Is an increase in skin temperature predictive of neuropathic foot ulceration in people with diabetes? A systematic review and meta-analysis

Vanessa J Houghton, Virginia M Bower, David C Chant, Vanessa J Houghton, Virginia M Bower, David C Chant

Abstract

Introduction: The aim of this systematic review was to evaluate the strength of the existing research to answer the question: Is an increase in skin temperature predictive of neuropathic foot ulceration in people with diabetes?

Methods: This study is a systematic review and meta-analysis of temperature-monitoring in the prediction and prevention of diabetic foot ulceration. Two investigators conducted a literature search for all relevant articles from 1960 until July 2011. During this process the following data bases were searched: MEDLINE, Science Direct, AMED, Australian Medical Index, APAIS-Health, ATSIhealth, EMBASE, Web of Science and OneSearch. Keywords used in this search included diabetes, foot complications, ulceration, temperature-monitoring, prediction and prevention.

Results: Results of the meta-analysis support the theory that an increase in skin temperature is predictive of foot ulceration when compared with the same site on the contralateral limb. The theory that there is a mean norm foot temperature which can be used as a benchmark to monitor pathological change was unsupported by this meta-analysis.

Conclusions: The conclusions derived from this review are based on the best available scientific evidence in this field. It is intended that the results of this study will improve clinical decision-making and encourage the appropriate measures used to predict and prevent ulceration in people with diabetes at high risk of foot complications. Based on quality studies in this area, the results of this review have indicated that the use of temperature-monitoring is an effective way to predict, and thus prevent, diabetic foot ulceration.

Figures

Figure 1
Figure 1
Quorum Flowchart of the Reviewing Process.
Figure 2
Figure 2
Random effects modelling of eight mean temperature differences in the “Effect” column (°F) and associated forest plot of observed mean temperature differences (°F, 95% CI) for groups “one” and “two”.
Figure 3
Figure 3
A funnel plot of observed mean temperature differences (°F, 95% CI).
Figure 4
Figure 4
Random effects meta-analysis - four odds ratios and forest plot of observed odds ratios and 95% confidence intervals for the prevention studies.
Figure 5
Figure 5
Random effects meta-analysis of three odds ratios (Lavery 2004 omitted) and forest plot of observed odds ratios and 95% confidence intervals for the prevention studies (Lavery 2004 omitted).
Figure 6
Figure 6
A funnel plot of odds ratios from the three prevention articles.

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