By treating foot ulcers, Belgium kept its death toll down.
Belgium has prioritized diabetic foot ulcer (DFU) care during the coronavirus pandemic, and has, in general, a national diabetic foot care program since 2005 with 34 multidisciplinary clinics recognized by the Belgium Ministry of Health for the treatment of diabetic foot ulcers (DFUs). The country takes the care of these ulcers very seriously.
Foot ulcers are a common consequence of living with diabetes. They are a result of poor circulation, high blood sugar (hyperglycemia), nerve damage, and/or irritated or wounded feet. They can develop if diabetic symptoms are poorly managed, and sugar isn’t properly regulated. One of the first signs an ulcer is present includes drainage from the foot that could stain socks or shoes. Other signs include unusual swelling, irritation, redness, and odors. As the ulcers develop, they can become increasingly distressing and can even be life-threatening.
A new study now suggests that Belgium’s prioritization ulcer care during the pandemic lockdown “minimized both delays in care and adverse outcomes,” according to researchers. While all nonurgent medical care in Belgium was postponed during the national lockdown between March 14 and May 3, of last year, the foot care clinics followed advice from professional associations that considered the condition urgent. Therefore, these clinics remained open for use.
“Thanks to the great efforts of diabetic foot clinics, continued availability of diabetic foot ulcer services during lockdown, although in a limited capacity, were really helpful, and may be the reason why we didn’t see late presentation,” said An-Sofie Vanherwegen, PhD, of Health Services Research, Sciensano, in Brussels, Belgium, at the meeting of the European Association for the Study of Diabetes. “The only impact on DFU severity was that wounds tended to be slightly lighter,” she said, adding, “Our findings will hopefully guide diabetic foot clinics in serving their patients using innovative strategies, such as telemedicine, during the current, and eventual future, public health crises.”
The meeting moderator Nikolaos Papanas, MD, PhD, explained, “These results are important inasmuch as they provide information about diabetic foot patients during that critical period. The observation that patients did not delay in presenting to the health system is new and very reassuring, because it implies that they were educated about foot hygiene and that the system was able to cope with foot morbidity despite the new situation. Ulcers were larger but not otherwise more severe, which is probably due to the same reasons.”
“Both system restructuring to incorporate telemedicine and patient education were key,” said Papanas, head of the Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace in Xanthi, Greece. “We have also previously formulated that every healthcare professional must command an absolute minimum of knowledge to detect alarming signs in any new foot lesion. Meticulous foot care and maintenance of multidisciplinary expert management should be available with or without lockdowns.”
Doctors can remove foot ulcers in severe cases. An infection is a serious complication of the condition and requires immediate treatment. Around a quarter of all people living with diabetes will develop a foot ulcer in their lifetime, according to the Centers for Disease Control and Prevention (CDC). If they are not treated properly, amputation of the foot can result.