Revascularization prevents amputation among patients with diabetic foot during the COVID-19 era

Abstract

Objective The COVID‐19 pandemic has led to significant changes in healthcare systems that impact the management of chronic diseases such as diabetic foot (DF). We hypothesized that lack of access to healthcare would increase the severity of disease and lead to worse outcomes. Methods The medical records of patients with DF were reviewed to determine demographic data and outcomes including wound healing, major amputation (MA), and death. Groups were divided into the pre–COVID-19 era (15 March 2019–15 March 2020) and the COVID-19 era (16 March 2020–16 March 2021); multivariable logistic analysis was performed to identify risk factors for MA. Results 261 patients with DF were included, 163 in the pre–COVID-19 era and 98 during the COVID-19 era. Patients in the COVID-19 presented with increased cardiovascular disease (19 vs 7%, p = 0.01), increased mean HbA1C (9.1 ± 2.1 vs 8.2 ± 2.1, p = 0.008) and higher WIFI-IV stage (78 vs 53%, p ≤ 0.0001). Patients with DF in the COVID-19 era were more likely to require MA (41 vs 21%, p ≤ 0.0001). Revascularization (OR = 0.12; 95% CI, 0.038–0.38) was a protective factor to reduce MA. Conclusions MA among DF patients increased two-fold during the COVID-19 era. Revascularization avoids MA in diabetic patients even during the COVID-19 pandemic, suggesting that revascularization should be performed when possible.

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 ]. 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.…”