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Dermal thermometer helped detect diabetic foot ulcers in high-risk patients
Patients detected a 4.8 times greater temperature difference the week before developing an ulcer.
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December 2007
Patients with diabetes who used dermal thermometry were able to detect high-temperature differences between their feet, thus making it a practical method to predict the onset of neuropathic ulceration, according to study results.
Self-monitoring may reduce the risk for ulceration, according to David G. Armstrong, DPM, PhD, director of Scholl’s Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science.
“Our data point to the fact that giving patients at high risk for ulceration or re-ulceration a thermometer is similar to giving patients a glucose meter, in that they can dose their activity by checking their skin temperatures just like they dose their insulin by checking their glucose,” he told Endocrine Today.
Temperature differences
Armstrong and colleagues randomly assigned 225 American veterans with diabetes to a dermal thermometry group or a standard therapy group. The thermometry group used an infrared skin thermometer (TempTouch, Xilas Medical) to measure temperatures on six sites on their feet twice a day. Participants in the standard therapy group used foot inspection and therapeutic footwear.
The dermal thermometer is equipped with a touch sensor, which patients can place on the skin to trigger a temperature measurement.
After 18 months of follow-up, 19 patients (8.4%) ulcerated, with more ulcers among patients in the standard therapy group compared with the dermal thermometry group (12.2% vs. 4.7%).
“Skin temperatures seem to show up higher at least a week before the skin breaks down,” Armstrong said.
Patients who ulcerated had a temperature difference that was 4.8 times greater in the region of ulceration in the week prior to the event compared with patients who did not ulcerate. In addition, standard therapy treatment, elevated foot ulcer classification, age and minority status were significantly associated with a shorter time to ulceration.
Surrogate marker
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“This modality seems to be promising,” he said. “It reduces [high-risk patients’] risk for getting another ulcer by a factor of three.”
This is the third randomized controlled trial with this intervention. All of the data show a threefold to 10-fold reduction in foot ulcers when high-risk patients with diabetes use this as part of a prevention program, according to Lawrence A. Lavery, DPM, MPH, professor, department of surgery, Texas A&M University College of Medicine. Data from a study in the January issue of Diabetes Care, reported that by the time patients in a control group could visually identify an area of concern there was already an ulcer present 98% of the time, he said.
“This is a new concept for physicians, nurses and diabetes educators. Before a patient with neuropathy develops an ulcer, we can measure the change in temperature ... we may have a window of several days, perhaps even longer, to stop the injury/inflammatory process,” he said. – by Katie Kalvaitis
Dr. Lavery was one of the inventors of the TempTouch and owns stock in and is on the scientific advisory board for Xilas Medical.
For more information:
- Armstrong DG, Holtz-Neiderer K, Wendel C, et al. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med. In press.
- Lavery LA, Higgins KR, Lanctot DR, et al. Preventing diabetic foot ulcer recurrence in high-risk patients. Diabetes Care. 2007;30:14-20.