In compliance with the data obtained in the study, and considering its complexity, Non-Communicable Diseases (NCDs) have a significant impact, leading to a decline in people’s quality of life, resulting in disability and a high degree of limitation in daily activities. Additionally, they are responsible for a considerable increase in mortality rates among individuals under the age of 70. This is due to systemic causes and multifactorial clinical conditions that lead to changes in the function and structure of target organs, combined with metabolic alterations that induce negative outcomes when associated with other pathologies [5].

Diabetes Mellitus primarily affects circulation, directly impairing renal function, increasing the likelihood of poor prognosis, and prolonging hospital stays. Consequently, these patients require a broader team of professionals to assist with rehabilitation and intensive care, along with specialized supplies and materials, which exponentially increase healthcare expenses [6].

Systemic alterations and chronic complications, caused by glycemic disorders and elevated glucose levels, favor the development of Diabetic Neuropathies. One of the most critical consequences of this condition is peripheral nerve involvement, which significantly limits tactile and pain sensitivity. As a result, patients are more susceptible to trauma and potential wound formation in areas where sensitivity is compromised. This, combined with tissue hypoperfusion due to circulatory impairment, creates a favorable scenario for complications arising from Diabetes Mellitus, such as delayed wound healing, amputations, and even death [7].

In cases of diabetic wounds, delayed healing is primarily caused by tissue ischemia resulting from compromised perfusion, leading to inefficient blood supply [8]. Other factors contributing to unfavorable patient outcomes include poor glycemic control, pre-existing cardiovascular diseases, ulcer formation in the lower limbs, and other peripheral arterial diseases [9].

A study conducted in all hospitals providing care under the Brazilian Unified Health System (SUS) in the state of Sergipe demonstrated that, among 109 patients hospitalized with a diagnosis of diabetic foot, 95 (87.2%) were discharged, while 14 (12.8%) progressed to death. The treatment provided ranged from primary dressings and topical treatment (15%) to surgical debridement (37.6%), amputation (62.4%), and femoropopliteal revascularization (4.6%). More severe ulcers, classified as grades 4 and 5 on the Wagner scale, were more frequently associated with amputations. By the end of the hospitalization period for these 109 patients, the total hospital expenses exceeded 486,000 reais, averaging R$ 4,461.04 ± 2,995.30 per patient [10].

The highest costs were related to hospital expenses (57%), followed by medical fees (23%), medications (17%), and complementary exams (3%), corroborating the results of this study, which highlight the high costs of hospital expenses. However, the same study indicates that SUS funding was seven times lower than the total expenditure, revealing a discrepancy in the reimbursement values. Furthermore, it was observed that patients who underwent primary healing and minor amputations required longer hospitalization periods, increasing hospital costs [10].

It is estimated that SUS performed 102,056 amputation surgeries, with 70% resulting from complications of Diabetes Mellitus, significantly impacting the financing of public healthcare in Brazil [11]. This information aligns with data from other countries, such as the Netherlands and Spain, where hospitalization periods were longer, but amputation rates were lower [12,13].

From this perspective, it is necessary to assess not only the economic impact but also the social and human costs. Amputations are considered a significant public health issue as they lead to disabilities, social and psychological distress, lifestyle changes, financial difficulties for patients, prolonged hospital stays, and increased mortality rates [14–16].

Studies indicate that amputations bring radical changes to patients’ daily lives, affecting their functional abilities, autonomy, and physical dependence for daily activities. This can lead to an exacerbated emotional burden, with significant psychological impacts, including depression, anxiety, fear, grief over the lost limb, and social discomfort [16].

In this context, the Unified Health System (SUS), recognized as one of the largest and most complex healthcare systems in the world, plays a crucial role in promoting and providing healthcare services to the population. It extends beyond medical care and hospital-based models, actively incorporating primary healthcare actions, including medium and high complexity hospital services, sanitary and epidemiological surveillance, environmental monitoring, and pharmaceutical assistance, which also includes the distribution of chronic-use medications [17].

All these services are part of a set of public policies integrated into SUS, aiming to reduce inequality based on its constitutional principles of universality, equity, and comprehensiveness. These principles contribute to the country’s economic and social development, as healthcare directly impacts quality of life and population well-being. The funding of this complex system is a public responsibility, structured in a tripartite manner, involving contributions from the federal, state, and municipal governments, as well as taxpayer contributions [17].

As a major public health concern, uncontrolled diabetes is among the conditions that generate the highest expenses for SUS, particularly as it is one of the leading causes of non-traumatic amputations, which require prolonged hospitalization and consequently incur higher costs to cover patient expenses during recovery [18].

With the establishment of the Family Health Program (PSF) in Brazil, improvements and advancements in primary healthcare have enabled the development of structured healthcare actions through multidisciplinary teams. This contributes to the planning and implementation of health education and disease prevention strategies [17].

Thus, primary care serves as the foundation for the entire healthcare service flow. Strengthening preventive actions at this level helps avoid severe complications, particularly NCDs, which lead to costly and complex hospital care. Many of these conditions could be prevented or even avoided if health education initiatives were effectively disseminated and easily accessible to all citizens [17].

Among the numerous initiatives within SUS, the structuring of pharmaceutical assistance stands out as it ensures access to essential medications for low-income populations. Medication expenses constitute a significant portion of family health expenditures. Public spending on medications within the free access policy continues to rise and represents the second-largest healthcare expenditure, surpassed only by hospital care. The high prevalence of chronic diseases, particularly among the most vulnerable populations, further increases medication consumption, highlighting the need for greater financial investment [19,20].

Other strategies reinforce the care continuum for NCDs, such as Hiperdia, a program within the Family Health Strategy (ESF) aimed at monitoring and educating patients with hypertension and diabetes. This program seeks to promote health education tailored to patients’ conditions while monitoring the risks of disease-related complications [21].

In this strategy, a multidisciplinary approach is adopted, with professionals within their respective fields setting goals and actions for health promotion and complication prevention. Patient registration facilitates long-term follow-up and generates essential data for healthcare management bodies to allocate further investments in this sector. Within the context of primary healthcare investments, the Previne Brasil program was established through Ordinance No. 2,979, dated November 12, 2019 [21].

This new funding model modifies the distribution of financial transfers to municipalities based on three criteria: weighted capitation, performance-based payment, and incentives for strategic actions. It represents a new financing proposal for primary healthcare, primarily focused on increasing public access to primary care services, thereby expanding patient interaction with healthcare teams. However, there is no guarantee of rapid and effective care, as this would require increasing healthcare teams to support the growing assisted population, representing yet another challenge in the efficient management of NCDs [22].

Despite current strategies for diabetes management, such as the provision of insulin and regular medical follow-ups, Brazil faces challenges in ensuring comprehensive care for people with Diabetes Mellitus, mainly due to socioeconomic disparities. The lack of universal access to adequate treatment, coupled with resource shortages in some regions, makes disease management a complex challenge. Many diabetes patients do not receive the necessary follow-up, leading to severe complications, increased hospitalizations, overburdening the healthcare system, and escalating costs [23].

One limitation of this study is the possibility of underreporting in the data collection and recording system. This may occur due to communication failures or incomplete information, compromising data accuracy and comprehensiveness. Another limitation is the delay in updating the data used in the study, as updates do not occur continuously or immediately. This discrepancy may affect the temporal relevance of findings, especially in the analysis of dynamic or rapidly changing phenomena.