Diabetic Foot Disease during the COVID-19 Pandemic

Abstract

Throughout 2020, the COVID-19 pandemic has had a major impact on the care of non-communicable diseases across the world and diabetes is no exception. Whereas many branches of medicine have adapted to telemedicine, this is difficult and challenging for the diabetic foot which often requires “hands on” treatment. This review covers the challenges that have faced clinicians across the world in the management of complex diabetic foot problems and also includes some illustrative case vignettes which show how it is possible to manage foot ulcers without the usual access to laboratory and radiological testing. There is no doubt that the COVID-19 experience when handling diabetic foot problems will likely transform our approach to the management of diabetic foot disease especially in the areas of digital health and smart technology.

Desafios Do Cuidado Ao Pé Diabético No Cenário Da Pandemia De Covid-19: Reflexões

“…A fim de enfrentar os impactos da pandemia, os estudos citam diferentes estratégias, sobretudo a educação em saúde e utilização de recursos on-line, consultas de telemedicina, incentivo ao auto exame dos pés e cuidados regulares, uso de palmilhas de detecção de pressão e temperatura, monitoramento remoto, vídeo-consultas (SHIN et al, 2020;KYROU;ROBBINS;RANDEVA, 2020;MADER, 2020;BOULTON, 2021).…”

“…Para manter a qualidade do serviço prestado e a atenção integral à saúde, evitar visitas, deslocamentos e exposição desnecessária desses pacientes ao vírus, adotou-se protocolos de triagem e serviços de telessaúde/telemedicina em diversos países. (BOULTON, 2021;RATLIFF et al, 2020;OROPALLO et al, 2021). Conforme, Ratliff et al (2020), os serviços de atendimento virtual consideram cuidados urgentes de baixo risco, pacientes negativos para COVID-19, facilitando encaminhamentos apropriados, assim como o suporte e gerenciamento de condições crônicas, acompanhamento de pacientes de instituições de longa permanência, pós-operatório e hospitalização, para minimizar reinternações, assim como a educação e treinamento para profissionais de saúde.…”

The Management of Diabetic Foot Ulcers in Patients with SARS-CoV-2 During the COVID-19 Pandemic

“…Both survivors and non-survivors had deranged coagulation parameters such as prolonged protime and partial thromboplastin time and increased levels of D-dimer, which can be attributed to both their diabetic foot ulcers and COVID-19 illnesses. [11][12][13] D-dimer represents the activation of the coagulation and fibrinolysis systems and a 3-to 4-fold increase in its levels in the early stages of COVID-19 may lead to a poor prognosis. 20 Yao, in a case control study, also noted that D-dimer levels significantly increased with increasing severity of COVID-19.…”

“…11 In a recent article, Boulton noted that the risk factors for mortality in patients with diabetes admitted for COVID-19 (i.e., elderly, male with poor glycemic control, hypertension and cardiovascular disease) were the same risk factors for people with diabetes who develop foot complications. 12 On the other hand, Atri et al proposed several pathogenetic links between diabetic foot ulcers and COVID-19. This included the chronic low-grade inflammation and the hypercoagulable states that may lead to peripheral arterial disease, which are seen in both diabetics and COVID-19 afflicted patients, that may, in turn, have the propensity to develop a more severe diabetic foot complication.…”

Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies

“…It is predicted that in the general population (≥45 years), the incidence of vascular LLA in the diabetic is eight times higher than in non-diabetic individuals, and when it comes to the age group ≥ 85 years, the incidence in men increases to 15 times higher and 12 times higher in women than the mean incidence rates of all population groups [ 16 ]. Unfortunately, the COVID-19 outbreak has had a negative impact on healthcare delivery to patients with DFUs [ 17 , 18 ]. In fact, a study in Naples reported that patients with diabetes admitted to a Tertiary Care Center for DFU management had a threefold risk of amputation compared to 2019 numbers [ 19 ].…”