Remote Temperature Monitoring in Patients With Visual Impairment Due to Diabetes Mellitus: A Proposed Improvement to Current Standard of Care for Prevention of Diabetic Foot Ulcers

Abstract

Background: Two debilitating sequelae of diabetes are foot ulcerations and vision impairing conditions including retinopathy, open-angle glaucoma, and cataracts. Current standard of care recommends daily visual screening of feet. Despite willingness, many patients are impeded by visual impairment. We investigate whether once-daily remote temperature monitoring can improve self-screening for patients at risk for diabetic foot complications.

Methods: We followed four male veterans with diabetes mellitus, peripheral neuropathy, impaired visual acuity, and at least one other diabetes-related visual impairment in a high-risk podiatry clinic. Patients received a telemedicine remote temperature monitoring mat and instructed on proper daily use. Each patient developed a "hotspot," defined as a 1.75°C localized temperature difference between matched pedal locations, which resulted in telephone triage outreach.

Results: In three cases, outreach resulted in a sooner appointment where patients were found to have a relevant outcome at the hotspot. Patients in cases 1-3 had University of Texas (UT) 1A ulcerations. The patient in case 4 had inflammation from trauma. All patients had refractive errors plus another vision impairing condition that potentially delayed identification of lesions. Patients in cases 1 and 2 have cataracts, patients in cases 2 and 3 have retinopathy, and patient in case 4 has glaucoma.

Conclusions: As an adjunct to daily preventative diabetic self-care, once-daily remote temperature monitoring technology can augment self-screening to prompt necessary outreach and treatment and potentially prevent costly and debilitating diabetic foot complications. This case series serves as a pilot study for real-world application of thermometry, where further large-scale research is needed.

Keywords: diabetic foot ulcer; early detection; remote temperature monitoring; visual impairment.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1A.

The smart telemedicine remote temperature monitoring mat. Copyright 2018. Wounds.41

Figure 1B.

Secure clinician portal to analyze thermograms.

Figure 2.

Localized inflammation hotspot of 3.1°C detected on the right hallux. A superficial plantar hallux ulcer was found.

Figure 3.

Diffuse forefoot hotspot of 2.7°C detected on the right forefoot. Superficial ulcer found plantar to second metatarsal.

Figure 4.

Hotspot of 3.7°C detected on the left hallux. A fissure in the hallux sulcus was found.

Figure 5.

Asymmetry between halluces of 3°C. The right hallux was initially warmer, then cooled to ambient temperature. Inflammation due to trauma.