Use of a Remote Temperature Monitoring Mat for the Early Identification of Foot Ulcers

Jaminelli L. Banks, DPM; Brian J. Petersen, MS, MBA; Gary M. Rothenberg, DPM; Annie S. Jong, DPM; Jeffrey C. Page, DPM, DABFAS

Disclosures

Wounds. 2020;32(2):44-49. 

In This Article

Abstract and Introduction

Abstract

Introduction: Diabetic foot ulcers (DFUs) are responsible for considerable morbidity, mortality, and cost. Remote temperature monitoring (RTM) is an evidenced-based and recommended component of standard foot care for at-risk patients. Although previous research has demonstrated the value of RTM for foot ulcer prevention, its benefits related to the early identification of diabetic foot complications may be underappreciated.

Objective: This article presents a case series supporting the use of RTM for early identification of DFUs.

Materials and Methods: The cases of 4 veteran patients who presented consecutively with inflammation, which was detected by a telemedicine temperature monitoring mat, are reported. The authors collected subjective history from each patient via telephone outreach and triaged these patients according to standard diabetic foot care recommendations.

Results: Each patient required a clinical exam prompted by the mat and the patient's subjective history. In each case, the patient required callus debridement upon which a pre-ulcerative lesion or partial-thickness wound was discovered. The DFUs in these 4 cases healed quickly and without complication. In 2 of the cases, the outreach prompted by the mat reestablished specialist foot care after a prolonged period without routine exam.

Conclusions: In each of these cases, the RTM mat detected inflammation accompanying a preulcerative lesion or a partial-thickness wound, allowing for timely intervention and treatment, including debridement and offloading, which may have the potential to improve care and reduce morbidity, mortality, and costs.

Introduction

Diabetic foot ulcers (DFUs) are among the most devastating and costly sequelae of diabetes. Between 75% and 95% of all lower extremity amputations are preceded by a DFU,[1–7] and the mortality rates for those with incident DFUs are worse than for patients with most types of cancer.[8–13]

As a result, primary objectives of care for patients with diabetes are prevention and effective management of DFUs.[14] Research suggests early identification of DFUs is a critical factor for ensuring good patient outcomes and containing costs.[15–21] Oyibo et al[22] found a strong correlation between the severity of a DFU at presentation and subsequent amputation rate. In 2017, Smith-Strøm et al[23] concluded that "early detection and referral by both the patient and general practitioner are crucial for optimal foot ulcer healing." It is estimated that more than two-thirds of the episodic costs of DFUs are attributable to hospitalization,[24–27] which is often an outcome of chronic DFUs.

Recently, the emergence of remote temperature monitoring (RTM) has offered an efficacious preventive option for diabetic foot care in high-risk patients.[28,29] The objective of RTM is to monitor dermal foot temperatures for thermal signs of inflammation; this allows the provision of targeted and timely interventions, such as debridement of callus, pressure offloading of the affected inflamed areas, and treatment of any wounds previously not possible to prevent the worst complications of DFUs. Remote temperature monitoring is supported by 3 randomized controlled trials,[30–32] which found a large treatment effect (62%–90% relative risk reduction in DFU incidence) when used to prompt reduced ambulation. Building on this research, an RTM foot mat recently was evaluated in a multicenter study following 129 patients, each followed for 34 weeks.[33] The investigators[33] found the mat predicted 97% of nonacute plantar DFUs, with an average lead time of about 5 weeks.

Although previous research has demonstrated the value of RTM for preventing foot ulcers, perhaps less appreciated are its benefits for the early identification of diabetic foot complications. With this in mind, the case series reported herein evaluated the use of RTM for early identification of DFUs in 4 at-risk patients.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....