Aim: To perform an updated systematic review of randomised controlled trials examining the efficacy of at-home foot temperature monitoring in reducing the risk of a diabetes-related foot ulcer (DFU).
Methods: Systematic review performed according to PRISMA guidelines. Risk-of-bias was assessed using version 2 of the Cochrane risk-of-bias tool. Meta-analyses were performed using random effects models. Leave-one-out sensitivity analyses and a sub-analysis excluding trials considered at high risk-of-bias assessed the consistency of findings. The certainty of the evidence was assessed with GRADE.
Results: Five randomised controlled trials involving 772 participants meeting the IWGDF risk category 2 or 3 were included. All trials reported instructing participants to measure skin temperature at-home at six or more sites on each foot using a hand-held infra-red thermometer at least daily and reduce ambulatory activity in response to hotspots (temperature differences >2.2°C on two consecutive days between similar locations in both feet). One, one and three trials were considered at low, moderate and high risk-of-bias respectively. Participants allocated to at-home foot temperature monitoring had a reduced risk of developing a DFU (relative risk 0.51, 95% CI 0.31 to 0.84) compared to controls. Sensitivity and sub-analyses suggested that the significance of this finding was consistent. The GRADE assessment suggested a low degree of certainty in the finding.
Conclusion: At-home daily foot temperature monitoring and reduction of ambulatory activity in response to hotspots reduces the risk of a DFU in moderate or high risk people with a low level of certainty. This article is protected by copyright. All rights reserved.