By Jane Hart, MD
Healthnotes Newswire (February 7, 2008)—People with diabetes may be able to reduce the risk of a common and uncomfortable complication of the disease: they may avoid painful foot ulcers by monitoring the temperature of their feet. According to a new study published in the American Journal of Medicine, this kind of care may reduce the risk of foot ulcers by more than 30%.
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 in the skin thermometer group had a temperature difference of 4.8 times greater in the region of ulceration 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 health care 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 Med J 2007;120:1042–6)
Jane Hart, MD, board-certified in internal medicine, serves in a variety of professional roles including consultant, journalist, and educator. Dr. Hart, a Clinical Instructor at Case Medical School in Cleveland, Ohio, writes extensively about health and wellness and a variety of other topics for nationally recognized organizations, Web sites, and print publications. Sought out for her expertise in the areas of integrative and preventive medicine, she is frequently quoted by national and local media. Dr. Hart is a professional lecturer for healthcare professionals, consumers, and youth and is a regular corporate speaker.
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