Implementation of foot thermometry and SMS to prevent diabetic foot ulcer

Background

Diabetic foot ulcer is one of the most important complications of diabetes mellitus; early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is can be a barrier. This project used text messages to remind patients to perform thermometry and foot care to try to ensure regular foot monitoring.

Aims

Primary research aim

Compare the incidence of diabetic foot ulcer (DFU) during the study between the arm that receives thermometry alone and the arm that receives thermometry + SMS.

Secondary research aims

Compare compliance with foot thermometer use between the thermometry alone arm and the arm that receives thermometry + SMS.

Project plan

Objectives

Compare the incidence of DFU during the study between the arm that receives thermometry alone and the arm that receives thermometry + SMS. We hypothesized that subjects who received SMS would have a lower incidence of DFU than the subjects who did not receive SMS.
Compare compliance with foot thermometer use between the two arms. We hypothesized that subjects who received SMS would be more compliant with temperature measurement.

Design

Physician-blinded, randomized, 12-month trial.

Intervention

Participants in both groups received enhanced education about diabetic foot ulcers at the beginning of the study and were also provided with TempStat, equipment that captured a thermal image of feet with different colors representing different temperatures. When a yellow spot was detected, subjects were instructed to contact the research nurse by phone or text message. The nurse then asked about the patient’s activity on the previous two days, and made recommendations on how to decrease activity. In addition, the enhanced intervention arm received SMS reminders via mobile phones five times a week, at 12 o ́clock during the first week and then twice a week until the end of the trial. The SMS reminded patients to use the TempStat and perform foot care.

Outcome

The primary outcome was foot ulceration occurring at any point during the 12 month study duration.

Impact

Based on the findings of this project, the team obtained follow-on funding to develop a ‘foot selfie App’ to aid self management of diabetic foot ulcers in Peru.

Publications and output

GACD have also published an end-of-programme report providing a comprehensive summary of the programme and outcomes.