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Fuentes-Oliver EI, Ortiz-Sosa R, Serrano-Loyola R, Solalinde-Vargas R, García-Segundo C. Quantitative interpretation of infrared images of lower limbs in individuals with and without type 2 diabetes mellitus. Skin Res Technol 2024; 30:e70039. [PMID: 39233343 PMCID: PMC11374692 DOI: 10.1111/srt.70039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/17/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND The quantitative interpretation of the radiometric information extracted from infrared (IR) images in individuals with and without type 2 diabetes mellitus (DM2) is an open problem yet to be solved. This is of particular value given that DM2 is a worldwide health problem and onset for evolution toward diabetic foot disease (DFD). Since DM2 causes changes at the vascular and neurological levels, the metabolic heat distribution on the outer skin is modified as a consequence of such alterations. Of particular interest in this contribution are those alterations displayed over the skin's heat patterns at the lower limbs. At the core of such alterations is the deterioration of the vascular and neurological networks responsible for procuring systemic thermoregulation. It is within this context that IR imaging is introduced as a likely aiding tool to assist with the clinical diagnosis of DM2 at stages early enough to prevent the evolution of the DFD. METHODS IR images of lower limbs are acquired from a cohort of individuals clinically diagnosed with and without DM2. Additional inclusion criteria for patients are to be free from any visible wound or tissue-related trauma (e.g., injuries, edema, and so forth), and also free from non-metabolic comorbidities. All images and data are equally processed and analyzed using indices that evaluate the spatial and temporal evolution of temperature distribution in lower limbs. We studied the temporal response of individuals' legs after inducing an external stimulus. For this purpose, we combine the information of the asymmetry and thermal response index (ATR) and the thermal response index (TRI), computed using images at different times, improving the results previously obtained individually with ATR and TRI. RESULTS A novel representation of the information extracted from IR images of the lower limbs in individuals with and without DM2 is presented. This representation was built using the ATR and TRI indices for the anterior and posterior views (PVs), individually and combining the information from both views. In all cases, the information of each index and each view presents linearity properties that allow said information to be interpreted quantitatively in a well-defined and limited space. This representation, built in a polar coordinate space, allows obtaining sensitivity values of 86%, 97%, and 97%, and specificity values of 83%, 72%, and 78% for the anterior view (AV), the PV, and the combined views, respectively. Additionally, it was observed that the angular variable that defines this new representation space allows to significantly (p < 0.01) differentiate the groups, while correlating with clinical variables of interest, such as glucose and glycated hemoglobin. CONCLUSION The linearity properties that exist between the ATR and TRI indices allow a quantitative interpretation of the information extracted from IR images of the lower extremities of individuals with and without DM2, and allow the construction of a representation space that eliminates possible ambiguities in the interpretation, while simplifying it, making it accessible for clinical use.
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Affiliation(s)
- Edgar I Fuentes-Oliver
- ICAT, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Posgrado en Ing. Eléctrica: Instrumentación, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rosalinda Ortiz-Sosa
- ICAT, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Raúl Serrano-Loyola
- Servicio de Cirugía Vascular y Angiología, Hospital General de México, Mexico City, Mexico
| | | | - Crescencio García-Segundo
- ICAT, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Institute of Biological and Medical Imaging, Helmholtz Zentrum, München, Germany
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Thakku Sivakumar D, Murray B, Moore Z, Patton D, O'Connor T, Avsar P. Can thermography predict diabetic foot ulcer risk in patients with diabetes mellitus? A systematic review. J Tissue Viability 2024:S0965-206X(24)00093-7. [PMID: 39025743 DOI: 10.1016/j.jtv.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/13/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND There is a growing prevalence of diabetic foot ulcers (DFUs) in patients with diabetes mellitus and the use of thermography has sparked interest in a non-invasive diagnostic method for early DFU risk assessment and management. AIM This systematic review aims to assess the use of thermography in predicting diabetic foot ulcer risk in patients with diabetes mellitus. METHODS A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in April 2023, and relevant articles were reviewed. Data was extracted and a narrative synthesis was undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the studies included. Reviewing these articles to the primary and secondary outcomes of this literature review. The primary outcome focused on the predictive capabilities of thermography for DFU prediction, while the secondary outcome assessed the feasibility, usability, and effectiveness of thermography. RESULTS Eight studies were conducted from 1994 to 2021 with an emphasis on the predictability of thermography in predicting DFU risk. All eight studies focused on temperature variations associated with DFU development. Six of the included studies compared the effectiveness of DFU occurrence in diabetic patients and non-DFU use. The overall results showed that employing thermography in DFU prevention might allow for early detection and intervention, offering a non-invasive and effective means to reduce the risk of DFU development and its associated complications in patients with diabetes mellitus. CONCLUSION The systematic review indicates that thermography holds promise for predicting DFU risk, with studies showcasing predictive capabilities and patient benefits. Despite some challenges and limitations, the evidence suggests thermography's value in assessing DFU risk in diabetes patients, warranting further research on device types and locations.
