Objective  To assess direct economic burden of type 2 diabetes mellitus (T2DM) and its influencing factors among community patients and to provide evidences to developing strategies for T2DM prevention and control.

  Methods  Using stratified random cluster sampling, we conducted a face-to-face questionnaire survey on demographics, disease conditions, and self-paid medical expenditure among 2 412 T2DM patients recruited at 12 community health centers in 6 districts of 3 cities (Nanjing City of Jiangsu province, Jinzhong city of Shanxi province and Yinchuan city of Ningxia Hui Autonomous Region) with different economic development from June to December 2015. Mean and 95% confidence interval were adopted to describe direct economic burden. Multivariable linear regression model was used to analyze influencing factors of direct economic burden of T2DM.

  Results  The average annual direct medical expenditure (ADME) for all T2DM patients was 4 701.2 (RMB Yuan) (95% confidence interval 95% CI: 4 250.1 – 5 152.3); the lowest (2 504.5, 95% CI: 1 977.6 – 3 031.4) and the highest (6 358.0, 95% CI: 5 149.6 – 7 566.4) ADME were reported by the patients aged < 50 years and ≥ 70 years; lower ADME (2 971.6, 95% CI: 2 480.1 – 3 463.1) was reported by the patients in Jinzhong city of Shanxi province compared to those (5 624.8 95% CI: 4 549.0 – 6 700.6 and 5 592.9 95% CI: 4 909.9 – 6 275.9) reported by the patients in Yinchuan city of Ningxia Hui Autonomous Region and Nanjing city of Jiangsu province; in comparison with the patients with shorter disease duration (< 5 years) and without comorbidity or complications, the patients with longer disease duration (≥ 15 years) and with comorbidity or complications reported higher ADME (6 247.9 95% CI: 5 278.1 – 7 217.7 vs. 4 201.3 95% CI: 3 252.0 – 5 150.6 and 6 927.7 95% CI: 4 178.8 – 5 792.0 vs. 4 038.9 95% CI: 3 562.1 – 4 515.7) . The proportion of individual ADME accounting for yearly consumption expenditure per capita for local residents was 28.3%, 25.9%, 22.5% for the patients in Jinzhong city of Shanxi province, Yinchuan city of Ningxia Hui Autonomous Region and Nanjing city of Jiangsu province. Multivariate linear regression analysis indicated that major influencing factors of ADME among the patients were residential region, duration of T2DM, and whether having comorbidity or complication, which could explain 9.58%, 3.8%, and 1.61% of total variance of ADME, respectively.

  Conclusion  The proportion of annual direct medical expenditure to yearly consumption expenditure per capita is high among community patients with type 2 diabetes mellitus in China and the patients′ medical expenditure is restricted by local economic development situation.