The experience of an adult diabetic foot unit continuing face-to-face consults during the COVID-19 pandemic

Background and Aims

The COVID-19 pandemic significantly disrupted lower limb diabetes care. We aimed to map trends in diabetes-related lower limb amputation and hospitalisation rates through the COVID-19 pandemic.

Methods

We performed a retrospective cohort study of all individuals who underwent a lower limb amputation for a diabetes-related foot complication from 2018 to 2021 at the Royal Melbourne Hospital, a quaternary hospital in Australia. Hospitalisation rates with a diabetes-related foot complication were collected for comparison. The start of the COVID-19 epoch was defined as 16 March 2020, when a state of emergency was declared in Melbourne.

Results

During the study period, 360 lower limb amputations for diabetes-related foot complications were performed in 247 individuals. The median monthly number of amputations remained stable prior to and during the COVID-19 epoch; there was a median of 8.0 amputations per month (interquartile range (IQR) = 6.5–11) before COVID-19, compared to 6.5 amputations (IQR = 5.0–8.3) during the COVID-19 epoch (P = 0.23). Hospitalisation with a diabetes-related foot complication significantly increased from a median monthly rate of 11 individuals (IQR = 9.0–14) before COVID-19 to 19 individuals (IQR = 14–22) during the COVID-19 epoch (p < 0.001).

Conclusions

Despite increased hospitalisations for diabetes-related foot complications during COVID-19, there was not a corresponding increase in amputation rates. Face-to-face care of diabetes-related foot complications was prioritised at this centre and may have contributed to stable amputation rates during the pandemic.