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Affiliation(s)
- Divyeshz Thakku Sivakumar
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
| | - Bridget Murray
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Zena Moore
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia; Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.
| | - Declan Patton
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.
| | - Tom O'Connor
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China.
| | - Pinar Avsar
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Liew H, Tang W, Plassmann P, Machin G, Simpson R, Edmonds ME, Petrova NL. Infrared Thermography Shows That a Temperature Difference of 2.2°C (4°F) or Greater Between Corresponding Sites of Neuropathic Feet Does Not Always Lead to a Diabetic Foot Ulcer. J Diabetes Sci Technol 2024:19322968241249970. [PMID: 38708580 DOI: 10.1177/19322968241249970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND There is emerging interest in the application of foot temperature monitoring as means of diabetic foot ulcer (DFU) prevention. However, the variability in temperature readings of neuropathic feet remains unknown. The aim of this study was to analyze the long-term consistency of foot thermograms of diabetic feet at the risk of DFU. METHODS A post-hoc analysis of thermal images of 15 participants who remained ulcer-free during a 12-month follow-up were unblinded at the end of the trial. Skin foot temperatures of 12 plantar, 15 dorsal, 3 lateral, and 3 medial regions of interests (ROIs) were derived on monthly thermograms. The temperature differences (∆Ts) of corresponding ROIs of both feet were calculated. RESULTS Over the 12-month study period, out of the total 2026 plantar data points, 20.3% ROIs were rated as abnormal (absolute ∆T ≥ 2.2°C). There was a significant between-visit variability in the proportion of plantar ROIs with ∆T ≥ 2.2°C (range 7.6%-30.8%, chi-square test, P = .001). The proportion of patients presenting with hotspots (ROIs with ∆T ≥ 2.2°C), abnormal plantar foot temperature (mean ∆T of 12 plantar ROIs ≥ 2.2°C), and abnormal whole foot temperature (mean ∆T of 33 ROIs ≥ 2.2°C) varied between visits and showed no pattern (P > .05 for all comparisons). This variability was not related to the season of assessment. CONCLUSIONS Despite the high rate of hotspots on monthly thermograms, all feet remained intact. This study underscores a significant between-visit inconsistency in thermal images of neuropathic feet which should be considered when planning DFU-prevention programs for self-testing and behavior modification.
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Affiliation(s)
- Huiling Liew
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Wegin Tang
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Graham Machin
- Temperature and Humidity Group, National Physical Laboratory, London, UK
| | - Robert Simpson
- Temperature and Humidity Group, National Physical Laboratory, London, UK
| | - Michael E Edmonds
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nina L Petrova
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Barsotti E, Goodman B, Samuelson R, Carvour ML. A Scoping Review of Wearable Technologies for Use in Individuals With Intellectual Disabilities and Diabetic Peripheral Neuropathy. J Diabetes Sci Technol 2024:19322968241231279. [PMID: 38439547 DOI: 10.1177/19322968241231279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Individuals with intellectual disabilities (IDs) are at risk of diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN), which can lead to foot ulcers and lower-extremity amputations. However, cognitive differences and communication barriers may impede some methods for screening and prevention of DPN. Wearable and mobile technologies-such as smartphone apps and pressure-sensitive insoles-could help to offset these barriers, yet little is known about the effectiveness of these technologies among individuals with ID. METHODS We conducted a scoping review of the databases Embase, PubMed, and Web of Science using search terms for DM, DPN, ID, and technology to diagnose or monitor DPN. Finding a lack of research in this area, we broadened our search terms to include any literature on technology to diagnose or monitor DPN and then applied these findings within the context of ID. RESULTS We identified 88 articles; 43 of 88 (48.9%) articles were concerned with gait mechanics or foot pressures. No articles explicitly included individuals with ID as the target population, although three articles involved individuals with other cognitive impairments (two among patients with a history of stroke, one among patients with hemodialysis-related cognitive changes). CONCLUSIONS Individuals with ID are not represented in studies using technology to diagnose or monitor DPN. This is a concern given the risk of DM complications among patients with ID and the potential for added benefit of such technologies to reduce barriers to screening and prevention. More studies should investigate how wearable devices can be used among patients with ID.
