A recently published study in Diabetes Care reinforces the notion that patients with diabetes are at an increased risk of developing severe COVID-19-related complications.1
In this prospective cohort study, Gregory and colleagues surveyed the medical records of over 6,000 patients within the Vanderbilt University Medical Center health system (between March and August 2020) and found that patients with type 1 diabetes (n=40) and type 2 diabetes (n=273) were more than three times as likely as patients without diabetes (n=6138) to develop severe COVID-19-related complications, including greater severity of illness, hospitalization and death.1
Furthermore, when focusing specifically on patients with type 1 diabetes, the study authors found a significant association between severity of illness and factors such as glycosylated hemoglobin (HbA1c), hypertension, race, recent diabetic ketoacidosis, status of health insurance and less use of diabetes technology (i.e. a continuous glucose monitor).1
In fact, according to a recent analysis by The New York Times, there has been a 15 percent increase in diabetes-related deaths since the start of the current pandemic (March to November 2020).2 Remarkably, according to the same analysis, approximately 512,000 more Americans died (between March 15, 2020 and January 30, 2021) than would have in a normal year, including deaths not directly attributable to COVID-19, representing a 20 percent increase.3 Basing their analysis on mortality data from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, The New York Times investigators used excess deaths (“typically defined as the difference between the observed numbers of deaths in specific time periods and expected numbers of deaths in the same time periods”) as a basis for quantifying the impact of the current pandemic.3,4 As official death counts continue to take place, these numbers may actually represent an undercount.
In terms of the lower extremity, several recent studies describe the increased severity of diabetic foot-related complications and incidence of amputations observed during the current pandemic.5-8 We need look no further than our own practices to understand the potential risks involved in delaying or even postponing care for this most vulnerable population. Whether it is at-risk diabetic foot care (including serial nail, corn and callus debridements), care of the diabetic foot in remission or complex ulcer and amputation care, we bear the burden of protecting our patients from limb loss while ensuring their safety and well-being in terms of minimizing COVID-19 exposure.
As Rogers and colleagues note, “increased awareness, proper prioritization, and efficiencies of care in lower risk settings are the first steps in mitigating this parallel pandemic of diabetes-related amputations.”9 Moreover, we must maintain a proactive approach to amputation prevention during the current pandemic while adapting to changes in the current practice model. Never has the role of the podiatric profession been so critically important and intertwined with the health and well-being of our nation as today. Let us embrace this challenge head-on.
Dr. Isaac is the Director of Research with Foot & Ankle Specialists of the Mid-Atlantic (FASMA). He is a Diplomate of the American Board of Foot and Ankle Surgery.
1. Gregory JM, Slaughter JC, Duffus SH, et al. COVID-19 severity is tripled in the diabetes community: a prospective analysis of the pandemic’s impact in type 1 and type 2 diabetes. Diabetes Care. 2021;44(2):526-532.
2. Lu D. 2020 was especially deadly. COVID wasn’t the only culprit. The New York Times. Available at: https://www.nytimes.com/interactive/2020/12/13/us/deaths-covid-other-causes.html . Published December 13, 2020. Accessed February 24, 2021.
3. Katz J, Lu D, Sanger-Katz M. Since Covid arrived: half a million more u.s. deaths than normal. The New York Times. Available at: https://www.nytimes.com/interactive/2021/01/14/us/covid-19-death-toll.html . Published February,17 2021. Accessed February 24, 2021.
4. Centers for Disease Control and Prevention National Center for Health Statistics. Excess Deaths Associated with COVID-19. Available at: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm . Accessed February 24, 2021.
5. Casciato DJ, Yancovitz S, Thompson J, et al. Diabetes-related major and minor amputation risk increased during the COVID-19 pandemic. J Am Podiatr Med Assoc. Available at: https://meridian.allenpress.com/japma/article/doi/10.7547/20-224/446968/Diabetes-related-major-and-minor-amputation-risk . Published November 3, 2020. Accessed February 26, 2021.
6. Caruso P, Longo M, Signoriello S, et al. Diabetic foot problems during the COVID-19 pandemic in a tertiary care center: the emergency among the emergencies. Diabetes Care. 2020;43(10):e123-124.
7. Schuivens PM, Buijs M, Boonman-de Winter L, et al. Impact of the COVID-19 lockdown strategy on vascular surgery practice: more major amputations than usual. Ann Vasc Surg. 2020;69:74-79.
8. Lancaster EM, Wu B, Iannuzzi J, et al. Impact of the coronavirus disease 2019 pandemic on an academic vascular practice and a multidisciplinary limb preservation program. J Vascular Surgery. 2020;72(6):1850-1855.
9. Rogers LC, Snyder RJ, Joseph WS. Diabetes-related amputations: a pandemic within a pandemic. J Am Podiatr Med Assoc. Available at: https://meridian.allenpress.com/japma/article/doi/10.7547/20-248/446969/Diabetes-related-Amputations-A-Pandemic-within-a . Published November 3, 2020. Accessed February 26, 2021.