Diabetes mellitus is one of the most prevalent endocrine disorders associated with macro and micro vascular complications. Lower limb complications associated with diabetes including Diabetic Foot Ulcers (DFU) are a major public health issue worldwide. Novel Coronavirus (COVID-19) is a strain of coronavirus which causes illness in animals and humans. COVID-19 has significantly affected people with chronic medical conditions such as diabetes, hypertension, cardiovascular disease and cancer with severe illness and worse outcomes as well as disruption of their routine medical care provision. We presented a case-study of 59-year-old patient with diabetes and hypertension, with an unexpected DFU complication that resulted in big toe amputation. Therefore it is vital for us as health care professional to find innovative ways to ensure the continuity of medical care/service provision along with the fight of COVID-19.
KeywordsDiabetic Foot UlcerAmputationCOVID-19Primary Health Care
International Diabetes Federation (2017) IDF Diabetes Atlas, 8. International Diabetes Federation, Brussels. http://www.diabetesatlas.org
Singh, N., Armstrong, D.G. and Lipsky, B.A. (2005) Preventing Foot Ulcers in Patients with Diabetes. Journal of the American Medical Association, 293, 217-228. https://doi.org/10.1001/jama.293.2.217
Fatima, E., Ashfaq, A. and Kamran, H. (2018) Prevalence of Diabetic Foot Ulcer in Lahore, Pakistan: A Cross Sectional Study. AJAHS, 3, 34-38.
King, H., Aubert, R.E. and Herman, W.H. (1998) Global Burden of Diabetes, 1995-2025: Prevalence, Numerical Estimates, and Projections. Diabetes Care, 21, 1414-1431. https://doi.org/10.2337/diacare.21.9.1414
Boulton, A.J., Vileikyte, L., Ragnarson-Tennvall, G. and Apelqvist, J. (2005) The Global Burden of Diabetic Foot Disease. The Lancet, 366, 1719-1724. https://doi.org/10.1016/S0140-6736(05)67698-2
Wu, S.C., Driver, V.R., Wrobel, J.S. and Armstrong, D.G. (2007) Foot Ulcers in the Diabetic Patient, Prevention and Treatment. Vascular Health and Risk Management, 3, 65-76.
Amin, N. and Doupis, J. (2016) Diabetic Foot Disease: From the Evaluation of the “Foot at Risk” to the Novel Diabetic Ulcer Treatment Modalities. World Journal of Diabetes, 7, 153-164. https://doi.org/10.4239/wjd.v7.i7.153
Chammas, N.K., Hill, R.L.R. and Edmonds, M.E. (2016) Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type. Journal Diabetes Research, 1-7. https://doi.org/10.1155/2016/2879809
Bild, D.E., Selby, J.V., Sinnock, P., Browner, W.S., Braveman, P. and Showstack, J.A. (1989) Lower-Extremity Amputation in People with Diabetes: Epidemiology and Prevention. Diabetes Care, 12, 24-31. https://doi.org/10.2337/diacare.12.1.24
Nongmaithem, M., Bawa, A.P., Pithwa, A.K., Bhatia, S.K., Singh, G. and Gooptu, S. (2016) A Study of Risk Factors and Foot Care Behavior among Diabetics. Journal of Family Medicine and Primary Care, 5, 399-403. https://doi.org/10.4103/2249-4863.192340
Boulton, A.J. (2008) The Diabetic Foot: Grand Overview, Epidemiology and Pathogenesis. Diabetes/Metabolism Research and Reviews, 24, S3-S6. https://doi.org/10.1002/dmrr.833
Berendt, A.R. and Lipsky, B.A. (2005) Infection in the Diabetic Foot. Clinical Care of the Diabetic Foot, 23, 90-98.
Peters, E.J. and Lipsky, B.A. (2013) Diagnosis and Management of Infection in the Diabetic Foot. Medical Clinics, 97, 911-946. https://doi.org/10.1016/j.mcna.2013.04.005
Assaad-Khalil, S.H., Zaki, A., Rehim, A.A., Megallaa, M.H., Gaber, N., Gamal, H. and Rohoma, K.H. (2015) Prevalence of Diabetic Foot Disorders and Related Risk Factors among Egyptian Subjects with Diabetes. Primary Care Diabetes, 9, 297-303. https://doi.org/10.1016/j.pcd.2014.10.010
Nanwani, B., Shankar, P., Kumar, R. and Shaukat, F. (2019) Factors of Diabetic Foot Amputation in Pakistani Type II Diabetes Individuals. Cureus, 11, e4795. https://doi.org/10.7759/cureus.4795
Federation ID (2013) IDF Diabetes Atlas. International Diabetes Federation, Brussels.