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Affiliation(s)
- Ercole Barsotti
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Bailey Goodman
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Riley Samuelson
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, USA
| | - Martha L Carvour
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Faus Camarena M, Izquierdo-Renau M, Julian-Rochina I, Arrébola M, Miralles M. Update on the Use of Infrared Thermography in the Early Detection of Diabetic Foot Complications: A Bibliographic Review. SENSORS (BASEL, SWITZERLAND) 2023; 24:252. [PMID: 38203114 PMCID: PMC10781348 DOI: 10.3390/s24010252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
Foot lesions are among the most frequent causes of morbidity and disability in the diabetic population. Thus, the exploration of preventive control measures is vital for detecting early signs and symptoms of this disease. Infrared thermography is one of the complementary diagnostic tools available that has proven to be effective in the control of diabetic foot. The last review on this topic was published in 2015 and so, we conducted a bibliographic review of the main databases (PubMed, the Web of Science, Cochrane library, and Scopus) during the third quarter of 2023. We aimed to identify the effectiveness of infrared thermography as a diagnostic element in pre-ulcerous states in diabetic patients and to detect diabetic foot ulcer complications. We obtained a total of 1199 articles, 26 of which were finally included in the present review and published after 2013. After analyzing the use of infrared thermography in diabetic patients both with and without ulcers, as well as in healthy individuals, we concluded that is an effective tool for detecting early-stage ulcers in diabetic foot patients.
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Affiliation(s)
- Marina Faus Camarena
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
| | - Marta Izquierdo-Renau
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
| | - Iván Julian-Rochina
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (M.F.C.); (M.I.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Manel Arrébola
- Department Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.A.); (M.M.)
| | - Manuel Miralles
- Department Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (M.A.); (M.M.)
- Department of Surgery, University of Valencia, 46010 Valencia, Spain
- Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Medical Research Institute, Hospital La Fe, 46026 Valencia, Spain
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Carro GV, Noli ML, Rodriguez MG, Ticona M, Fuentes M, Llanos MDLÁ, Caporaso F, Marciales G, Turco SLE. Plantar Thermography in High-Risk Patients With Diabetes Mellitus Compared to Nondiabetic Individuals. INT J LOW EXTR WOUND 2023:15347346231218034. [PMID: 38112384 DOI: 10.1177/15347346231218034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Diabetic foot (DF) is one of the most devastating complications of diabetes mellitus (DM). Infrared thermography has been studied for its potential in early diagnosis and preventive measures against DF ulcers, although its role in the management and prevention of DF complications remains uncertain. The objective of this study was to determine the average temperatures of different points of the plantar foot using infrared thermography in patients with DM and history of DF (DFa group, at the highest risk of developing foot ulcers) and compare them to people without DM (NoDM group). One hundred and twenty-three feet were included, 63 of them belonged to DFa Group and the other 60 to NoDM Group. The average temperature in the NoDM Group was 27.4 (26.3-28.5) versus 28.6 (26.8-30.3) in the DFa Group (p = .002). There were differences between both groups in temperatures at the metatarsal heads and heels, but not in the arch. Average foot temperatures did not relate to sex, ankle-brachial index, and age, and had a mild correlation with daily temperature (Spearman 0.51, p < .001). Data provided in our study could be useful in establishing a parameter of normal temperatures for high-risk patients. This could serve as a foundational framework for future research and provide reference values, not only for preventative purposes, as commonly addressed in most studies, but also to assess the applicability of thermography in clinical scenarios particularly when one foot cannot serve as a reference, suspected osteomyelitis of the remaining bone, or instances of increased temperature in specific areas which may necessitate adjustments to the insoles in secondary prevention.
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Affiliation(s)
| | - María Laura Noli
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | | | - Miguel Ticona
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | - Mariana Fuentes
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | | | - Federico Caporaso
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | - Guillermo Marciales
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
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Vas P, Chockalingam N. Improving Physical, Physiological, and Psychological Health Outcomes in Patients with Diabetic Foot Ulcers - State of the Art. Clin Cosmet Investig Dermatol 2023; 16:3547-3560. [PMID: 38107668 PMCID: PMC10725647 DOI: 10.2147/ccid.s333660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
Diabetic foot disease is a complex and challenging complication of diabetes mellitus, which imposes a significant burden of disease on patients, their carers, and the wider health systems. Recurrence rates are high, and current evidence indicates a high mortality associated with it. While management algorithms have primarily focused on the physical aspects of healing, there is increasing recognition of the critical role played by psychological and biomechanical factors in the development and resolution of diabetic foot disease. Therefore, in this paper, we aim to explore how diabetic foot outcomes can be improved by addressing not only the physical but also the psychological and biomechanical aspects that are integral to the development of this condition and its optimal resolution. We explore new technologies that allow for non-invasive objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics.
