Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities

Abstract

Of all the late complications of diabetes, those involving the foot have traditionally required more face-to-face patient visits to clinics to treat wounds by debridement, offloading, and many other treatment modalities. The advent of the coronavirus disease 2019 (COVID-19) pandemic has resulted not only in the closing of most outpatient clinics for face-to-face consultations but also in the inability to perform most laboratory and imaging investigations. This has resulted in a paradigm shift in the delivery of care for those with diabetic foot ulcers. The approaches to this challenge in two centers with an interest in diabetic foot disease, including virtual consultations using physician-to-patient and physician–to–home nurse telemedicine as well as home podiatry visits, are described in this review and are illustrated by several case vignettes. The outcomes from these two centers suggest that we may be witnessing new possibilities in models of care for the diabetic foot.

Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission

“…We believe that, with advances made in home-based monitoring and telehealth in the peripandemic period, significant improvements in detection and reporting may be possible. 34–36 …”

“…We believe that, with advances made in home-based monitoring and telehealth in the peripandemic period, significant improvements in detection and reporting may be possible. [34][35][36] If true, our findings would also have important potential implications for the analysis and interpretation of data from studies with diabetic foot recurrence as an outcome. The results suggest that identification of a plantar DFU by investigators during a trial may not be a good indication of when the DFU actually occurred due to delays in identification until routine or scheduled exams.…”

The COVID-19 Outbreak Negatively Affects the Delivery of Care for Patients With Diabetic Foot Ulcers

“…The median time courses of delivery of care were 85 (interquartile range 66-131) days in group A and 64 (43-108) days in group B (P 5 0.024). When the time frame was stratified, there were significant differences between groups regarding the median intervals from patient-reported DFU onset to their medical visits (75 [49-120] days vs. 45 [30-90] days, P 5 0.001) and from outpatient assessment to hospital admission (3 [2][3][4][5] days vs. 7 [5][6][7][8][9][10] days, P , 0.001). However, the durations of inpatient care were homogenous (10 [6-14] days vs. 9 [7-18] days, P 5 0.584).…”

Diabetes and COVID-19: Moving From News to Knowledge and a Glucose Hypothesis

“…They report an increased risk of amputation and attribute it to impaired access to providers. A Perspective in a previous issue of Diabetes Care proposed that this problem might be avoided by active decentralization of care (10).…”