Status of Diabetic Neuropathy in Korea: A National Health Insurance Service-National Sample Cohort Analysis (2006 to 2015) (Diabetes Metab J 2021;45:115-9)

Abstract

Corresponding author: Tímea Csákvári https://orcid.org/0000-0002-3339-4953 University of Pécs, Faculty of Health Sciences, Institute for Health Insurance, 33 Landorhegyi street, Zalaegerszeg H-8900, Hungary E-mail: [email protected] Health insurance costs of diseases that pose a significant public health burden provide decision-makers important information not only in terms of the epidemiological consequences but also regarding their economic impact. Studying changes in this respect over a longer period of time focusing on diseases causing a significant health burden may reveal valuable information and thus, may help identify and predict trends that can subsequently contribute to designing and implementing actions that target the reduction of the disease burden related to these medical conditions. In 2019, diabetes affected around 463 million people worldwide [1]. Nerve damage as a microvascular complication is the most common complication among diabetic patients. Diabetic neuropathy (DN) is the most common cause of non-traumatic lower extremity amputations [2]. In a study, Moon et al. [3] focused on neuropathy as the most prevalent complication of diabetes mellitus. The strength of the study is that the prevalence of the disease/complication was investigated on a representative cohort sample. Authors found that the prevalence of neuropathy showed a decreasing tendency after 2007 (2007, 26.6%; 2015, 20.8%). According to estimates published in the international literature, the prevalence of painful neuropathy is between 5.8% and 34% in the European diabetic population [4]. Although these estimates are in line with findings of the above study, authors highlight the fact that these numbers may actually be higher. We have previously studied the epidemiological and disease burden of type 2 diabetes mellitus (T2DM) with neurological complications and diabetic polyneuropathy (DPN) in Hungary [5,6]. Data were derived from the database of the National Health Insurance Fund Administration (NHIFA), the sole health insurance provider of Hungary that allowed us to perform a comprehensive nationwide analysis. The table below shows the distribution of International Classification of Diseases (ICD) codes E11.4 and G63.2 that may identify nerve damage related to T2DM in Hungary according to levels of care (Table 1) [7]. In 2018, the health insurance treatment cost of non-insulin dependent diabetes mellitus with neurological complications (E11.4) was 12.22 million United States dollar (USD) in Hungary, its prevalence was 365.9/100.000 in women and 350.5/10.000 in men amounting to a total of 358.5/ 100.000. The NHIFA spent 24.52 million USD on the treatment of DPN (G63.2) in the same year. Based on costs of pharmaceuticals, the prevalence of DPN for the entire population was 838.6/100.000 in men and 972.3/100.000 in women accounting for a total of 908.4/100,000. Diabetic foot syndrome is the most severe condition related to diabetes and its neurological complications and requires a complex therapy [8]. The presence of neuropathy has been proved to contribute to the development of diabetic foot synLetter