Characteristics of Diabetic Foot Ulcer Patients Pre- and During COVID-19 Pandemic: Lessons Learnt From a National Referral Hospital in Indonesia

Abstract

Background: Diabetic foot ulcer (DFU) is one of the most terrifying diabetic complications for patients, due to the high mortality rate and risk for amputation. During the COVID-19 pandemic, many diabetic patients limited their visits to the hospital, resulting in delays for treatment especially in emergency cases. Objective: This study aimed to compare the characteristics of patients with DFU pre- and during COVID-19 pandemic period. Methods: This study was a retrospective cohort study using foot registry data. We compared our patients’ characteristics pre-COVID-19 pandemic period (1 March 2019-28 February 2020) and during COVID-19 pandemic period (1 March 2020-28 February 2021). Results: Cohorts of 84 and 71 patients with DFU pre- and during COVID-19 pandemic period, respectively, were included in this study. High infection grade (66.7% vs 83.1%, P = .032), osteomyelitis event (72.6% vs 87.3%, P = .04), leukocyte count (15 565.0/μL vs 20 280.0/μL, P = .002), neutrophil-to-lymphocyte ratio (7.7 vs 12.1, P = .008), waiting time-to-surgery (39.0 h vs 78.5 h, P = .034), and number of major amputation (20.2% vs 39.4%, P = .014) were significantly higher during the COVID-19 pandemic period. Conclusion: During the COVID-19 pandemic, patients with DFU had more severe infection, higher proportion of osteomyelitis, longer waiting time for getting surgical intervention, and higher incidence of major amputation.

Diabetic foot disease during the COVID-19 pandemic: lessons learned for our future

“…In South India, a retrospective, single-centered study [ 48 ] showed a 54.1% increase in major amputations noted in the pandemic period compared to the pre-pandemic period. In Indonesia, in a retrospective study [ 49 ] conducted in a tertiary referral hospital, the authors found that the proportion of amputation was higher during the pandemic (39.3% vs. 56.3%) and the proportion of major amputation was almost twice as high during the pandemic than the pre-pandemic (20.2% vs. 39.4%). In Bangladesh, a retrospective single-center study [ 50 ] reported increased prevalence of total amputations as well as major and minor amputations during the pandemic period.…”

“…The first reports during the lockdown were limited to small cohorts of single specialized centers which showed different results [24,39,40,43,[47][48][49][50][51][52], while subsequently several complete population studies have been published [42,[44][45][46]56].…”

Telehealth has comparable outcomes to in-person diabetic foot care during the COVID-19 pandemic

“…Likewise, research needs to expand by getting more diverse and inclusive of a greater spectrum of socio-political landscapes. A good example of that is a recent study by Yunir et al [ 26 ] in Indonesia. We believe the conditions of the pandemic will inevitably contribute to the rapid development of the means of this method, either in the form of new software or patient and physician digital education and familiarization.…”

The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future

“…The COVID-19 pandemic posed major challenges in DFU care across the globe due the above reasons[ 9 - 11 ]. Delays in ulcer reviews may be associated with detrimental effects on DFU healing that may even lead to amputations[ 10 , 11 ].…”

“…The COVID-19 pandemic posed major challenges in DFU care across the globe due the above reasons[ 9 - 11 ]. Delays in ulcer reviews may be associated with detrimental effects on DFU healing that may even lead to amputations[ 10 , 11 ]. Telephone and video clinics during the pandemic period helped clinicians to address some of the issues related to the inability of patients to attend medical clinics during the COVID-19 lock-down period.…”