Long term outcomes after incident diabetic foot ulcer: Multicenter large cohort prospective study (EDI-FOCUS investigators) epidemiology of diabetic foot complications study

Rastogi, Ashu; Ghanshyam, Goyal; Kesavan, Rajesh; Bal, Antonin; Kumar, Harish; Mangalanadanam,; Kamath, Priyatham; Jude, Edward B.; Armstrong, David G.; Bhansali, Anil

doi:10.1016/j.diabres.2020.108113

Cited by 93 publications

(69 citation statements)

References 26 publications

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“…Our results also suggest that people with significant co-morbidities of diabetes that limit outdoor activities like foot complications are also able to achieve good glycemic control. Knowing that people with foot complications like neuropathic foot ulcers or Charcot neuroarthropathy and foot deformities are likely to have higher mortality as compared to individuals with diabetes without foot complications [ 15 , 16 ], good glycemic control in this cohort is more desirable. The improvement in glycemic parameters associated with an increase in physical activity and weight loss was observed irrespective of gender.…”

Section: Discussionmentioning

confidence: 99%

Improved glycemic control amongst people with long-standing diabetes during COVID-19 lockdown: a prospective, observational, nested cohort study

Rastogi

Hiteshi

Bhansali

2020

Int J Diabetes Dev Ctries

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Background and aims COVID-19 is likely to affect the lives of individuals with type 2 diabetes. However, the effect of COVID-19 lockdown on physical activity and glycemic control in such individuals is not known. We studied the physical activity and glycemic control during lockdown in comparison to pre-lockdown parameters in individuals with long-standing type 2 diabetes. Methods This prospective, observational study includes 2240 people with T2DM regularly attending diabetes clinic prior to lockdown. Glycemic record, HbA1c, and physical activity assessed with Global Physical Activity Questionnaire (GPAQ) as metabolic equivalents (MetS min/week) were obtained during lockdown (minimum duration of 3 months). Results A total of 422 out of 750 participants (nest) responded. The median (IQR) for age was 58 (52 to 64) years, duration of diabetes 11 (6 to 16) years, prevalent foot complications in 59.7%, and atherosclerotic cardiovascular disease in 21.3% of participants. There was a decrease in HbA1c from 7.8% (6.9 to 9.4) prior lockdown to 7.4% (6.6 to8.7) during lockdown [ΔHbA1c − 0.41 ± 0.27% (p = 0.005)] and postprandial blood glucose 200.0 mg/dl (152.0 to 252.0) to 158.0 (140.0 to 200.0) mg/dl (p < 0.001). The physical activity increased during lockdown from a GPAQ score 140 (0.0 to 1260) MetS to 840 (0.0 to 1680) MetS (p = 0.014). The improvement of glycemic control was observed in either gender and independent of the presence of foot complications or increase in physical activity. Conclusions There is an overall improvement of glycemic control during COVID-19 lockdown independent of increase in physical activity in people with long duration of diabetes.

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Section: Discussionmentioning

confidence: 99%

Improved glycemic control amongst people with long-standing diabetes during COVID-19 lockdown: a prospective, observational, nested cohort study

Rastogi

Hiteshi

Bhansali

2020

Int J Diabetes Dev Ctries

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“…One of the co-morbidities that can affect the outcomes of COVID-19 is diabetes mellitus (DM), with India having more than 62 million individuals with diabetes [ 1 ]. People with DM are already a vulnerable group, as they have a higher rates for hospitalisation and mortality [ 2 , 3 ], and this risk increases when they contract COVID-19 [ 4 ]. Recently, guidance documents for managing diabetes and associated complications during COVID-19 pandemic have become available but none address the psychological issues in people with diabetes [ [5] , [6] , [7] ].…”

Section: Introductionmentioning

confidence: 99%

Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus

Singhai

Swami

Nebhinani

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Background and aims People with diabetes have multiple psychosocial issues related to diabetes and its complications and this may be exacerbated during the COVID-19 pandemic. Methods We reviewed the psychological adaptative difficulties in people with diabetes especially during natural disasters including the prevailing COVID-19 pandemic. Results There are significant concerns regarding worsening of glycemic control, unavailability of appropriate medicines, inaccessibility to health care or acquiring SARS- CoV-2 infection and subsequent poorer outcomes during the COVID-19 pandemic. Although there are some guidance documents for managing diabetes and associated complications during COVID-19 pandemic but very few address the psychological issues in people with diabetes. We discuss the psychological adaptive difficulties and an approach to address the psychosocial concerns in people with diabetes during the COVID-19 pandemic. Conclusions People with diabetes have significant diabetes distress and psychological adaptive difficulties that is aggravated by the COVID-19 pandemic. An integrated multidisciplinary approach is needed to manage the prevailing psychological issues amongst people with diabetes during the COVID-19 pandemic.

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“…Diabetic foot ulcers (DFU) remain one of the most common complications of diabetes and are the leading cause of lower extremity amputation with every sixth individual having an early demise as a result. 1. , 2.…”

Section: Introductionmentioning

confidence: 99%

Strategies to educe severe diabetic foot nfections and complications uring pidemics (STRIDE)

Schmidt

Munson

Rothenberg

et al. 2020

Journal of Diabetes and its Complications

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Aims Patients with diabetes, including those with foot complications, are at highest risk for severe outcomes during the COVID-19 pandemic. Diabetic foot ulcers (DFU) present additional challenges given their superimposed risk for severe infections and amputations. The main objectives were to develop a triage algorithm to effectively risk-stratify all DFUs for potential complications, complying with social distancing regulations, preserving personal protective equipment, and to assess feasibility of virtual care for DFU. Methods Longitudinal study during the COVID-19 pandemic performed at a large tertiary institution evaluating the effectiveness of a targeted triage protocol developed using a combined approach of virtual care, electronic medical record data mining, and tracing for rapid risk stratification to derive optimal care delivery methods. 2868 patients with diabetes at risk for foot complications within last 12 months were included and rates of encounters, hospitalizations, and minor amputations were compared to one year prior. Results The STRIDE protocol was implemented in 1-week and eventually included 2600 patients (90.7%) demonstrating effective triage. During normal operations, 40% (938 of 2345) of all visits were due to DFUs and none were performed virtually. After implementation, 98% face-to-face visits were due to DFU, and virtual visits increased by 21,900%. This risk stratified approach led to similar low rates of DFU-related-hospitalization and minor amputation rates 20% versus 24% (p > 0.05) during and prior the pandemic, respectively. Conclusions Implementation of STRIDE protocol was effective to risk-stratify and triage all patients with diabetic foot complications preventing increase in hospitalization and amputations while promoting both social and physical distancing.

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Long term outcomes after incident diabetic foot ulcer: Multicenter large cohort prospective study (EDI-FOCUS investigators) epidemiology of diabetic foot complications study

Cited by 93 publications

References 26 publications

Improved glycemic control amongst people with long-standing diabetes during COVID-19 lockdown: a prospective, observational, nested cohort study

Improved glycemic control amongst people with long-standing diabetes during COVID-19 lockdown: a prospective, observational, nested cohort study

Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus

Strategies to educe severe diabetic foot nfections and complications uring pidemics (STRIDE)

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