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

Research output: Contribution to journalArticle

182 Citations (Scopus)

Abstract

Purpose: To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk patients 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 (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 >4°F 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 one third as likely to ulcerate in the Dermal Thermometry Group compared with the Standard Therapy Group (12.2% vs 4.7%, odds ratio 3.0, 95% confidence interval, 1.0 to 8.5, P = .038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (P = .04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Patients that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week before 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 = .001). Conclusions: High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.

Original languageEnglish (US)
Pages (from-to)1042-1046
Number of pages5
JournalAmerican Journal of Medicine
Volume120
Issue number12
DOIs
StatePublished - Dec 2007

Fingerprint

Diabetic Foot
Thermometry
Skin Temperature
Temperature
Skin
Foot Ulcer
Foot
Group Psychotherapy
Thermometers
Randomized Controlled Trials
Odds Ratio
Nurses
Regression Analysis
Confidence Intervals
Physicians
Education
Incidence
Therapeutics

Keywords

  • Diabetes
  • Foot
  • Thermometry
  • Ulcer
  • Wound

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Skin Temperature Monitoring Reduces the Risk for Diabetic Foot Ulceration in High-risk Patients. / Armstrong, David G.; Holtz-Neiderer, Katherine; Wendel, Christopher; Mohler, M. Jane; Kimbriel, Heather R.; Lavery, Lawrence A.

In: American Journal of Medicine, Vol. 120, No. 12, 12.2007, p. 1042-1046.

Research output: Contribution to journalArticle

Armstrong, David G. ; Holtz-Neiderer, Katherine ; Wendel, Christopher ; Mohler, M. Jane ; Kimbriel, Heather R. ; Lavery, Lawrence A. / Skin Temperature Monitoring Reduces the Risk for Diabetic Foot Ulceration in High-risk Patients. In: American Journal of Medicine. 2007 ; Vol. 120, No. 12. pp. 1042-1046.
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abstract = "Purpose: To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk patients 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 (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 >4°F 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 one third as likely to ulcerate in the Dermal Thermometry Group compared with the Standard Therapy Group (12.2{\%} vs 4.7{\%}, odds ratio 3.0, 95{\%} confidence interval, 1.0 to 8.5, P = .038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (P = .04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Patients that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week before 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 = .001). Conclusions: High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.",
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AB - Purpose: To evaluate the effectiveness of home temperature monitoring to reduce the incidence of foot ulcers in high-risk patients 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 (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 >4°F 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 one third as likely to ulcerate in the Dermal Thermometry Group compared with the Standard Therapy Group (12.2% vs 4.7%, odds ratio 3.0, 95% confidence interval, 1.0 to 8.5, P = .038). Proportional hazards regression analysis suggested that thermometry intervention was associated with a significantly longer time to ulceration (P = .04), adjusted for elevated foot ulcer classification (International Working Group Risk Factor 3), age, and minority status. Patients that ulcerated had a temperature difference that was 4.8 times greater at the site of ulceration in the week before 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 = .001). Conclusions: High temperature gradients between feet may predict the onset of neuropathic ulceration and self-monitoring may reduce the risk of ulceration.

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