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Affiliation(s)
- Prashanth Vas
- Department of Diabetes and Diabetic Foot, King’s College Hospital NHS Foundation Trust, London, UK
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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Cassidy B, Hoon Yap M, Pappachan JM, Ahmad N, Haycocks S, O'Shea C, Fernandez CJ, Chacko E, Jacob K, Reeves ND. Artificial intelligence for automated detection of diabetic foot ulcers: A real-world proof-of-concept clinical evaluation. Diabetes Res Clin Pract 2023; 205:110951. [PMID: 37848163 DOI: 10.1016/j.diabres.2023.110951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Conduct a multicenter proof-of-concept clinical evaluation to assess the accuracy of an artificial intelligence system on a smartphone for automated detection of diabetic foot ulcers. METHODS The evaluation was undertaken with patients with diabetes (n = 81) from September 2020 to January 2021. A total of 203 foot photographs were collected using a smartphone, analysed using the artificial intelligence system, and compared against expert clinician judgement, with 162 images showing at least one ulcer, and 41 showing no ulcer. Sensitivity and specificity of the system against clinician decisions was determined and inter- and intra-rater reliability analysed. RESULTS Predictions/decisions made by the system showed excellent sensitivity (0.9157) and high specificity (0.8857). Merging of intersecting predictions improved specificity to 0.9243. High levels of inter- and intra-rater reliability for clinician agreement on the ability of the artificial intelligence system to detect diabetic foot ulcers was also demonstrated (Kα > 0.8000 for all studies, between and within raters). CONCLUSIONS We demonstrate highly accurate automated diabetic foot ulcer detection using an artificial intelligence system with a low-end smartphone. This is the first key stage in the creation of a fully automated diabetic foot ulcer detection and monitoring system, with these findings underpinning medical device development.
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Affiliation(s)
- Bill Cassidy
- Department of Computing Mathematics, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
| | - Moi Hoon Yap
- Department of Computing Mathematics, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
| | - Joseph M Pappachan
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK.
| | - Naseer Ahmad
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK.
| | | | - Claire O'Shea
- Te Whatu Ora Health New Zealand Waikato, Pembroke Street, Hamilton 3240, New Zealand. claire.o'
| | - Cornelious J Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston LN2 5QY, UK.
| | - Elias Chacko
- Jersey General Hospital, The Parade, St Helier, JE1 3QS Jersey, UK.
| | - Koshy Jacob
- Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK.
| | - Neil D Reeves
- Faculty of Science & Engineering, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
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Haryanto H, Amrullah S, Jais S, Supriadi S, Imran I, Sari Y. INDIFURUTO: A novel tool for assessing diabetic foot recurrence risk in type 2 diabetes. J Med Life 2023; 16:1514-1518. [PMID: 38313180 PMCID: PMC10835566 DOI: 10.25122/jml-2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 02/06/2024] Open
Abstract
This study aimed to evaluate diabetic foot ulcer recurrence using the Indonesia Diabetic Foot Ulcer Recurrence Assessment Tool (INDIFURUTO), a new diabetic foot risk recurrence assessment tool. This study used a prospective cohort design. A total of thirty-three participants met the inclusion criteria. We used sensitivity, specificity values, AUC, and, respectively, a 95% confidence interval (CI) to calculate prognostic accuracy measures. The results showed that this study had an AUC of 0,97 [95% confidence interval (CI) 0.91-1.00]. The cut-off point (Youden Index) was <45, with sensitivity and specificity values of 100% and 90%, respectively. The utilization of this model can facilitate the monitoring and enhancement of foot ulcer recurrence prevention in individuals diagnosed with diabetes. This study showed that the new model had a high prediction. Therefore, this model better stratifies people at high risk of foot ulceration.
