Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jul 20, 2022; 12(4): 285-292
Published online Jul 20, 2022. doi: 10.5662/wjm.v12.i4.285
Telehealth has comparable outcomes to in-person diabetic foot care during the COVID-19 pandemic
Nikolaos Kamaratos-Sevdalis, Alexandros Kamaratos, Marios Papadakis, Christos Tsagkaris
Nikolaos Kamaratos-Sevdalis, Alexandros Kamaratos, Christos Tsagkaris, Diabetic Foot Clinic, Diabetes Center and 1st Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
Marios Papadakis, Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
Author contributions: Kamaratos-Sevdalis N co-performed literature search, performed the majority of the writing, and prepared the figures and tables; Kamaratos A and Papadakis M provided input in searching the literature and writing the paper; and Tsagkaris C designed the outline, co-performed literature search and coordinated the writing of the paper.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Marios Papadakis, MD, MSc, PhD, Consultant Physician-Scientist, Doctor, Research Scientist, Surgery II, University of Witten-Herdecke, Heusnerstrasse 40, Wuppertal 42283, Germany.
Received: February 9, 2022
Peer-review started: February 9, 2022
First decision: April 12, 2022
Revised: May 19, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: July 20, 2022

The coronavirus disease 2019 (COVID-19) pandemic has posed obstacles to the delivery of diabetic foot care. In response to this remote healthcare services have been deployed offering monitoring, follow-up, and referral services to patients with diabetic foot ulcers and related conditions. Although, remote diabetic foot care has been studied before the COVID-19 pandemic as an alternative to in-person care, the peculiar situation of the pandemic, which dictates that remote care would be the sole available option for healthcare practitioners and patients, necessitates an evaluation of the relevant knowledge obtained since the beginning of the severe acute respiratory syndrome coronavirus 2 outbreak.


To perform a thorough search in PubMed/Medline and Cochrane to identify original records on the topic.


To identify relevant peer-reviewed publications and gray literature, the authors searched PubMed-MEDLINE and Cochrane Library-Cochrane Central Register of Controlled Trials starting September 27 till October 31, 2021. The reference lists of the selected sources and relevant systematic reviews were also hand–searched to identify potentially relevant resources. Otherwise, the authors searched Reference Citation Analysis (


A number of randomized prospective studies, case series, and case reports have shown that the effectiveness of remote care is comparable to in-person care in terms of hospitalizations, amputations, and mortality. The level of satisfaction of patients’ receiving this type of care was high. The cost of remote healthcare was not significantly lower than in - person care though.


It is noteworthy that remote care during the COVID-19 pandemic appeared to be more effective and well - received than remote care in the past. Nevertheless, larger studies spanning over longer time intervals are necessary in order to validate these results and provide additional insights.

Keywords: Diabetes, Diabetic foot, Telehealth, Telemedicine, COVID-19, SARS-CoV-2

Core Tip: Telehealth has a major potential to sustain and improve diabetic foot care during the coronavirus disease 2019 (COVID-19) pandemic. Studies reporting the experience of healthcare providers and patients around the globe are encouraging. These findings need to be validated with larger and long – term studies. In the post COVID era, the knowledge and experience obtained can serve as the standpoint of a hybrid approach of telemedicine and in-person care oriented towards delivering fast, efficient and cost-effective care to the patients.