A major concern of health care personnel who treat diabetes concerns complications that could result from the disease. One issue relates to problems that can occur in patient’s feet. High blood glucose from diabetes can result in two problems that can damage patients’ feet. The first problem concerns nerve damage in the legs and feet. With damaged nerves, diabetic patients may not feel pain, heat, or cold in their legs and feet. A sore or cut on their foot may get worse because they do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage, in turn, can lead to a sore or an infection. The second problem is poor blood flow. This occurs when not enough blood flows to a patient’s legs and feet. Poor blood flow makes it hard for a sore or infection to heal. The problem is called peripheral vascular disease.

Self-management has found a permanent home in the treatment of diabetes. It is not only an accepted procedure for overall control of the disorder, but for controlling complications of diabetes. Lavery and colleagues demonstrated this point in a study designed to evaluate the effectiveness of a temperature-monitoring instrument to reduce the incidence of foot ulcers in individuals with diabetes with a high risk for lower extremity complications. In this physician-blinded, randomized, 15-month, multicenter trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to: (a) standard therapy, (b) structured foot examination, or (c) enhanced therapy groups. Each group received therapeutic footwear, diabetic foot education, and regular foot care. Subjects in the structured foot examination group performed a structured foot inspection daily and recorded their findings in a logbook. If standard therapy or structured foot examinations identified any foot abnormalities, subjects were instructed to contact the study nurse immediately. Subjects in the enhanced therapy group used an infrared skin thermometer to measure temperatures on six-foot sites each day. Temperature differences more than 4 degrees between left and right corresponding sites were supposed to prompt patients to contact the study nurse and reduce activity until temperatures normalized. The enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups. Patients in the standard therapy and structured foot examination groups were 4.37 and 4.71 times more likely, respectively, to develop ulcers than patients in the enhanced therapy group.

COMMENTS: Lavery and coworkers concluded that infrared temperature home monitoring, in serving as an "early warning sign," was a simple and useful adjunct in the prevention of diabetic foot ulcerations. It showed the value of the simple daily self-monitoring of one’s feet could reduce the possibility of developing foot ulcers. We don’t know how expensive the infrared skin thermometer was, but it would add but a small cost in adding benefits for diabetic patients prone to foot ulcers. The study is a nice addition to the literature.

L.A. Lavery et al. Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool. Diabetes Care, 2007;30:14-20.