Aim: The Belgian government introduced a national COVID-19 lockdown from 14/03 until 03/05/2020 during which only urgent medical care was allowed. In a first phase of this study, we showed that diabetic foot clinics (DFC) remained accessible to patients and that the impact of the lockdown on DFU severity was limited to larger lesions. This second phase investigates the impact of the lockdown on the treatment and outcome of DFU.

Method: Within the national care quality improvement initiative (IQED-Foot), a prospective cohort study was conducted among 21 DFC. 910 consecutive patients with DFU of Wagner grade ≥ 2 were included between 01/01 and 30/09/2020. Patients were divided based on their first contact into the pre-lockdown (A, n=324), lockdown (B,  n=94) or post-lockdown group (C, n=492). Groups were compared with each other and with 2018 data. Competing risks for healing, major amputation or death as first event were assessed by Cox proportional hazards regression.

Results:  Although overall offloading rates for plantar DFU did not differ, patients that presented during lockdown received more often ankle-high offloading using a shoe (B: 60% vs. C: 42%; p<0.05). Revascularization rates of patients with (sub)critical ischemia were similar, however less patients that presented during lockdown underwent open vascular surgery compared to the same period in 2018 (B: 3.3% vs. 31.3% in 2018; p<0.001). No differences were observed regarding minor or major amputation rates. The overall probability of DFU healing (HR=1.03, 95%CI 0.88-1.21), major amputation (HR=0.77, 95%CI 0.58-1.01) or death (HR=1.26, 95%CI 0.79-1.99) as a first event was not different compared to 2018.

Conclusion: Organization of multidisciplinary diabetic foot care into specialized tertiary DFC has shown to be a robust system. DFC guaranteed continued access and delivery of DFU care during the COVID-19 crisis. This resulted in similar outcomes of DFU compared to the 2018 IQED-Foot audit.