Effects of the COVID-19 Pandemic on the Management of Diabetic Foot Ulcers

Experiences From a Dedicated Diabetic Foot Care Center

Murat Kendirci, MD; Ibrahim Tayfun Sahiner, MD; İsmail Sezikli, MD; Merve Akın, MD; Ahmet Cinar Yasti, MD

Disclosures

Wounds. 2022;34(5):146-150. 

In This Article

Results

During the 2 study periods, 72 patients were hospitalized at the authors' diabetic foot clinic—46 during the prepandemic period (2019) and 26 during the pandemic period (2020). Each patient hospitalized during the pandemic as well as the patient's companion were tested for COVID-19 using the polymerase chain reaction test, and none was positive for the virus. There was no difference between the 2 groups concerning sex, age, and comorbidities at presentation (Table 1). Among the patients who presented to the hospital during the non-COVID period, 39.1% lived in neighboring cities and 34.8% lived in distant cities (> 300 km from the hospital); these rates significantly decreased to 15.4% and 7.7%, respectively, during the pandemic period (P <.001).

Analysis of time between the onset of DFU and hospital admission showed that a lower percentage of patients were admitted to the diabetic foot center in the early stage of their DFU at the pandemic compared with the prepandemic period (Table 1). Whereas in the prepandemic period, 2 of 6 patients (33.3%) and 3 of 11 patients (27.3%) with acute exacerbation of DFU were admitted within 14 days and 21 days, respectively, during the pandemic period, the 1 patient with acute exacerbation of DFU (100%) and 4 of 5 patients with acute exacerbation of DFU (80%) were admitted within 14 days and 21 days, respectively.

The mean duration of diabetes was similar between the 2 groups (Table 2). The mean C-reactive protein and blood glucose levels were also similar between the 2 groups. However, the hemoglobin (Hb) A1c level was significantly higher in the pandemic group. Furthermore, according to the Wagner classification of DFU, patients who presented to the hospital during the pandemic period had significantly worse conditions than those in the prepandemic group who presented to the hospital.

During the pandemic period, the rate of patients undergoing debridement alone significantly decreased and the rate of amputation significantly increased (P =.008) (Table 3). After removing the patients who underwent grafting, the rate of amputation was significantly higher in the pandemic group than in the nonpandemic group (71.4% vs. 34.1%, respectively; P =.005). There was no significant difference between the 2 groups in length of hospital stay, and there was no mortality in either group.

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