Diabetic foot ulcer severity increased significantly during the COVID-19 pandemic, according to a study published in Diabetes/Metabolism Research and Reviews. These more aggressive forms of diabetic foot ulcers warranted more revascularization procedures and costly therapies, but the amputation rate remained unchanged, the report shows.
Investigators conducted a single center retrospective analysis admitting patients with diabetic foot ulcers before the pandemic (2017-2019; n=111) and during the pandemic (2020-2021; n=86). The team compared demographic and clinical data between the 2 groups, including body mass index (BMI), diabetes mellitus (DM) type and duration, ulcer type, and lesion grade and stage. Study participants also underwent evaluation of biomechanical parameters, which included glycated hemoglobin (HbA1c) and indices of inflammation (ultrasensitive C‐ reactive protein [CRP], erythrocyte sedimentation rate [ESR], and number of white blood cells).
Overall, patients treated during the pandemic had a significantly higher prevalence of deep ulcers with involvement in the osteo-articular plane, ulcers involving tendons and capsules (36% vs 58.1%), and ulcers with bone involvement (12.6% vs 20.9%) compared with individuals treated before the pandemic. These patients also had an increased incidence of systemic inflammatory response syndrome, according to the report. White blood cell count and reactive C protein levels were significantly higher among individuals admitted during the pandemic (P ≤.001 for both) and a significantly higher percentage of men (78.6%; P =.009) presented for treatment during this phase.
Patients hospitalized during the pandemic period underwent more revascularization procedures compared with participants treated before the pandemic (41.6% vs 20%; P =.001), and had a similar percentage of minor and major amputations (2.3% vs 5.4% and 25% vs 21.8%, respectively). No differences in HbA1c were noted between the cohorts.
Study limitations include a small sample size and retrospective nature.
“Our study documented a greater severity of ulcers in terms of deep tissue involvement, systemic inflammatory involvement, and severity of ischemia, requiring a significantly higher number of revascularizations and more expensive therapy but without increasing the amputation rate observed in the pandemic period,” according to the study authors. “The main message of our study is that the collaboration of several professional figures is confirmed as fundamental as is the timeliness of diagnosis and intervention in the diagnostic and therapeutic pathway of [diabetic foot ulcers], which were probably deficient due to the pandemic emergency.”
This article originally appeared on Endocrinology Advisor
Radellini S, Vigneri E, Smeraldi L, et al. Evidence of greater severity of diabetic foot ulcers during COVID-19 pandemic: a real-life single-centre cohort study. Diabetes Metab Res Rev. Published online February 22, 2023. doi:10.1002/dmrr.3626.