Diabetic foot ulcer prognosis unchanged during COVID-19 lockdown
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Lockdown during the COVID-19 pandemic did not compromise diabetic foot ulcer prognosis if patients remained under the care of expert wound centers, according to findings published in Diabetes/Metabolism Research and Reviews.
“For people with diabetic foot ulcer, this period of containment in the midst of a viral pandemic was a plunge into the unknown,” Jean-Baptiste Bonnet, MD, assistant specialist in the endocrinology diabetes department at Montpellier University Hospital and the Desbrest Institute of Epidemiology and Public Health, INSERM and University of Montpellier, France, and colleagues wrote. “As much as the effect of a reduction in the possibilities of mobility may give hope for better compliance with offloading, the restriction of movement also raises fears of less good nursing care and less support from life-support workers or any other outside helpers.”
The prospective, observational single-center study included 27 adults (median age, 69.4 years; 77.8% men) followed for a diabetic foot ulcer in an expert wound center from April 15 to May 11, 2020, at Montpellier University Hospital. Researchers conducted baseline assessment 4 weeks after lockdown began, and follow-up visits were conducted 4 to 6 weeks after lockdown began to ease.
Most patients had type 2 diabetes (81.5%) with a history of diabetic foot ulcer (77.8%) and amputation (40.7%). Median SINBAD (site, ischemia, neuropathy, bacterial infection, area and depth) classification score was 2 at baseline and 1 as lockdown began to ease (mean change, –0.32; 95% CI, –0.93 to 0.29). Researchers observed stable or improved scores among 72% of patients between both visits.
Compared with patients who had worsening or stable scores, patients whose score improved often used off-loading footwear (72% vs. 44% and 28%, respectively). Type of diabetes was associated with diabetic foot ulcer prognosis, according to researchers, with none of those with type 1 diabetes experiencing deterioration.
Five patients were hospitalized during follow-up.
“The wide use of telemedicine seems relevant of the follow-up of diabetic foot ulcer,” the researchers wrote. “A more in-depth study of the impact of delays in the initial assessment during the lockdown period, particularly on ischemic or infected wounds, should be conducted.”
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