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

Liu, Chao; You, Jiaxing; Zhu, Weifen; Chen, Yixin; Li, Shengyun; Zhu, Yuefeng; Ji, Shujuan; Wang, Ying; Li, Hongye; Li, Lin; Fan, Shunwu

doi:10.2337/dc20-1581

Cited by 39 publications

(41 citation statements)

References 5 publications

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“…The median teleconsultations provided/required for patients in group 1 during the study period was 6 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) in the DFU group and 1(1-3) in non-DFU group (p<0.01). The FBG was 124 mg/dl (101 to 167) and PPBG was 171 mg/dl (133 to 234.2) at last virtual consultation during the lockdown.…”

Section: Resultsmentioning

confidence: 97%

“…People with diabetic foot require periodic visits to hospital for appropriate foot care and or regular monitoring of existing foot complications especially diabetic foot infections (DFI) and foot ulcer (DFU) [ 8 ]. The global pandemic and subsequent lockdown to curb SARS-CoV-2 transmission has resulted in the suspension of non-emergent foot care services including preventative and conventional out-patient foot care that is essential for an early recognition and treatment of foot complications [ 9 , 10 ]. Face to face consultations in most clinics have been reduced or are non-existent during COVID-19 pandemic perpetuated by lockdown [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Virtual triage and outcomes of diabetic foot complications during Covid-19 pandemic: A retro-prospective, observational cohort study

Rastogi

Jude

2021

PLoS ONE

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Aims Limb and patient outcomes in people with diabetic foot complications including diabetic foot ulcer (DFU) provided virtual triage and personalized video consultations during COVID-19 pandemic are not known. Methods Patients with foot complications attending the diabetic foot clinic prior to lockdown who sought teleconsultations during COVID-19 lockdown underwent virtual triage to include clinical history, visual inspection of feet, domiciliary wound care (community nurse assisted dressings) and offloading instructions. The subsequent ulcer, limb and mortality outcomes during the following 24 weeks of COVID-19 lockdown (April-September 2020, group 1) were assessed and compared with those who attended foot clinic during the same period in 2019 (April-September, group 2). Results Group 1 included 561 participants with foot complications provided with teleconsultations, median age 57 (51 to 63) years and diabetes duration of 10 (5 to 16) years. Twelve patients with severe DFU were excluded and 549 patients [357 (65%) neuropathic foot, 104 (18.9%) ischemic foot and 88 (16%) chronic Charcot foot with deformities] were evaluated. There were 227 (41.3%) participants with active DFU at start of lockdown, 32 (5.8%) with new onset ulcer during lockdown (47.1%) and 290 patients without ulcers. Group 2 included 650 participants; active foot ulcer was present in 366 patients. Wound closed or reduced in area in 78.4% of participants of group 1 compared to 76.0% (p = 0.318) in group 2. Fourteen (5.4%) patients required amputations [3 major and 11 minor] in group 1 during the study period compared to 6.8% in group 2 (p = 0.191). Twenty-one (3.8%) and 28 (4.3%) patients died (p = 0.532) during 24 weeks of follow up in group 1 and 2, respectively. Conclusions Targeted foot-care service through virtual triage and teleconsultations during COVID-19 pandemic for people with foot complications have similar ulcer and limb outcomes compared to face-to-face foot care delivery.

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Section: Resultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Virtual triage and outcomes of diabetic foot complications during Covid-19 pandemic: A retro-prospective, observational cohort study

Rastogi

Jude

2021

PLoS ONE

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“…Two articles in the present issue suggest a disruption of care for foot ulcers in people with diabetes during lockdown for COVID-19 compared with experience the year before (8,9). They report an increased risk of amputation and attribute it to impaired access to providers.…”

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confidence: 92%

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

Riddle

2020

Diabetes Care

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“…24 A number of studies have also reported changing practices globally in Diabetic patients with related foot pathology due to COVID-19. 25 , 26 However, our study has shown a return to normal levels of diabetic surgery practice in the post-lockdown period, with only a two month period of affected activity. Some studies have indicated a higher rate of severe infections, with significant increases in amputation rate and a higher rate of major amputation during the pandemic.…”

Section: Discussionmentioning

confidence: 57%

The UK foot and ankle COVID-19 national (FAlCoN) audit – Regional variations in COVID-19 infection and national foot and ankle surgical activity

Mason

Malhotra

Houchen-Wolloff

et al. 2022

Foot and Ankle Surgery

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Aims This paper details the impact of COVID-19 on foot and ankle activity in the UK. It describes regional variations and COVID-19 infection rate in patients undergoing foot and ankle surgery before, during and after the first national lock-down. Patients & methods This was a multicentre, retrospective, UK-based, national audit on foot and ankle patients who underwent surgery between 13 th January and 31 st July 2020. Data was examined pre- UK national lockdown, during lockdown (23 rd March to 11 th May 2020) and post-lockdown. All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland. Regional, demographic and COVID-19 related data were captured. Results 6644 patients were included. In total 0.53% of operated patients contracted COVID-19 (n = 35). The rate of COVID-19 infection was highest during lockdown (2.11%, n = 16) and lowest after lockdown (0.16%, n = 3). Overall mean activity during lockdown was 24.44% of pre-lockdown activity with decreases in trauma, diabetic and elective foot and ankle surgery; the change in elective surgery was most marked with only 1.73% activity during lock down and 10.72% activity post lockdown as compared to pre-lockdown. There was marked regional variation in numbers of cases performed, but the proportion of decrease in cases during and after lockdown was comparable between all regions. There was also a significant difference between rates of COVID-19 and timing of peak, cumulative COVID-19 infections between regions with the highest rate noted in South East England (3.21%). The overall national peak infection rate was 1.37%, occurring during the final week of lockdown. General anaesthetic remained the most common method of anaesthesia for foot and ankle surgery, although a significant increase in regional anaesthesia was witnessed in the lock-down and post-lockdown periods. Conclusions National surgical activity reduced significantly for all cases across the country during lockdown with only a slow subsequent increase in elective activity. The COVID-19 infection rate and peaks differed significantly across the country. Clinical relevance This paper highlights a significant regional variation in COVID-19 infection rates and peak of COVID-19 infections across the country; this data may be useful in planning response to subsequent waves. The cumulative COVID-19 infection rates suggest that the risk of contracting COVID-19 in patients undergoing foot and ankle surgery is not insignificant. The marked decrease in, and slow recovery of elective activity seen will need to be considered when planning restoration of elective foot and ankle services.

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

Cited by 39 publications

References 5 publications

Virtual triage and outcomes of diabetic foot complications during Covid-19 pandemic: A retro-prospective, observational cohort study

Virtual triage and outcomes of diabetic foot complications during Covid-19 pandemic: A retro-prospective, observational cohort study

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

The UK foot and ankle COVID-19 national (FAlCoN) audit – Regional variations in COVID-19 infection and national foot and ankle surgical activity

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