Diabetes Care Volume 43, October 2020 e125
Chao Liu,1 Jiaxing You,1 Weifen Zhu,2 The COVID-19 Outbreak Negatively Yixin Chen,2 Shengyun Li,1 Affects the Delivery of Care for Patients Yuefeng Zhu,3 Shujuan Ji,4 Ying Wang,5 1 2 1 With Diabetic Foot Ulcers Hongye Li, Lin Li, and Shunwu Fan Diabetes Care 2020;43:e125–e126 | https://doi.org/10.2337/dc20-1581
Diabetic foot ulcers (DFUs) represent the In the second part, we concurrently died, one from myocardial infarction and most frequent diabetes-related cause for collected the data of hospitalized patients the other from sepsis. There was one hospitalization (1). Currently, the coro- with active DFUs in the first trimester death (1.1%, P 5 0.261) in group B due to navirus disease 2019 (COVID-19) pan- of 2020 (group A) and retrospectively end-stage renal disease. Of the surviving demic is likely to pose a threat to the reviewed the charts of all patients ad- patients, no statistical significance was delivery of care, leading to some un- mitted during the corresponding period observed between groups in ulcer status intended consequences. We aimed to of 2019 for DFU treatment (group B). at the 8-week follow-up. determine the impact of the COVID-19 Patient demographics and comorbidities The study was approved by the Human outbreak on patients with DFUs at a were similar between groups. Twenty- Research Ethics Committee of Zhejiang multidisciplinary center in China. three (52.3%) of 44 patients in group A University School of Medicine Sir Run In the firstpartofthisstudy,an suffered from severe infection on initial Run Shaw Hospital (SRRSH2020005569). interrupted time-series design was applied presentation compared with 18 (20.7%) This study suggests that the COVID-19 to estimate the trends in hospitalization for of 87 in group B (P , 0.001). The median outbreak has had serious and disruptive patients with DFUs before the COVID-19 time courses of delivery of care were effects on the delivery of DFU care, in outbreak to generate the predicted value 85 (interquartile range 66–131) days in terms of considerable drops in hospital- in 2020. Monthly hospitalization records group A and 64 (43–108) days in group B ization and extended periods in treat- from 2016 to 2019 were abstracted to (P 5 0.024). When the time frame was ment. It is conceivable that fears of being fit the autoregressive integrated moving- stratified, there were significant differ- infected or stigmatized with COVID-19 average model. We compared the pre- ences between groups regarding the compromise patients’ accessibility to diction with the actual values in the first median intervals from patient-reported medical services. A recent survey from trimester of 2020 to project changes in DFU onset to their medical visits (75 [49– Manchester, U.K., and Los Angeles, CA, trends that were assumed to have been 120] days vs. 45 [30–90] days, P 5 0.001) revealed that more than half of patients caused by the outbreak. This analysis and from outpatient assessment to hos- were deterred from traditional face-to- showed significant reductions in January pital admission (3 [2–5] days vs. 7 [5–10] face appointments and those admitted and February, as indicated by actual hos- days, P , 0.001). However, the durations from clinics for inpatient DFU care were COVID-19 AND DIABETES pitalizations being significantly lower than of inpatient care were homogenous candidates for surgical interventions (2). the lower boundary of 95% CI of predicted (10 [6–14] days vs. 9 [7–18] days, P 5 Additionally, we witnessed fluctuating values. The number of hospitalizations in 0.584). The major amputation rate was monthly hospitalizations that were con- Marchreboundedandwasclosetothe 11.4% in group A and 4.6% in group B (P 5 comitant with the public health emer- usual level (Fig. 1). 0.162). Two patients (4.5%) from group A gency switch in response to COVID-19 in