COVID-19 led to surge in diabetic foot amputations in Italy

The COVID-19 lockdown had a “detrimental impact” on diabetic foot ulceration (DFUs) in Italy, according to researchers there.

A newly published study has shown that amputation rates significantly increased  at a hospital far from the hardest-hit region as many people developed gangrene.

The research team wanted to investigate how people with diabetes and DFU fared during the height of the pandemic in Italy, where tens of thousands of people died.

They focused on those in who live in the southern region who were admitted to the division of endocrinology and metabolic diseases at the Teaching Hospital at the University of Campania Luigi Vanvitelli.

They compared 25 people who were admitted from March 9 to May 18, 2020, with 38 individuals who were admitted from a longer period between January and May 2019.

The demographics of the groups are similar, with average ages in the early 60s and more men than women.

Emergent and serious cases

The results revealed high numbers of emergent and serious cases in 2020. Compared with 2019, fewer were outpatients (16% vs. 45%, P = .028) and more were emergency patients (76% vs. 26%, P < .001).

Clinically, gangrene was much more common in the 2020 group, compared with the 2019 group (64% vs. 29%, P = .009), as was amputation (60% vs. 18%, P = .001).

The researchers determined that amputation was more than three times more likely in the 2020 versus the 2019 group (relative risk, 3.26; 95% confidence interval, 1.55-6.84) even though the 2019 period was longer. After adjustment for gender, the heightened risk in 2020 was 2.50 (95% CI, 1.18-5.29).

There was no statistically significant increase in the risk of revascularisation.

Lead author Dr Paola Caruso, from the University of Campania Luigi Vanvitelli in Naples, said: “The COVID-19 lockdown may have had a detrimental impact on amputation risk because of the sudden interruption of DFU care and lower-limb preservation pathways, resulting in delayed diagnosis and treatment.

“DFU is often characterised by progressive clinical course, which can rapidly lead patients to critical worsening of their ulcers.”

The researchers concluded that “the higher risk of amputation observed during COVID-19 lockdown confirms the need for proper and timely management of DFU patients to prevent dramatic outcomes responsible for a reduction of quality of life and increased morbidity and mortality.”

The study was published in the Diabetes Care journal. To read the study, click here.

Image by andreas160578 from Pixabay

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