those without DRLEC, and evaluate how caregivers' sociodemographic characteristics influence these associations. Methods: We enrolled individuals from healthcare institutions in Singapore with T2DM and their caregivers. Caregiving burden was evaluated comprehensively, with both subjective burden and caregiving time assessed through interviewer-administered questionnaires. We measured subjective burden using the brief assessment scale for caregivers (BASC), while the monetary value of caregiving time was estimated using the replacement cost method. DRLEC was defined as current or previous ulceration and/or amputation. Linear regression was used to investigate associations between DRLEC and caregiving burden, adjusting for care recipient-related factors (age, sex, race, occupation, and duration of diabetes), while caregiver-related factors (age, sex, monthly income, working status, and marital status) were assessed as effect modifiers. Results: A total of 143 informal caregiver-care-recipient dyads were enrolled. Mean age of caregivers was 53.4 years (standard deviation (SD) = 14.1), and 64.3% were females. Mean BASC score was 1.98 (SD = 0.55; range = 0-3). Caregivers reported spending an average of 48 hours/week on caregiving duties. The presence of DRLEC among care recipients was associated with significantly greater caregiver burden (approximately 0.30 points), weekly caregiving hours (approximately 14.27 hours), and annual caregiving cost (approximately SGD 12 520), compared with caregivers of individuals without DRLEC. Associations were stronger among caregivers who were female, employed, married, and had a lower monthly income. Conclusions: Presence of diabetes-related lower extremity complications was associated with a disproportionately high caregiver burden, particularly in married female caregivers from lower-income households.