Rates of comprehensive in-person diabetes care assessment and HbA 1c measurement declined sharply and remained below 2019-2020 levels (eg, in-person assessment, March 11 to May 19: RR, 0.28 95% CI, 0.28-0.28). There were no consistent differences in demographic characteristics or comorbidities of patients undergoing amputation in the 2020-2021 vs 2019-2020 periods. The RR for the prepandemic period from January 1 to March 10 was 1.05 (95% CI, 0.88-1.25), with RRs in the pandemic periods ranging from 0.86 (95% CI, 0.72-1.03) in May 20 to July 28 to 0.95 (95% CI, 0.80-1.13) in October 7 to December 15. ![]() After the onset of the pandemic, rates of major amputation in 2020-2021 decreased compared with 2019-2020 levels. Results On March 11, 2020, the study included 1 488 605 adults with diabetes (median age, 65 years 776 665 men), and on March 11, 2019, the study included 1 441 029 adults with diabetes (median age, 65 years 751 459 men). Rates and rate ratios (RRs) comparing 2020-2021 vs 2019-2020 for each measure were calculated for 10-week periods, anchored relative to onset of the pandemic on Ma(11th week of 2020). Main Outcomes and Measures Comprehensive in-person diabetes care assessment, including foot examination hemoglobin A 1c (HbA 1c) measurement emergency department visit or hospitalization for diabetic foot ulceration, osteomyelitis, or gangrene lower extremity open or endovascular revascularization minor (toe or partial-foot) amputation and major (above-ankle) leg amputation. Objective To evaluate the association of the COVID-19 pandemic with diabetes-related care measures, foot complications, and amputation.ĭesign, Setting, and Participants This population-based cohort study included all adult residents of Ontario, Canada, with diabetes and compared the rates of selected outcomes from January 1, 2020, to February 23, 2021, vs January 1, 2019, to February 23, 2020. Importance Deferred diabetic foot screening and delays in timely care of acute foot complications during the COVID-19 pandemic may have contributed to an increase in limb loss.
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