{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:19:02Z","timestamp":1777879142040,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Endocrinology"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Lower extremity amputation resulting from diabetic foot ulcer, with neuropathic and\/or ischemic etiologies, remains a devastating and costly complication of diabetes mellitus. This study evaluated changes in care delivery of diabetic foot ulcer patients during the COVID-19 pandemic. A longitudinal assessment evaluating the ratio of major lower extremity amputation to minor lower extremity amputations after implementation of novel strategies to combat access restrictions was compared to the pre-COVID-19 era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The ratio of major to minor lower extremity amputation (i.e. the high-to-low ratio) was assessed at two academic institutions, the University of Michigan, and University of Southern California, in a population of patients with diabetes who had direct access to multidisciplinary foot care clinics in the 2\u2009years prior to the pandemic and the first 2\u2009years of the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Patient characteristics and volumes including patients with diabetes and those with a diabetic foot ulcer were similar between eras. In addition, inpatient diabetic foot-related admissions were similar, but were suppressed by government shelter in placed mandates and subsequent COVID-19 variants surges (e.g. delta, omicron). In the control group, the Hi-Lo ratio increased every 6\u2009months by an average of 11.8%. Meanwhile, following STRIDE implementation during the pandemic, the Hi-Lo ratio reduced by (\u2212)11% ( p\u2009&lt;\u20090.001) and doubled limb salvage efforts as compared to the baseline era. The reduction of the Hi-Lo ratio was not influenced significant by patient volumes or inpatient admissions for foot infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These findings signify the importance of podiatric care in the at-risk diabetic foot population. Through strategic planning and rapid implementation of at-risk diabetic foot ulcer triage, multidisciplinary teams were able to maintain accessible care during the pandemic which resulted in a reduction of amputations. Furthermore, this manuscript highlights the value of the Hi-Lo ratio as an indicator of institutional limb salvage efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20420188231157203","type":"journal-article","created":{"date-parts":[[2023,3,4]],"date-time":"2023-03-04T01:52:45Z","timestamp":1677894765000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Tackling diabetic foot: limb salvage during the COVID-19 pandemic"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2561-9243","authenticated-orcid":false,"given":"Brian M.","family":"Schmidt","sequence":"first","affiliation":[{"name":"Associate Professor, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Drive, Lobby C, Ann Arbor, MI 48106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Clinical Surgery, Department of Vascular Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,3,3]]},"reference":[{"key":"bibr1-20420188231157203","doi-asserted-by":"publisher","DOI":"10.7547\/20-051."},{"key":"bibr2-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa342"},{"key":"bibr3-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2020.08.114"},{"key":"bibr4-20420188231157203","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-1347"},{"key":"bibr5-20420188231157203","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-1176"},{"key":"bibr6-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2020.107622"},{"key":"bibr7-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2020.107691"},{"key":"bibr8-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1080\/2000625X.2018.1452513"},{"key":"bibr9-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2006.09.015"},{"key":"bibr10-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2017.02.008"},{"key":"bibr11-20420188231157203","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.1.84"},{"key":"bibr12-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199609263351322"},{"key":"bibr13-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2011.02.001"},{"key":"bibr14-20420188231157203","volume-title":"Rdw\/Datadirect: a self-serve tool for data retrieval","author":"Kheterpal S.","year":"2015"},{"key":"bibr15-20420188231157203","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2020.08.132"},{"key":"bibr16-20420188231157203","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1380"}],"container-title":["Therapeutic Advances in Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20420188231157203","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20420188231157203","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20420188231157203","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:36:15Z","timestamp":1777592175000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20420188231157203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":16,"alternative-id":["10.1177\/20420188231157203"],"URL":"https:\/\/doi.org\/10.1177\/20420188231157203","relation":{},"ISSN":["2042-0188","2042-0196"],"issn-type":[{"value":"2042-0188","type":"print"},{"value":"2042-0196","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"article-number":"20420188231157203"}}