COVID-19 and the Diabetic Lower Limb

Q&A with Windy Cole, DPM, CWSP

Director of Wound Care Research,
Kent State University College of Podiatric Medicine

What is your presentation about?
Common late-stage complications seen in persons with diabetes include ischemic heart disease and peripheral arterial disease. These comorbid conditions further contribute to patient frailty and susceptibility to complications from the novel coronavirus. In some severe cases, COVID-19 patients have been crashing hard and fast from cardiac episodes, which have led some clinicians to believe that these sudden arrests may have been precipitated by thrombolytic events. It is hypothesized that critically ill COVID-19 patients are developing a pro-thrombotic form of disseminated intravascular coagulation (DIC) that is putting them at increased risk for thrombotic events. This growing concern is so common it has been recognized as a new pattern of clotting referred to as COVID-19 associated coagulopathy, or CAC. The COVID-19 virus induces a hyper-inflammatory state. It has been suggested that systemic inflammation induces endothelial injury. This will activate the coagulation cascade and impair fibrinolysis with disruption of endothelial barrier, and loss of physiologic antithrombotic factors which may elevate the risk for amputation .

What makes this topic important in 2022?
Diabetic foot care remained vital throughout the COVID-19 pandemic. Podiatric physicians provide essential care to an at-risk patient population. Many of our patients have diabetes, predisposing them to greater complications from coronavirus infection. Steps must be taken to limit disruptions in care including performing services in lower-risk settings to limit patient morbidity and mortality. Through the implementation of a triage system to categorize the needs of our patients with diabetes clinicians can continue to manage the care of our patients. Innovative therapies paired with alternative treatment sites of service such as telemedicine, home visits, mobile clinics and free-standing office sites can help to mitigate risks for these vulnerable patients with advanced comorbidities.

How did you become involved with this area of diabetes research or care?
I have been a wound care researcher and university professor for the past 8 years. I have a passion for finding new and innovative treatments to help patients with diabetes have better health care outcomes.

What are you most looking forward to at the 82nd Scientific Sessions?
This will be my first time attending and speaking at the event. I am really looking forward to networking and learning with other colleagues.