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Affiliation(s)
- Haryanto Haryanto
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Syahid Amrullah
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Suriadi Jais
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Supriadi Supriadi
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Imran Imran
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Yunita Sari
- Department of Nursing, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
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Villar Rodríguez J, Pérez Pico AM, García Blázquez FM, Morán Cortés JF, Mayordomo Acevedo R. Evaluation of Thermography as a Diagnostic Technique in Asymptomatic or Incipient Onychomycosis. J Fungi (Basel) 2023; 9:444. [PMID: 37108899 PMCID: PMC10144260 DOI: 10.3390/jof9040444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Onychomycosis is usually diagnosed symptomatically due to the very clear signs caused by the fungus on the nail surface and structure, although the growth of the infecting agent must also be verified by culture in an enriched medium. This procedure is normally lengthy (four weeks), and samples can be contaminated, delaying the prescription of appropriate and effective treatment. Only one previous study has addressed the possibility of using thermography as a diagnostic method for onychomycosis in older people (31-70 years). The present study confirms this use but in individuals aged 18-31 years with incipient mycosis and no pathological signs. Using an FLIR E60 BX camera in a study with 214 samples, we found that men had more onychomycosis than women. We observed a relation between the presence of infection and nail temperature, with a higher temperature in yeast infections (+1 °C) and a lower temperature in dermatophyte infections (-2 °C). A higher temperature by almost 1 °C was also observed in older participants. Thermography can be viewed as a new diagnostic method in asymptomatic or incipient onychomycosis, providing the thermographic camera is sufficiently sensitive and the appropriate procedure is followed, although fungal culture is always necessary to confirm recovery after treatment.
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Affiliation(s)
- Julia Villar Rodríguez
- Department of Anatomy, Cellular Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | - Ana María Pérez Pico
- Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | | | - Juan Francisco Morán Cortés
- Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
| | - Raquel Mayordomo Acevedo
- Department of Anatomy, Cellular Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, 10600 Plasencia, Spain
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Kurkela O, Lahtela J, Arffman M, Forma L. Infrared Thermography Compared to Standard Care in the Prevention and Care of Diabetic Foot: A Cost Analysis Utilizing Real-World Data and an Expert Panel. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:111-123. [PMID: 36855751 PMCID: PMC9968423 DOI: 10.2147/ceor.s396137] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/24/2023] Open
Abstract
Aim Infrared thermography (IRT) is a non-invasive technology for screening and early detection of diabetic foot. Real-world data and the Delphi technique were used to assess IRT's potential effect on typical care pathways of diabetic foot and their costs in the Finnish healthcare setting. Methods The most typical care pathways of diabetic foot were identified from national healthcare registers from 2011 to 2017. The effect of IRT in terms of avoidable care episodes was assessed by a Delphi panel including Finnish diabetic foot specialists (n=13). By combining a series of decision-analytic models, the IRT's potential effect on the costs of each pathway and their sensitivity to model assumptions were estimated. Results Hypothetical annual savings were estimated to be EUR ~1.7 million (EUR ~1.3 million-EUR ~2.5 million), constituting approximately 20% of the total annual care pathway costs examined. In the longer and more complex pathways, the application of IRT was estimated to result in notable savings while in the shorter pathways, IRT could increase costs. Conclusion Our modeling suggests that IRT could potentially reduce costs in a Finnish healthcare setting. Given our analysis, generation of robust evidence on the effectiveness of recent IRT technologies with up-to-date protocols seems appropriate.
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Affiliation(s)
- Olli Kurkela
- Faculty of Social Sciences, Tampere University, Tampere, 30014, Finland,Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, 00271, Finland,Laurea University of Applied Sciences, Vantaa, 01300, Finland,Correspondence: Olli Kurkela, Health Sciences, Faculty of Social Sciences, Tampere University, P.O. Box 100, Tampere, 33014, Finland, Tel +358 50 5099170, Email
| | - Jorma Lahtela
- Tampere University Hospital, Tampere, 33520, Finland
| | - Martti Arffman
- Faculty of Social Sciences, Tampere University, Tampere, 30014, Finland,Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, 00271, Finland
| | - Leena Forma
- Faculty of Social Sciences, Tampere University, Tampere, 30014, Finland,Laurea University of Applied Sciences, Vantaa, 01300, Finland
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Kaselimi M, Protopapadakis E, Doulamis A, Doulamis N. A review of non-invasive sensors and artificial intelligence models for diabetic foot monitoring. Front Physiol 2022; 13:924546. [PMID: 36338484 PMCID: PMC9635839 DOI: 10.3389/fphys.2022.924546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/05/2022] [Indexed: 06/04/2024] Open
Abstract
Diabetic foot complications have multiple adverse effects in a person's quality of life. Yet, efficient monitoring schemes can mitigate or postpone any disorders, mainly by early detecting regions of interest. Nowadays, optical sensors and artificial intelligence (AI) tools can contribute efficiently to such monitoring processes. In this work, we provide information on the adopted imaging schemes and related optical sensors on this topic. The analysis considers both the physiology of the patients and the characteristics of the sensors. Currently, there are multiple approaches considering both visible and infrared bands (multiple ranges), most of them coupled with various AI tools. The source of the data (sensor type) can support different monitoring strategies and imposes restrictions on the AI tools that should be used with. This review provides a comprehensive literature review of AI-assisted DFU monitoring methods. The paper presents the outcomes of a large number of recently published scholarly articles. Furthermore, the paper discusses the highlights of these methods and the challenges for transferring these methods into a practical and trustworthy framework for sufficient remote management of the patients.
