Level 1: Likely reliable evidence
Foot-temperature monitoring reduces diabetic foot ulcers in high-risk patients, based on two randomized trials that compared dermal thermometry (infrared skin temperature measurements at six plantar sites on each foot twice daily) vs. standard therapy.
In the most recent study, 225 adults with diabetes and at high risk for foot ulcer were randomized to dermal thermometry vs. standard therapy and followed for 18 months (Am J Med. 2007;120:1042-1046). All patients received therapeutic footwear, foot education, and regular foot care and performed structured foot inspection daily. Dermal thermometry patients were advised to contact their nurse case manager and reduce activity when the temperature difference between feet was >2.2°C (4°F). Standard-care patients were advised to contact their nurse case manager for any observed foot abnormalities. Using blinded outcome assessment, 4.7% dermal thermometry vs. 12.2% standard-care patients had ulcerations (P=.038, NNT 14).In a previously published study, 85 adults with diabetes and at high risk for foot ulcers (history of foot ulcer or partial foot amputation, or loss of protective sensation and foot deformity) were randomized to enhanced vs. standard therapy at a high-risk diabetes foot clinic for six months (Diabetes Care. 2004;27:2642-2647; full-text available online free of charge at: http://care.diabetesjournals.org/cgi/content/full/27/11/2642, accessed April 10, 2008). All patients received therapeutic footwear, education, and podiatrist evaluation every 10-12 weeks. The enhanced-therapy group used a handheld infrared skin thermometer and was advised to contact the nurse case manager and reduce the number of steps taken when the temperature difference between feet was >2.2°C (4°F). Comparing enhanced vs. standard therapy, 2.4% vs. 20% had diabetic foot complications (NNT 6) and 2.4% vs. 16% had ulcers (NNT 8). There were no significant differences in rates of Charcot fracture, infection, or local foot amputation. The study was not blinded and did not account for access to the nurse case manager vs. foot-temperature monitoring.