Home monitoring of foot skin temperatures to prevent ulceration.
OBJECTIVE
To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation.


METHODS
Eighty-five patients who fit diabetic foot risk category 2 or 3 (neuropathy and foot deformity or previous history of ulceration or partial foot amputation) were randomized into a standard therapy group (n = 41) or an enhanced therapy group (n = 44). Standard therapy consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. Enhanced therapy included the addition of a handheld infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening. Elevated temperatures (>4 degrees F compared with the opposite foot) were considered to be "at risk" of ulceration due to inflammation at the site of measurement. When foot temperatures were elevated, subjects were instructed to reduce their activity and contact the study nurse. Study subjects were followed for 6 months.


RESULTS
The enhanced therapy group had significantly fewer diabetic foot complications (enhanced therapy group 2% vs. standard therapy group 20%, P = 0.01, odds ratio 10.3, 95% CI 1.2-85.3). There were seven ulcers and two Charcot fractures among standard therapy patients and one ulcer in the enhanced therapy group.


CONCLUSIONS
These results suggest that at-home patient self-monitoring with daily foot temperatures may be an effective adjunctive tool to prevent foot complications in individuals at high risk for lower-extremity ulceration and amputation.
Lavery
Lawrence A
LA
College of Medicine, Texas A&M Health Science Center, Scott and White Hospital, Temple, Texas, USA. llavery@swmail.sw.org <llavery@swmail.sw.org>
Higgins
Kevin R
KR
Lanctot
Dan R
DR
Constantinides
George P
GP
Zamorano
Ruben G
RG
Armstrong
David G
DG
Athanasiou
Kyriacos A
KA
Agrawal
C Mauli
CM
D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000628:therapy; D017719:Diabetic Foot / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005528:Foot; D016523:Foot Ulcer / Q000517:prevention & control*; D006801:Humans; D007259:Infrared Rays; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D016037:Single-Blind Method; D012881:Skin Temperature; D013821:Thermometers