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Affiliation(s)
- Maria Kaselimi
- National Technical University of Athens, School of Rural, Surveying and Geoinformatics Engineering, Athens, Greece
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13
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Tekale S, Varma A, Tekale S, Kumbhare U. A Review on Newer Interventions for the Prevention of Diabetic Foot Disease. Cureus 2022; 14:e30591. [PMID: 36426316 PMCID: PMC9682366 DOI: 10.7759/cureus.30591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
Abstract
Diabetic foot disease (DFD), which includes ulcers on the foot, infections, and gangrene of the foot, is one of the leading causes of disability worldwide. About half of diabetic foot disease (DFD) patients have a recurrence in less than a year. To alleviate the burden of DFD globally, it is essential to give long-term medication to reduce the likelihood of recurrence. The effectiveness of telemedicine, wearable technologies, and sensors in DFD prevention is discussed in this review. Offloading footwear helps to cure and prevent ulcerated diabetic foot by distributing physical stress away from bony prominences. Sensors and wearables can record the temperatures of the foot, blood pressure (BP), and blood sugar levels and estimate lipid profile. These technologies have offered a practical means of reaching individuals in rural areas with a heightened risk of developing DFD. There is less need for in-person consultations with this strategy. This methodology is simple to operate and lessens reliance on patients. The benefits of adopting these remote monitoring approaches have been demonstrated in some studies with DFD-at-risk individuals. It is required to do more analysis to ascertain the effectiveness and value of incorporating different remote monitoring systems as part of an all-encompassing strategy to prevent DFD.
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Affiliation(s)
- Sanket Tekale
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Anuj Varma
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Shubhangi Tekale
- Department of Pathology, Dr. Ulhas Patil Medical College and Hospital, Jalgaon, IND
| | - Unnati Kumbhare
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
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14
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Golledge J, Fernando ME, Alahakoon C, Lazzarini PA, aan de Stegge WB, van Netten JJ, Bus SA. Efficacy of at home monitoring of foot temperature for risk reduction of diabetes-related foot ulcer: A meta-analysis. Diabetes Metab Res Rev 2022; 38:e3549. [PMID: 35605998 PMCID: PMC9541448 DOI: 10.1002/dmrr.3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/28/2022] [Accepted: 04/30/2022] [Indexed: 11/10/2022]
Abstract
AIMS 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 Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Risk-of-bias was assessed using version 2 of the Cochrane risk-of-bias tool. Meta-analyses were performed using random effect models. Leave-one-out sensitivity analyses and a sub-analysis excluding trials considered at high risk-of-bias assessed the consistency of the findings. The certainty of the evidence was assessed with GRADE. RESULTS Five randomised controlled trials involving 772 participants meeting the International Working Group on the Diabetic Foot (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 0.31-0.84) 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. CONCLUSIONS At-home daily foot temperature monitoring and reduction of ambulatory activity in response to hotspots reduce the risk of a DFU in moderate or high risk people with a low level of certainty.
