1. Diabetic Hot Spots:
Can they be predicted using temperature monitoring tools and
subsequently prevent foot ulceration?
Primary Author: Fiona Simpson Secondary Author: Professor Stuart Baird (Supervisor) Contact: GCU Podiatry Department
Student ID: S1218907 School of Health and Life Sciences
Email: fsimps200@caledonian.ac.uk 70 Cowcaddens Road, Glasgow, G4 0BA
1. BACKGROUND
OBJECTIVE
To critically appraise evidence and assess the
effectiveness of self-temperature monitoring tools,
specifically infrared thermometers to predict areas
of and prevent diabetic foot ulceration.
Diabetes can no longer be sugar-coated; the chronic life-
altering condition is one of the largest non-communicable
diseases, labelled the silent killer.
• Worldwide: 415 million adults (IDF, 2015)
• UK: 1 in 16 individuals (Diabetes UK, 2015)
2. METHODOLOGY
3. FINDINGS
Study Study Results SIGN Level
of Evidence
Primary Outcomes: Foot Ulcer Incidence
Lavery et al
(2004)
 Temperature monitoring: n=1/44
 Standard therapy: n=7/41
Ulceration sites had consistently higher temperatures compared
to areas that did not ulcerate.
Low Quality
(1-)
Lavery et al
(2007)
 Temperature monitoring: n=5/59
 Standard: n=17/58; Structured therapy: n=17/56
Statistically significant (p=0.008; 0.0061)
High Quality
(1++)
Armstrong et
al (2007)
 Temperature monitoring: n=5
 Standard therapy: n=14
Statistically significant (p= 0.038)
A week prior to ulceration, sites experienced 4.8x greater
temperature than a site that did not breakdown (p=0.001)
Low Quality
(1-)
Skafjeld et al
(2015)
 Temperature monitoring: n= 7/21
 Standard therapy: n=10/20
No statistically significant difference (p=0.532)
Acceptable
Quality
(1+)
4. DISCUSSION
The research presented highlights raised temperatures can be
representative of forthcoming ulceration. Monitoring
temperature via infrared thermometers such as TempTouch can
predict these areas and act as an insightful tool for prevention.
Although this was not consistent throughout all studies.
5. CONCLUSION
REFERENCES
ARMSTRONG, D.G. et al., 2007. Skin Temperature Monitoring Reduces the Risk for Diabetic Foot Ulceration in High-Risk
Patients. The American Journal of Medicine [online]. 120 (2), pp. 1042-1046. [viewed 9 March 2016]. Available from:
http://www.amjmed.com/article/S0002-9343(07)00739-5/pdf
DIABETES UK, 2015. Diabetes: Facts and Stats [online]. Diabetes UK. [viewed 5 March 2016]. Available from:
https://www.diabetes.org.uk/Documents/Position%20statements/Diabetes%20UK%20Facts%20and%20Stats_Dec%202015.pdf
FREED, S. 2008. TempTouch – Infrared Skin Thermometer [online]. Diabetes in Control. [viewed 12 March 2016]. Available
from: http://www.diabetesincontrol.com/temptouchr/
INTERNATIONAL DIABETES FEDERATION, 2015. IDF Diabetes Atlas 7th Edition [online]. International Diabetes
Federation. [viewed 5 March 2016]. Available from: http://www.diabetesatlas.org/
LAVERY, L.A. et al., 2004. Home Monitoring of Foot Skin Temperature to Prevent Ulceration. Diabetes Care [online]. 27 (11),
pp. 2642-2647. [viewed 9 March 2016]. Available from: http://care.diabetesjournals.org/content/27/11/2642.full.pdf+html
LAVERY, L.A. et al., 2007. Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients. Diabetes Care [online]. 30 (1),
pp. 14-20. [viewed 9 March 2016]. Available from: http://care.diabetesjournals.org/content/30/1/14.full.pdf+html
SKAFJELD, A. et al., 2015. A Pilot study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers in
patients with diabetes – a randomized controlled trial. BMC Endocrine Disorders [online]. 15 (55), pp. 1-7. [viewed 9 March
2016]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600271/pdf/12902_2015_Article_54.pdf
THE FOOT SHOP, 2008. Diabetes: The Diabetic Foot [online]. The Foot Shop. [viewed 12 March 2016]. Available from:
http://www.thefootshop.org.uk/conditions/dia.html
This review established a correlation between self
temperature monitoring and diabetic foot ulcer
prevention - characterised by reduced ulcer incidence
rates compared to standard therapies.
However, more robust research needs to be undertaken
before devices could be implemented, with standardised
procedures in place. Finally, temperature monitoring has
the potential to be the next step in the diabetic foot
ulceration prevention pathway.
Identified:
439
Identified:
439
Screened:
393
Eligible:
188
Included:
4
PREDICTIVE PREVENTIVEPROACTIVE
Research Strengths
• All studies primary outcome being measured was DFU incidence.
• All studies evaluated the same infrared thermometer - TempTouch.
• All studies compared positive control groups including standard therapy - ethical.
Research Limitations
• Information often withheld e.g. randomisation, concealment, group allocation, attrition rates
• Different outcome measurements used by each study - some tools not validated
• Comparability between studies weak
• Two studies conducted by exact same research group - possible bias.
The critical review process was undertaken between
September 2015 and February 2016.
7 relevant podiatry databases were searched thoroughly
including AMED, CINAHL, Cochrane Library, Health
Source, MEDLINE, ProQuest and Web of Science.
The search strategy was composed of five sets of terms;
synonyms of - temperature monitoring, self-assessment,
diabetic foot ulceration, prevention and prediction.
Figure 2 highlights the eligibility screening process. All four
studies included were randomised controlled trials and were
analysed thematically: primary outcome measure, inclusion
and exclusion criteria, study methods, study design, outcome
statistics and analysis.
Diabetic foot ulceration is an increasing yet preventable
costly consequence:
• biggest perpetrator of non-traumatic lower limb
amputation
• negative predictor of mortality
Inflammation precedes ulceration – a characteristic sign is
elevated temperature. As ulceration and neuropathy go hand
in hand, inflammatory signs can go undetected.
Temperature can be monitored
objectively by patients using infrared
thermometers. Despite its success in
other aspects of diabetic footcare; no
guidance currently exists on this
subject. Figure 1: Ulceration Diagram
(The Foot Shop, 2008)
Figure 3: TempTouch
(Freed, 2008)
Figure 2: Study Selection
Every paper had issues relating to
methodological rigour; impacting
validity, generalisability and
repeatability.
Implications and Considerations
• In line with healthcare plans: prevention is better than cure
• Cost effective and simple device
• Compliance and result interpretation issues
• Possible increase in podiatry appointments and workload
• Transferred to part of diabetic annual review assessment for
long term monitoring
PODIATRYNHS