Managing diabetic foot in times of COVID-19: time to put the best 'foot' forward

Abstract

Introduction: The COVID-19 pandemic has had an unparalleled impact on the socio-economic and healthcare structure of India. Due to our large populations of diabetic patients, who have an increased risk of worse outcomes with COVID-19 infection, it is of utmost public health importance to analyse the relationship between the two. The aim of our review was to analyse the possible relationship between COVID-19 infection and DFUs, which are a fairly common, yet serious complication in diabetic patients, as well as their management, under the given changing circumstances.

Methodology: An extensive review of related educational articles was analysed from various databases.

Results: The two main pathogenic mechanisms described in COVID-19 infection are a cytokine storm (causing ARDS) as well as an acquired coagulopathy, with widespread thrombosis. DFUs are associated with an underlying peripheral neuropathy, a chronic low-grade inflammatory state and peripheral arterial disease, which lead to chronic non-healing ulcers. Similarities seen in the pathogenic mechanisms of these two conditions make a bidirectional relationship highly plausible.

Conclusion: Due to the disruptions in the healthcare system brought on by the COVID-19 pandemic, changes in practice to a telehealth-driven approach, with emphasis on homecare and community clinics, need to be adopted, to ensure best possible care to patients with DFUs, in order to reduce their risk of DFU-related complications and need for hospitalization.

Keywords: COVID-19; Cytokine storm; Diabetic foot ulcers (DFU); Diabetic peripheral neuropathy (DPN); Ischemia.

Fig. 1

Pathogenesis: diabetes mellitus, DFUs and COVID-19

Fig. 2

Approach to management of diabetic foot care in the COVID-19 pandemic in India