Schmidt Brian M, Shin Laura
Associate Professor, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Ann Arbor, MI 48106, USA.
Division of Clinical Surgery, Department of Vascular Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Ther Adv Endocrinol Metab. 2023 Mar 3;14:20420188231157203. doi: 10.1177/20420188231157203. eCollection 2023.
Lower extremity amputation resulting from diabetic foot ulcer, with neuropathic and/or ischemic etiologies, remains a devastating and costly complication of diabetes mellitus. This study evaluated changes in care delivery of diabetic foot ulcer patients during the COVID-19 pandemic. A longitudinal assessment evaluating the ratio of major lower extremity amputation to minor lower extremity amputations after implementation of novel strategies to combat access restrictions was compared to the pre-COVID-19 era.
The ratio of major to minor lower extremity amputation (i.e. the high-to-low ratio) was assessed at two academic institutions, the University of Michigan, and University of Southern California, in a population of patients with diabetes who had direct access to multidisciplinary foot care clinics in the 2 years prior to the pandemic and the first 2 years of the COVID-19 pandemic.
Patient characteristics and volumes including patients with diabetes and those with a diabetic foot ulcer were similar between eras. In addition, inpatient diabetic foot-related admissions were similar, but were suppressed by government shelter in placed mandates and subsequent COVID-19 variants surges (e.g. delta, omicron). In the control group, the Hi-Lo ratio increased every 6 months by an average of 11.8%. Meanwhile, following STRIDE implementation during the pandemic, the Hi-Lo ratio reduced by (-)11% ( < 0.001) and doubled limb salvage efforts as compared to the baseline era. The reduction of the Hi-Lo ratio was not influenced significant by patient volumes or inpatient admissions for foot infections.
These findings signify the importance of podiatric care in the at-risk diabetic foot population. Through strategic planning and rapid implementation of at-risk diabetic foot ulcer triage, multidisciplinary teams were able to maintain accessible care during the pandemic which resulted in a reduction of amputations. Furthermore, this manuscript highlights the value of the Hi-Lo ratio as an indicator of institutional limb salvage efforts.
由糖尿病足溃疡导致的下肢截肢，病因包括神经病变和/或缺血，仍然是糖尿病一种极具破坏性且成本高昂的并发症。本研究评估了2019年冠状病毒病（COVID-19）大流行期间糖尿病足溃疡患者护理方式的变化。将实施应对就诊限制的新策略后主要下肢截肢与次要下肢截肢的比例进行纵向评估，并与COVID-19大流行前的时代进行比较。
在密歇根大学和南加州大学这两个学术机构，对在大流行前2年以及COVID-19大流行的前2年可直接就诊多学科足部护理诊所的糖尿病患者群体，评估主要与次要下肢截肢的比例（即高低比例）。
不同时期患者特征和数量相似，包括糖尿病患者和糖尿病足溃疡患者。此外，与糖尿病足相关的住院人数相似，但受到政府强制要求居家避难以及随后COVID-19变异毒株激增（如德尔塔、奥密克戎）的影响。在对照组中，高低比例每6个月平均增加11.8%。与此同时，在大流行期间实施STRIDE策略后，高低比例降低了（-）11%（<0.001），与基线时期相比，保肢努力增加了一倍。高低比例的降低不受患者数量或足部感染住院人数的显著影响。
这些发现表明足病护理在高危糖尿病足人群中的重要性。通过战略规划和对高危糖尿病足溃疡进行快速分诊，多学科团队在大流行期间能够维持可及的护理，从而减少了截肢。此外，本文强调了高低比例作为机构保肢努力指标的价值。
