Endocrine Abstracts

Introduction: The COVID-19 pandemic has presented many challenges in the management of diabetics around the world. While many people can be managed using new methods such as tele-consulting, the diabetic foot presents unique challenges due to the frequent need for “face-to-face” consultation and treatment. The pandemic has thus made the management of diabetic feet, already complex, even more difficult. This study aims to assess the impact of the COVID-19 pandemic on the diabetic foot.

Methods and results: It’s a retrospective study conducted at the endocrinology and diabetology department of the Ibn Rochd University Hospital, including patients who consulted in the emergency room for diabetic foot ulcer starting from the announcement of confinement in March 2020 until September 2021. Our study included 340 patients. The average age was 59 years, 62.35% were male and type 2 diabetics accounted for 93.23% with an average duration of diabetes of 12.3 years. Among the patients, 64.7% were on insulin, 22.6% on ADO and 7.3% on mixed treatment. Patients at very high cardiovascular risk represented 46.7% of which 6.9% were followed for ischemic cardiomyopathies and 40.8% for peripheral arterial disease. About microangiopathy, 27.3% had diabetic retinopathy and 25.3% diabetic kidney disease. Compared to the years 2018-2019, the number of patients who consulted was 1.9 times higher, the number of ulcers and cellulitis was 32.9% each, i.e. 6.8% more ulceration and 4% more cellulitis. The percentage of necrotizing fasciitis also increased by 18.4% as well as dry gangrene (22.6% vs 17%). 39.7% had to be referred for immediate surgical management due to the advanced stage of the lesions, which was 5.7% higher than in previous years. This increase in the number of emergencies was contrasting with a decrease in the number of outpatient consultations because of confinement.

Conclsion: The severity and increasing of the diabetic foot ulcers observed during the period of COVID-19 confirms the need for appropriate and rapid management to avoid dramatic results. Telemedicine and the use of new technologies are needed to provide optimal wound care while minimizing the exposure risk.