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Affiliation(s)
- Jonathan Golledge
- Ulcer and wound Healing consortium (UHEAL)Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Department of Vascular and Endovascular SurgeryTownsville University HospitalTownsvilleQueenslandAustralia
- Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
| | - Malindu E Fernando
- Ulcer and wound Healing consortium (UHEAL)Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Chanika Alahakoon
- Ulcer and wound Healing consortium (UHEAL)Queensland Research Centre for Peripheral Vascular DiseaseCollege of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Peter A. Lazzarini
- School of Public Health and Social WorkQueensland University of TechnologyBrisbaneQueenslandAustralia
- Allied Health Research CollaborativeMetro North Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Wouter B. aan de Stegge
- Amsterdam UMC, University of AmsterdamDepartment of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
- Department of SurgeryUniversity of GroningenGroningenThe Netherlands
| | - Jaap J. van Netten
- School of Public Health and Social WorkQueensland University of TechnologyBrisbaneQueenslandAustralia
- Amsterdam UMC, University of AmsterdamDepartment of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Sicco A. Bus
- Amsterdam UMC, University of AmsterdamDepartment of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdamThe Netherlands
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15
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Effects of Infrared Combined with Methylcobalamin on the Vibratory Sensory Threshold and Nerve Conduction Velocity of the Lower Extremity in Patients with Diabetic Foot Treatment. DISEASE MARKERS 2022; 2022:8287192. [PMID: 36072896 PMCID: PMC9441398 DOI: 10.1155/2022/8287192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/30/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Objective To investigate the effect of infrared combined with methylcobalamin on the vibratory sensory threshold and lower limb nerve conduction velocity of patients with diabetic foot. Methods One hundred and six patients with diabetic foot in our hospital from February 2018 to December 2020 were enrolled and divided into the study and control groups. The patients in the control group were given methylcobalamin, and the patients in the research group were treated with infrared light on the basis of the control group. The therapeutic effect, vibration sensory threshold, lower limb nerve conduction velocity, and related biochemical index levels before and after treatment in the two groups were counted. Result The total effective rate of the study group (94.34%) was significantly higher than that of the control group (81.13%). The left/right lower limb vibration sensation threshold decreased in both groups after treatment, and the study group was lower than that of the control group (P < 0.05). The conduction velocity of the left/right common peroneal nerve and tibial nerve increased in both groups after treatment, and the study group was larger than that of the control group (P < 0.05). The bFGF, VEGF, and APN increased in both groups after treatment. VEGF and APN increased and IL-6 and TNF-α decreased in both groups after treatment, and the study group was better than the control group (P < 0.05). Conclusion Infrared and methylcobalamin combined treatment of diabetic foot can effectively improve lower extremity nerve conduction velocity and vibration sensory threshold, regulate serum bFGF and VEGF levels, reduce the degree of inflammatory response, and help improve the overall treatment effect.
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16
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Fourier transform-based data augmentation in deep learning for diabetic foot thermograph classification. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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17
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Cassidy B, Reeves ND, Pappachan JM, Ahmad N, Haycocks S, Gillespie D, Yap MH. A Cloud-Based Deep Learning Framework for Remote Detection of Diabetic Foot Ulcers. IEEE PERVASIVE COMPUTING 2022. [DOI: 10.1109/mprv.2021.3135686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Featherston J, Wijlens AM, van Netten JJ. Is a Left-to-Right >2.2°C Difference a Valid Measurement to Predict Diabetic Foot Ulceration in People with Diabetes and a History of Diabetic Foot Ulceration? INT J LOW EXTR WOUND 2021:15347346211062719. [PMID: 34923865 DOI: 10.1177/15347346211062719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Monitoring foot skin temperatures at home have been shown to be effective at preventing the occurrence of diabetic foot ulcers. In this study, the construct validity of using >2.2°C difference between contralateral areas on the foot as a warning sign of imminent ulceration is explored. Thirty participants with diabetes at high risk of ulceration (loss of protective sensation and previous ulceration and/or amputation) monitored their foot temperatures at six sites, four times a day for six days using a handheld infrared thermometer. Walking activity, time of day, and environmental temperature were also monitored and correlated with foot temperatures. We found that contralateral mean skin temperature difference was 0.78°C at baseline. At single sites, left-to-right temperature differences exceeding the threshold were found in 9.6% of measurements (n = 365), which reduced to 0.4% when individually corrected and confirmed the next day. No correlation was found between contralateral temperature differences and activity, time of day, and environmental temperature. We conclude that using a >2.2°C difference is invalid as a single measurement in people at high risk of ulceration, but the construct validity is appropriate if both individual corrections and next day confirmation are applied.