Holstein, P., Ellitsgaard, N., Bornefeldt Olsen, B. and Ellitsgaard, V. (2000) Decreasing Incidence of Major Amputations in People with Diabetes. Diabetologia, 43, 844-847. https://doi.org/10.1007/s001250051459
Jupiter, D.C., Thorud, J.C., Buckley, C.J. and Shibuya, N. (2016) The Impact of Foot Ulceration and Amputation on Mortality in Diabetic Patients. I: From Ulceration to Death, a Systematic Review. International Wound Journal, 13, 892-903. https://doi.org/10.1111/iwj.12404
Chaturvedi, N., Stevens, L.K., Fuller, J.H., Lee, E.T. and Lu, M. (2001) Risk Factors, Ethnic Differences and Mortality Associated with Lower-Extremity Gangrene and Amputation in Diabetes: The WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia, 44, 65-71. https://doi.org/10.1007/PL00002941
Hamalainen, H., Rönnemaa, T., Halonen, J.P. and Toikka, T. (1999) Factors Predicting Lower Extremity Amputations in Patients with Type 1 or Type 2 Diabetes Mellitus: A Population-Based 7-Year Follow-Up Study. Journal of Internal Medicine, 246, 97-103. https://doi.org/10.1046/j.1365-2796.1999.00523.x
Tseng, C.H. (2006) Prevalence of Lower-Extremity Amputation among Patients with Diabetes Mellitus: Is Height a Factor? CMAJ, 174, 319-323. https://doi.org/10.1503/cmaj.050680
Hippisley-Cox, J. and Coupland, C. (2016) Diabetes Treatments and Risk of Amputation, Blindness, Severe Kidney Failure, Hyperglycaemia, and Hypoglycaemia: Open Cohort Study in Primary Care. BMJ, 352, 1450. https://doi.org/10.1136/bmj.i1450
Liu, M., Zhang, W., Yan, Z. and Yuan, X. (2017) Smoking Increases the Risk of Diabetic Foot Amputation: A Meta-Analysis. Experimental and Therapeutic Medicine, 15, 1680-1685. https://doi.org/10.3892/etm.2017.5538
Young, B.A., Lin, E., Von Korff, M., et al. (2008) Diabetes Complication Severity Index and Risk of Mortality, Hospitalization and Healthcare Utilization. The American Journal of Managed Care, 14, 15-24.
Lee, J.S., Lu, M.L., Lee, V.S., Russel, D., Bahr, C. and Lee, E.T. (1993) Lower-Extremity Amputation: Incidence, Risk Factors and Mortality in the Oklahoma Indian Diabetes Study. Diabetes, 42, 876-882. https://doi.org/10.2337/diabetes.42.6.876
Resnick, H.E., Carter, E.A., Sosenko, J.M., et al. (2004) Incidence of Lower-Extremity Amputation in American Indians: The Strong Heart Study. Diabetes Care, 27, 1885-1891. https://doi.org/10.2337/diacare.27.8.1885
Calle-Pascual, A.L., Garcia-Torre, N., Moraga, I., et al. (2001) Epidemiology of Nontraumatic Lower-Extremity Amputation in Area 7, Madrid, between 1989 and 1999: A Population-Based Study. Diabetes Care, 24, 1686-1689. https://doi.org/10.2337/diacare.24.9.1686
Margolis, D.J., Hofstad, O. and Feldman, H.I. (2008) Association between Renal Failure and Foot Ulcer or Lower-Extremity Amputation in Patients with Diabetes. Diabetes Care, 31, 1331-1336. https://doi.org/10.2337/dc07-2244
Zubair, M., Malik, A. and Ahmad, J. (2015) Diabetic Foot Ulcer: A Review. American Journal of Internal Medicine, 3, 28-49. https://doi.org/10.11648/j.ajim.20150302.11