Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities

Following World Diabetes Day and the great interview PodiatryInternational had with Dr Andrew Boulton, this great paper discusses the impact of the coronavirus disease 2019 (COVID-19) pandemic not only on the closing of most outpatient clinics for face-to-face consultations but also in the inability to perform most laboratory and imaging investigations. This has resulted in a paradigm shift in the delivery of care for those with diabetic foot ulcers.

A tale of two cities discussed the approaches to this challenge in two centers with an interest in diabetic foot disease. The outcomes from these two centers suggest that we may be witnessing new possibilities in models of care for the diabetic foot.

diabetic foot during the covid-19

Abstract

Of all the late complications of diabetes, those involving the foot have traditionally required more face-to-face patient visits to clinics to treat wounds by debridement, offloading, and many other treatment modalities. The advent of the coronavirus disease 2019 (COVID-19) pandemic has resulted not only in the closing of most outpatient clinics for face-to-face consultations but also in the inability to perform most laboratory and imaging investigations.

This has resulted in a paradigm shift in the delivery of care for those with diabetic foot ulcers. The approaches to this challenge in two centers with an interest in diabetic foot disease, including virtual consultations using physician-to-patient and physician–to–home nurse telemedicine as well as home podiatry visits, are described in this review and are illustrated by several case vignettes. The outcomes from these two centers suggest that we may be witnessing new possibilities in models of care for the diabetic foot.


Of all the late complications of diabetes, those involving the foot have traditionally
required more face-to-face patient visits to clinics to treat wounds by debridement,
offloading, and many other treatment modalities. The advent of the coronavirus
disease 2019 (COVID-19) pandemic has resulted not only in the closing of most
outpatient clinics for face-to-face consultations but also in the inability to perform
most laboratory and imaging investigations.

This has resulted in a paradigm shift in
the delivery of care for those with diabetic foot ulcers. The approaches to this
challenge in two centers with an interest in diabetic foot disease, including virtual
consultations using physician-to-patient and physician–to–home nurse telemedicine as well as home podiatry visits, are described in this review and are illustrated
by several case vignettes. The outcomes from these two centers suggest that we
may be witnessing new possibilities in models of care for the diabetic foot.

The coronavirus disease 2019 (COVID-19) global pandemic has presented many
challenges in the management of people with diabetes across the world. New modes
of patient consultation are being widely used, and these include telephone consultations and telemedicine using a video consultation. Whereas many people with
diabetes can be managed using these new methods of consultation, the diabetic foot,
the most common reason for hospital admission among people with diabetes,
presents unique challenges because of the frequent need for “face-to-face” consultation and treatment of foot lesions. In this review, the approaches from two
centers with a major interest in diabetic foot problems are compared and contrasted.

Although from the Dickensian title readers may be expecting this to be London and
Paris, in this review it is Manchester, U.K., and Los Angeles, CA. The approaches of each
center to the management of diabetic foot problems are examined in detail with a
clear description of how the service has changed to meet the challenge presented by
the pandemic. Data are presented in terms of numbers of patients seen in different
settings, with individual case presentations from each center demonstrating how the
challenge was met.

BACKGROUND

The current COVID-19 pandemic has presented major challenges to those looking
after people with noncommunicable diseases. At the time of writing, there have
been .1.5 million cases in the U.S. and .240,000 in the U.K., with .125,000 deaths
between the two countries. The outpatient management of people with diabetes and
its complications is facing a huge challenge as routine face-to-face clinics have been
canceled in many countries and the ability to order even basic tests has been severely
restricted. This has produced many challenges but also opportunities for the delivery
of diabetes care.

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