In a second study of 225 similarly high-risk patients that used the same methods, patients in the dermal thermometry group were one-third as likely to ulcerate at 18 months as were those in the standard therapy group (12% vs. 5%), and the thermometry was associated with a longer time to ulceration (Am. J. Med. 2007;120:1042-6).
In the third study, 173 high-risk patients with a history of foot wound and sensory neuropathy with a loss of protective sensation were randomized to one of three groups. Standard therapy consisted of lower-extremity evaluation by a physician every 8 weeks; education focusing on foot complications and self-care practices; therapeutic insoles and footwear; and advice to the patients to inspect their feet every day and to contact the study nurse if they identified any areas of concern (Diabetes Care 2007;30:14-20).
A second group had the standard therapy plus a structured foot exam, in which they were trained to use a mirror twice a day to inspect the bottom of their feet for redness, discoloration, swelling, and warmth by palpation and to log the results. Patients in a third group received standard therapy and were instructed to use the digital infrared thermometer twice daily and to record the temperatures.
At 15 months, the ulceration rate was essentially identical in the standard and structured foot exam groups (29% and 30%, respectively). In contrast, only 8.5% of the group that used the thermometer developed a foot ulcer, a fourfold reduction in risk.
Heat is an easy risk factor to identify, said Dr. Lavery, shown taking the temperature of a patient's Lawrence A. foot. ©Susan Gaetz Photography