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. 2020 Jul:165:108245.
doi: 10.1016/j.diabres.2020.108245. Epub 2020 Jun 1.

Management of diabetic persons with foot ulceration during COVID-19 health care emergency: Effectiveness of a new triage pathway

Marco Meloni  1 , Valentina Izzo  2 , Laura Giurato  2 , Roberto Gandini  2 , Luigi Uccioli  2
Affiliations

Management of diabetic persons with foot ulceration during COVID-19 health care emergency: Effectiveness of a new triage pathway

Marco Meloni et al. Diabetes Res Clin Pract. 2020 Jul.

Abstract

Aim: To define the outcomes of persons with diabetes and foot ulcers (DFUs) managed through a specific triage pathway during the COVID-19 crisis.

Methods: Patients who had an active DFU during the COVID-19 emergency were included. All participants were managed using a specific triage system driven both by ulcer'severity and concomitant co-diseases. Subjects with severely complicated DFUs were urgently referred to hospital regardless of the concomitant comorbidities. Subjects with complicated DFUs received outpatient evaluation (within 48-72 h) and were admitted to hospital if required (revascularization, surgical intervention, intravenous antibiotic therapy); after the first outpatient visit or hospitalization, patients were followed according to the number of comorbidities (in the case of 3 or more comorbidities patients were followed up by telemedicine). Patients with uncomplicated DFUs were managed by telemedicine after outpatient evaluation. Healing, major amputation, death and rate of COVID-19 infection were evaluated. The minimum follow-up was 1 month.

Results: The study group included 151 patients. The mean age was 69.9 ± 14.2 years, 58.9% were male and 91.4% had type 2 diabetes; 58.7% had severely complicated, 21% complicated and 20.3% uncomplicated DFUs. Among those, 78.8% presented with 3 or more comorbidities. One hundred and six patients had regular clinical follow-ups, while 45 were managed through telemedicine. Forty-one (27.1%) patients healed, 3 (1.9%) had major amputations and 3 (1.9%) died. One patient (0.6%) reported COVID-19 positivity due to infection acquired at home.

Conclusion: The triage pathway adopted during the COVID-19 pandemic showed adequate management of DFUs and no cases of hospital virus exposure.

Keywords: Amputation; COVID-19; Diabetes; Diabetic foot ulcers; Mortality.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Severity of DFUs according to fast-track pathway classification.
Fig. 2
Fig. 2
Rate of concomitant co-diseases.
See this image and copyright information in PMC

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