Trends of lower-limb complications in patients with type 2 diabetes mellitus during the COVID-19 pandemic

Abstract

Aims: The long-term impact of the COVID-19 pandemic on lower limb complications remains unclear. We aimed to assess the effect of the COVID-19 pandemic on the prevalence of diabetic foot ulcers (DFUs) and the incidence of lower extremity amputation (LEA) in patients with type 2 diabetes.

Methods: We conducted a cross-sectional analysis using TriNetX and included adults with type 2 diabetes from 2016 to 2023. DFU prevalence and LEA incidence were analyzed across pre-pandemic, pandemic, and post-pandemic periods. Annual percent changes (APC) were calculated using Joinpoint regression.

Results: Among 5,292,512 patients with type 2 diabetes (mean age, 66 ± 14.0 years; 47.3 % female), DFU prevalence increased pre-pandemic (APC 9.08%; 95% CI 6.24, 12.65), remained stable during the pandemic (APC -0.15%; 95% CI -1.94, 1.69), and rose significantly post-pandemic (APC 6.89%; 95% CI 3.50, 9.75). LEA incidence showed similar trends, which increased pre-pandemic (APC 9.18%; 95% CI 7.15, 12.58), remained stable during the pandemic (APC -3.75%; 95% CI -6.45, 0.63), and significantly increased post-pandemic (APC 11.46%; 95% CI 8.09, 19.63).

Conclusions: The disproportionately sharper increase in LEA rates compared with DFU prevalence post-pandemic suggests that delayed care during the pandemic may have contributed to a higher burden of preventable amputations.

Keywords: COVID-19 pandemic; Diabetic foot ulcers; Lower extremity amputation; Type 2 diabetes.