Diabetic Foot Syndrome in the COVID-19 era: How to Move from Classical to new Approaches

Anichini, Roberto; Cosentino, Claudia; Παπάνας, Νικόλαος

doi:10.1177/15347346221081572

Cited by 10 publications

(7 citation statements)

References 31 publications

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“…However, there are several potential general obstacles to providing a diabetic foot telemedicine service: many healthcare facilities are not adequately equipped to provide this service; and many persons may not be able to use the technology due to age or socioeconomic status [31][32][33].…”

Section: Diabetic Foot Disease Management During the Covid-19 Pandemicmentioning

confidence: 99%

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

Miranda¹,

Zanette²,

Ros³

2022

Arch Med Sci Atheroscler Dis

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The COVID-19 pandemic has had a strong impact on the treatment of all diseases, especially chronic ones, and diabetic foot is no exception. The COVID-19 pandemic has favored the adoption of a new model of assistance delivery to facilitate the delivery of remote assistance to patients. The standard model based on face-to-face visits has been integrated by a hybrid model of telemedicine, home care and face-to-face visits to keep patients at home to minimize the number of in-person visits to clinics and admissions except for complicated DFUs. However, telemedicine is not always possible or suitable for various reasons (patients not digital, need for practical treatment of the foot etc.). In this review, we looked at the different approaches to diabetic foot ulcer management and the indirect impact of the COVID-19 pandemic on diabetes-related lower extremity complications and the lessons we have learned for the future.

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Section: Diabetic Foot Disease Management During the Covid-19 Pandemicmentioning

confidence: 99%

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

Miranda¹,

Zanette²,

Ros³

2022

Arch Med Sci Atheroscler Dis

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“…Contemporary referral patterns and telemedicine practices may have shifted access to specialty care, especially amid the COVID-19 pandemic. 42 However, there is evidence that the rural mortality gap, both overall and related to diabetes, is increasing. 6 43 Third, claims data may introduce misclassification bias or underestimate comorbidities, especially vascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…Second, our data set spanned 2013–2014 and may not reflect current trends. Contemporary referral patterns and telemedicine practices may have shifted access to specialty care, especially amid the COVID-19 pandemic 42. However, there is evidence that the rural mortality gap, both overall and related to diabetes, is increasing 6 43.…”

Section: Discussionmentioning

confidence: 99%

Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study

Taylor

Gangnon

Powell

et al. 2023

BMJ Open Diab Res Care

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IntroductionRural patients with diabetic foot ulcers, especially those identifying as black, face increased risk of major amputation. Specialty care can reduce this risk. However, care disparities might beget outcome disparities. We aimed to determine whether a smaller proportion of rural patients, particularly those identifying as black, receive specialty care compared with the national proportion.Research design and methodsThis 100% national retrospective cohort examined Medicare beneficiaries hospitalized with diabetic foot ulcers (2013–2014). We report observed differences in specialty care, including: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, or vascular surgery. We used logistic regression to examine possible intersectionality between rurality and race, controlling for sociodemographics, comorbidities, and ulcer severity and including an interaction term between rurality and identifying as black.ResultsOverall, 32.15% (n=124 487) of patients hospitalized with a diabetic foot ulcer received specialty care. Among rural patients (n=13 100), the proportion decreased to 29.57%. For patients identifying as black (n=21 649), the proportion was 33.08%. Among rural patients identifying as black (n=1239), 26.23% received specialty care. This was >5 absolute percentage points less than the overall cohort. The adjusted OR for receiving specialty care among rural versus urban patients identifying as black was 0.61 (95% CI 0.53 to 0.71), which was lower than that for rural versus urban patients identifying as white (aOR 0.85, 95% CI 0.80 to 0.89). This metric supported a role for intersectionality between rurality and identifying as black.ConclusionsA smaller proportion of rural patients, particularly those identifying as black, received specialty care when hospitalized with a diabetic foot ulcer compared with the overall cohort. This might contribute to known disparities in major amputations. Future studies are needed to determine causality.

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“…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. This could serve as an excellent transition to the post-COVID era, as examined by Anichini et al [ 27 ], where a hybrid approach of telemedicine and in-person care will work best for all parties involved, delivering fast, efficient and cost-effective care to the patients.…”

Section: Discussionmentioning

confidence: 99%

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

Kamaratos-Sevdalis¹,

Kamaratos²,

Papadakis³

et al. 2022

WJM

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BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has posed obstacles to the delivery of diabetic foot care. In response to this remote healthcare services have been deployed offering monitoring, follow-up, and referral services to patients with diabetic foot ulcers and related conditions. Although, remote diabetic foot care has been studied before the COVID-19 pandemic as an alternative to in-person care, the peculiar situation of the pandemic, which dictates that remote care would be the sole available option for healthcare practitioners and patients, necessitates an evaluation of the relevant knowledge obtained since the beginning of the severe acute respiratory syndrome coronavirus 2 outbreak. AIM To perform a thorough search in PubMed/Medline and Cochrane to identify original records on the topic. METHODS To identify relevant peer-reviewed publications and gray literature, the authors searched PubMed-MEDLINE and Cochrane Library-Cochrane Central Register of Controlled Trials starting September 27 till October 31, 2021. The reference lists of the selected sources and relevant systematic reviews were also hand–searched to identify potentially relevant resources. Otherwise, the authors searched Reference Citation Analysis ( ). RESULTS A number of randomized prospective studies, case series, and case reports have shown that the effectiveness of remote care is comparable to in-person care in terms of hospitalizations, amputations, and mortality. The level of satisfaction of patients’ receiving this type of care was high. The cost of remote healthcare was not significantly lower than in - person care though. CONCLUSION It is noteworthy that remote care during the COVID-19 pandemic appeared to be more effective and well - received than remote care in the past. Nevertheless, larger studies spanning over longer time intervals are necessary in order to validate these results and provide additional insights.

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Diabetic Foot Syndrome in the COVID-19 era: How to Move from Classical to new Approaches

Cited by 10 publications

References 31 publications

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

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

Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study

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

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