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Affiliation(s)
- Jill Featherston
- 2787St Vincent's Hospital, Sydney, Australia
- 2111Cardiff University School of Medicine, Cardiff, Wales, UK
| | - Anke M Wijlens
- Twentse Huisartsen Onderneming Oost Nederland, Hengelo, the Netherlands
| | - Jaap J van Netten
- School of Public Health and Social Work, 1969Queensland University of Technology, Brisbane, Queensland, Australia
- 1234University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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19
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Beach C, Cooper G, Weightman A, Hodson-Tole EF, Reeves ND, Casson AJ. Monitoring of Dynamic Plantar Foot Temperatures in Diabetes with Personalised 3D-Printed Wearables. SENSORS 2021; 21:s21051717. [PMID: 33801346 PMCID: PMC7958320 DOI: 10.3390/s21051717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Diabetic foot ulcers (DFUs) are a life-changing complication of diabetes that can lead to amputation. There is increasing evidence that long-term management with wearables can reduce incidence and recurrence of this condition. Temperature asymmetry measurements can alert to DFU development, but measurements of dynamic information, such as rate of temperature change, are under investigated. We present a new wearable device for temperature monitoring at the foot that is personalised to account for anatomical variations at the foot. We validate this device on 13 participants with diabetes (no neuropathy) (group name D) and 12 control participants (group name C), during sitting and standing. We extract dynamic temperature parameters from four sites on each foot to compare the rate of temperature change. During sitting the time constant of temperature rise after shoe donning was significantly (p < 0.05) faster at the hallux (p = 0.032, 370.4 s (C), 279.1 s (D)) and 5th metatarsal head (p = 0.011, 481.9 s (C), 356.6 s (D)) in participants with diabetes compared to controls. No significant differences at the other sites or during standing were identified. These results suggest that temperature rise time is faster at parts of the foot in those who have developed diabetes. Elevated temperatures are known to be a risk factor of DFUs and measurement of time constants may provide information on their development. This work suggests that temperature rise time measured at the plantar surface may be an indicative biomarker for differences in soft tissue biomechanics and vascularisation during diabetes onset and progression.
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Affiliation(s)
- Christopher Beach
- Department of Electrical and Electronic Engineering, The University of Manchester, Manchester M13 9PL, UK;
- Correspondence:
| | - Glen Cooper
- Department of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester M13 9PL, UK; (G.C.); (A.W.)
| | - Andrew Weightman
- Department of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester M13 9PL, UK; (G.C.); (A.W.)
| | - Emma F. Hodson-Tole
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK; (E.F.H.-T.); (N.D.R.)
| | - Neil D. Reeves
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK; (E.F.H.-T.); (N.D.R.)
| | - Alexander J. Casson
- Department of Electrical and Electronic Engineering, The University of Manchester, Manchester M13 9PL, UK;
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20
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Golledge J, Fernando M, Lazzarini P, Najafi B, G. Armstrong D. The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4527. [PMID: 32823514 PMCID: PMC7491197 DOI: 10.3390/s20164527] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene, is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed.
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Affiliation(s)
- Jonathan Golledge
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland 4814, Australia
| | - Malindu Fernando
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4000, Australia;
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland 4006, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90089, USA;
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21
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Alahakoon C, Fernando M, Galappaththy C, Matthews EO, Lazzarini P, Moxon JV, Golledge J. Meta-analyses of randomized controlled trials reporting the effect of home foot temperature monitoring, patient education or offloading footwear on the incidence of diabetes-related foot ulcers. Diabet Med 2020; 37:1266-1279. [PMID: 32426872 DOI: 10.1111/dme.14323] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
Abstract
AIM The aim of this study was to perform an up-to-date systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy of home foot temperature monitoring, patient education and offloading footwear in reducing the incidence of diabetes-related foot ulcers. METHODS A literature search was performed using MEDLINE, PubMed, CINAHL, Scopus and Cochrane databases to identify relevant original studies. Meta-analyses were performed using intention-to-treat principals for worst (main analysis) and best (sub-analysis) case scenarios. Leave-one-out sensitivity analyses were used to assess the consistency of findings. RESULTS Of 7575 unique records, 17 RCTs involving 2729 participants were included. Four tested home foot temperature monitoring (n = 468), six examined patient education (n = 823) and seven assessed offloading footwear (n = 1438). Participants' who performed home foot temperature monitoring [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.31 to 0.84; n = 468] and those provided offloading footwear (OR 0.48, 95% CI 0.29 to 0.80; n = 1438) were less likely to develop a diabetes-related foot ulcer. Patient education programmes did not significantly reduce diabetes-related foot ulcer incidence (OR 0.59, 95% CI 0.29 to 1.20; n = 823). Sensitivity analyses suggested that offloading footwear findings were consistent, but home foot temperature findings were dependent on the individual inclusion of one trial. All RCTs had either high or unclear risk of bias. CONCLUSION This meta-analysis suggests that offloading footwear is effective in reducing the incidence of diabetes-related foot ulcers. Home foot temperature monitoring also appears beneficial but larger trials are needed (PROSPERO registration no.: CRD42019135226).
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Affiliation(s)
- C Alahakoon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M Fernando
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - C Galappaththy
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
| | - E O Matthews
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
| | - P Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - J V Moxon
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - J Golledge
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Australia
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