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Constant blood sugar elevation causes the nerve damage (neuropathy) responsible for diabetic foot ulcers. Neuropathy reduces the feelings of pain or inflammation, making it difficult for people with diabetes to notice inflammation or skin injuries. Unfortunately, if even a minor skin tear is left untreated, it can develop into a serious ulcer.
In this 18-month study, 225 military veterans with diabetes who were at risk for foot ulcers due to nerve damage, foot deformities, or prior foot ulceration were randomly assigned to receive either standard therapy—which consisted of therapeutic footwear, education, regular foot care, and a daily structured foot self-inspection—or standard therapy plus the use of an in-home infrared skin thermometer to measure the temperature of several spots on their feet twice a day.
During the study, 8.4% of the people developed foot ulcers—14 from the standard therapy group and 5 from the skin thermometer group. People who developed an ulcer had a temperature difference (between the affected foot and the same area on the other foot) 4.8 times greater during the week before the ulcer appeared than did a random sample of 50 people who did not develop ulcers. People in the skin thermometer group were one-third as likely to develop ulcers as people in the standard therapy group.
“Self-monitoring is necessary to identify early warning signs to reduce the incidence of diabetic foot complications and the associated decrements in quality of life and high resource costs,” said David Armstrong, DPM, PhD, and colleagues from the Rosalind Franklin University of Medicine and Science in Chicago, Illinois. “Sadly, the ability of the most motivated patients with diabetes, their family members, and even healthcare professionals to identify ‘early warning signs’ is limited. Self-evaluation of temperature seems to offer a mechanism to identify an early sign of injury, when there is still time to avert a wound.”
Foot ulcers can be painful and costly but the incidence can be reduced with disciplined foot care and attention to early warning signs such as inflammation or injury. Additionally, Armstrong and his colleagues recommend using the simple and inexpensive skin thermometer to reduce foot ulcers in high-risk patients. People with diabetes should speak with their physician or a diabetic educator about measures they can take to reduce their risk.
(Am J Med 2007;120:1042–6)