For more than two generations, our team and others have explored the use of temperature monitoring to predict and prevent diabetic foot ulcers. Typically, one does this by comparing one foot to its corresponding contralateral side. New data suggests that we can use algorithms to accurately predict ulceration using only one foot. This has profound implications for the future of artificial intelligence (AI)-based remote patient monitoring.
In the May 2019 issue of BMJ Open Diabetes Research & Care, we analyzed data from 129 participants and found temperature monitoring of a single foot predicted 91 percent of impending non-acute plantar foot ulcers.1 This prediction on average occurred 41 days before clinical presentation of the ulcer. As the sensitivity and specificity continue to be assessed based on tweaks in standard and AI-based algorithms, we believe strongly that this will continue to improve.1
Podiatrists witness on a daily basis the consequences of diabetic foot ulcers. If patients practice daily temperature monitoring, especially of a single foot, this data could contribute significantly to the improvement of outcomes. This may also facilitate more efficient use of resources, especially if we can prevent secondary complications of the impending ulceration, such as infection, osteomyelitis and amputation—and reduce hospital-free days.
I think that this study is the next in an important line of works suggesting that home-based monitoring of at-risk patients is ready for prime time.
We now see smarter algorithms that may identify potentially dangerous pre-ulcerative inflammation. We now see that we often don’t need to use the contralateral limb as a control with some of these newer data and analytics. This has significant impact when considering patients that may not have a contralateral limb, an existing ulcer or have other barriers to accurate bilateral measurement. As evidenced by this study, we are closer than ever to “subscription-based care” as we have been discussing for many years.
Dr. Armstrong is a Professor of Surgery at Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
- Lavery LA, Petersen BJ, Linders DR, Bloom JD, Rothenberg DM, Armstrong DG. Unilateral remote temperature monitoring to predict future ulceration for the diabetic foot in remission. BMJ Open Diab Res Care. 2019;7(1):e000696. doi: 10.1136/bmjdrc-2019-000696. Accessed August 28, 2019.
Editor's Note: This blog originally appeared at https://diabeticfootonline.com/2019/08/11/can-unilateral-temperature-monitoring-predict-plantar-foot-ulcers-bmj-diabetesrc-study-from-usc-keckmedusc-utswortho-umichmedicine/. It is adapted with permission from the author.