59.3 Advanced foot surveillance with skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients

David G. Armstrong; Katherine Holtz-Neiderer; Christopher Wendel; M. Jane Mohler; Heather R. Kimbriel; Lawrence A. Lavery; Dr. William M. Scholl College of Podiatric Medicine

Background: Diabetic foot ulcers are preceded by inflammation, making their occurrence or recurrence potentially detectable and preventable by empowering the patient. Therefore, the purpose of this study was to evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk persons with diabetes.

Methods: In this physician-blinded 18-month randomized controlled trial, 225 subjects with diabetes at high risk for ulceration were assigned to standard therapy (ST) or dermal thermometry (DT) groups. Both groups received therapeutic footwear, diabetic foot education, regular foot care, and performed a structured foot inspection daily. DT subjects used an infrared skin thermometer to measure temperatures on 6 foot sites, twice daily. Temperature differences > 4ûF between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.

Results: A total of 8.4% (n = 19) subjects ulcerated over the study period. Subjects were 3 times less likely to ulcerate in the DT group compared to ST (12.2% versus 4.7%, OR = 3.0, CI 1.0 Ð 8.5, P = 0.038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly shorter time to ulceration (P = .045), 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 versus 0.74 ± 0.05; P = 0.001).

Conclusions: These results suggest that high temperature gradients between feet may predict the onset of neuropathic ulceration and that temperature monitoring reduces the risk of ulceration.