Aim: The Belgian government introduced a national COVID-19 lockdown from 14/03 until 03/05/2020. Free movement was restricted and only urgent medical care was allowed. Although diabetic foot clinics (DFC) were advised to treat all foot problems as urgent, patients were reluctant to visit the hospital. This study investigates the impact of the lockdown on presentation rate and diabetic foot ulcer (DFU) severity at presentation.
Method: Within the ongoing national care quality improvement initiative (IQED-Foot), a prospective cohort study was conducted among 22 DFC. 887 consecutive patients with DFU of Wagner grade ≥ 2 were included. Patients were divided based on their first contact: pre-lockdown group (A, first contact between 01/01 and 13/03/2020, n=322) or (post-)lockdown group (B, first contact between 14/03 and 30/09/2020, n=565).
Results: All DFC, except one, remained open for active foot problems with implementation of COVID-19 measures. During lockdown, the average weekly presentation rate was strongly reduced (0.6 vs. 1.4 patients/week/DFC in 2018; p<0.001). However, median patient-reported presentation delay did not increase (A: 3 [1-8] vs. B: 3 [1-7] weeks; p=0,81). Demographic data such as gender, age, diabetes type and duration were not different. Patients that presented during/after lockdown had less frequently a prior DFU (B: 50% vs. A: 60%; p=0,005). Regarding DFU severity, patients seen during/after lockdown had less frequently critical ischemia (B: 11% vs. A: 18%; p=0.0103) and presented with slightly larger lesions (< 1cm2 B: 32% vs. A: 38%; p=0.0003, 1-3cm2 B: 45% vs. A: 40%; p=0.0152). No differences in depth, infection or loss of protective sensation were observed.
Conclusion: DFC in Belgium remained accessible to patients with foot problems. Although patient inclusion was strongly reduced, overall presentation delay did not increase. The impact on DFU severity was limited to slightly larger lesions. Follow-up is ongoing and outcome data will be available by September.
