Diabetic foot care before and during the COVID-19 epidemic: Can we deliver?

ABSTRACT

Background: The COVID-19 pandemic produced extreme challenges for the delivery of safe and effective diabetes foot services at every level. This retrospective study (April 2020 to March 202) at Ipswich Hospital shows that, despite the challenges, adoption of innovative measures including change of referral pathways and templates, clinical triaging and liaisons with primary care services can still be effective in the delivery of safe and effective diabetic foot care. Results and outcomes: The total number of patients reviewed in secondary care during COVID-19 was 505 compared with 622 in the previous year (209-2020);the number of individual appointments attended was 2,754 (2,950). Similarly, hospital inpatient referrals were 380 with 736 reviews compared with 506 with ,028 reviews in the preceding year. During COVID-19, average HbA1c for diabetes foot patients was 8 . 2 ± . 7 5% (7.67±2.2%), uACR was 24.3±68.83 (24.32±72.38) and total cholesterol 4.9±.63 (3.97±.95). The total number of angioplasty procedures performed during COVID-19 was 44 (45), lower limb bypasses 5 (4) and lower limb endarterectomies 8 (6). During COVID-19 major amputations were 9 (5) and minor amputations 35 (43). Mortality in diabetic foot subjects was 52 (47) equating to 0 . 3% (7.5%) of the outpatient caseload. Conclusion: Compared with the pre-COVID-19 data, the outcomes obtained during COVID-19 demonstrate the importance of access to diabetic foot services in mitigating the risk of complications during a pandemic. Our data suggest appropriate early planning, close liaisons with care providers and timely interventions were key in reducing morbidity and mortality due to diabetic foot complications.