Hick JL, Hanfling D, Wynia MK, et al: Crisis standards of care and COVID-19: what did we learn? How do we ensure equity? What should we do? NAM Perspect 2021: 2021, .
Godlee F: Surviving the long road ahead. BMJ 369: m1840, 2020.
Zhou Y, Chi J, Lv W, et al: Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). Diabetes Metab Res Rev 37: e3377, 2021.
Rogers LC, Lavery LA, Joseph WS, et al: All feet on deck: the role of podiatry during the COVID-19 pandemic: preventing hospitalizations in an overburdened healthcare system, reducing amputation and death in people with diabetes. JAPMA 113: 20-051, 2020.
Monteiro-Soares M, Russell D, Boyko EJ, et al: Guidelines on the classification of diabetic foot ulcers (IWGDF 2019). Diabetes Metab Res Rev 36 (suppl 1): e3273, 2020.
Berendt AR, Peters EJ, Bakker K, et al: Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev 24 (suppl 1): S145, 2008.
Casciato DJ, Yancovitz S, Thompson J, et al: Diabetes-related major and minor amputation risk increased during the COVID-19 pandemic. JAPMA 113: 20-224, 2023.
Liu C, You J, Zhu W, et al: The COVID-19 outbreak negatively affects the delivery of care for patients with diabetic foot ulcers. Diabetes Care 43: e125, 2020.
Caruso P, Longo M, Signoriello S, et al: Diabetic foot problems during the COVID-19 pandemic in a tertiary care center: the emergency among the emergencies. Diabetes Care 43: e123, 2020.
Viswanathan V, Nachimuthu S: Major lower-limb amputation during the COVID pandemic in South India. Int J Low Extrem Wounds 22: 475, 2023.
Miranda JA, Chung J, Mills JL: Influence of the COVID-19 pandemic on the management of chronic limb-threatening ischemia. Semin Vasc Surg 34: 89, 2021.
de Mestral C, Gomez D, Wilton AS, et al: A population-based analysis of diabetes-related care measures, foot complications, and amputation during the COVID-19 pandemic in Ontario, Canada. JAMA Netw Open 5: e2142354, 2022.
Ilonzo N, Koleilat I, Prakash V, et al: The effect of COVID-19 on training and case volume of vascular surgery trainees. Vasc Endovascular Surg 55: 429, 2021.
Schuivens PME, Buijs M, Boonman-de Winter L, et al: Impact of the COVID-19 lockdown strategy on vascular surgery practice: more major amputations than usual. Ann Vasc Surg 69: 74, 2020.
Lipscomb D, Smith AS, Adamson S, et al: Diabetic foot ulceration in COVID-19 lockdown: cause for concern or unexpected benefit? Diabet Med 37: 1409, 2020.
Background: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality.
Methods: This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]).
Results: During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP.
Conclusions: The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.