Atri Avica, Kocherlakota Chaithanya Murthy, Dasgupta Riddhi
Christian Medical College & Hospital, Vellore, Tamil Nadu India.
Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu India.
Int J Diabetes Dev Ctries. 2020 Sep;40(3):321-328. doi: 10.1007/s13410-020-00866-9. Epub 2020 Sep 1.
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.
An extensive review of related educational articles was analysed from various databases.
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.
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.
新冠疫情对印度的社会经济和医疗结构产生了前所未有的影响。由于我国糖尿病患者数量众多，他们感染新冠病毒后出现不良后果的风险增加，因此分析两者之间的关系具有极其重要的公共卫生意义。我们此次综述的目的是分析新冠病毒感染与糖尿病足溃疡（DFUs）之间可能存在的关系，糖尿病足溃疡在糖尿病患者中是一种相当常见但严重的并发症，同时还要分析在当前不断变化的情况下对其的管理。
对来自各种数据库的相关教育文章进行了广泛综述。
新冠病毒感染中描述的两个主要致病机制是细胞因子风暴（导致急性呼吸窘迫综合征）以及获得性凝血病，并伴有广泛血栓形成。糖尿病足溃疡与潜在的周围神经病变、慢性低度炎症状态和周围动脉疾病有关，这些会导致慢性不愈合溃疡。这两种情况在致病机制上的相似性使得双向关系非常有可能存在。
由于新冠疫情给医疗系统带来的干扰，需要采用向远程医疗驱动方法转变的实践方式，重点是家庭护理和社区诊所，以确保为糖尿病足溃疡患者提供尽可能好的护理，从而降低他们发生与糖尿病足溃疡相关并发症的风险以及住院需求。
