Background: The rising prevalence of type 2 diabetes mellitus (T2DM) with the huge burden
of diabetic foot amputation is a challenge to the health economy of Pakistan and other countries. Identification
of various risk factors for amputation, along with its financial burden, is needed to address this
Objectives: This study aimed to determine the financial burden and risk factors associated with T2DMrelated
Methods: Retrospective hospital-based study from January 2017 to December 2018. Patients with
T2DM with and without amputation were enrolled. The direct medical costs of amputation along with
various risk factors, were determined. Risk factors were evaluated by logistic regression analysis.
Results: A total of 1460 patients with T2DM were included; 484 (33%) patients had an amputation. The
mean total cost of below knee, fingers and toe amputation was 886.63±23.91, 263.35 ±19.58 and 166.68
± 8.47 US$, respectively. This difference among groups was significant (p<0.0001). Male gender (odds
ratio, OR: 1.29, 1.01-1.63, p=0.037), peripheral artery disease (OR: 1.93, 1.52-2.46, p=0.000), peripheral
neuropathy (OR: 1.31, 1.40-1.63, p=0.000), prior diabetic foot ulcer (OR: 2.02, 1.56- 2.56,
p=0.000) and raised glycated haemoglobin (HbA1c) (OR: 3.50, 2.75-4.4, p=0.000) were risk factors for
Conclusion: The health-related financial impact of amputations is high. Peripheral artery disease, peripheral
neuropathy, prior diabetic foot ulcer and raised HbA1c were risk factors for amputation.