Abstract
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. 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). 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. 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.
Highlights
The coronavirus disease (COVID-19) was declared a global pandemic by WHO that has adversely affected the lives of millions of individuals
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
Wound closed or reduced in area in 78.4% of participants of group 1 compared to 76.0% (p = 0.318) in group 2
Summary
The coronavirus disease (COVID-19) was declared a global pandemic by WHO that has adversely affected the lives of millions of individuals. India is already a witness to an epidemic of non-communicable disease with more than 62 million individuals living with diabetes [1]. COVID-19 is known to be associated with poor outcomes in vulnerable population amongst people with diabetes [2, 3]. The COVID 19 pandemic is unprecedented and has affected routine care of people with diabetic foot complications [4]. Foot complications in diabetes encompass a spectrum ranging from the “at risk foot” to more severe diabetic foot disease including foot ulcer, diabetic foot infections, limb claudication, gangrene and Charcot neuroarthropathy. It has been shown that irrespective of the type of foot complications, these patients have higher mortality risk than those with without foot complications [5, 6]
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