Armstrong DG (Rosalind Franklin University of Medicine and Science), Neiderer KM
(Southern Arizona VA HCS), Wendel C
(Southern Arizona VA HCS), Mohler MJ
(Southern Arizona VA HCS), Kimbriel HR
(Southern Arizona VA HCS), Lavery LA
(Texas A&M College of Medicine)
To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk persons with diabetes.
In this physician-blinded 18-month randomized controlled trial, 225 subjects with diabetes at high risk for ulceration were assigned to standard therapy (Standard Therapy Group) or dermal thermometry (Dermal Thermometry Group) groups. Both groups received therapeutic footwear, diabetic foot education, regular foot care, and performed a structured foot inspection daily. Dermal Thermometry Group subjects used an infrared skin thermometer to measure temperatures on 6 foot sites, twice daily. Temperature differences greater than 4 degrees fahrenheit between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.
A total of 8.4 percent (n = 19) subjects ulcerated over the study period. Subjects were one–third as likely to ulcerate in the Dermal Thermometry Group compared to Standard Therapy Group (12.2 percent vs. 4.7 percent, OR = 3.0, 95 percent confidence interval 1.0 – 8.5, p=0.038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (p=0.04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Persons that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week prior to ulceration than did a random 7 consecutive day sample of 50 other subjects that did not ulcerate (3.50 ± 1.0 vs. 0.74 ± 0.05, p = 0.001).
High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.
Data from this study suggest that self-monitoring through use of a dermal thermometer of high-risk diabetic patients, both VA and non-VA, could decrease foot ulceration. This could lead to prevention of amputation, improve quality of life, and decrease health care expenditures.