Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
Diabet Med. 2023 Oct;40(10):e15189. doi: 10.1111/dme.15189. Epub 2023 Jul 28.
Home foot temperature monitoring (HFTM) is recommended for those at moderate to high ulcer risk. Where a > 2.2°C difference in temperature between feet (hotspot) is detected, it is suggested that individuals (1) notify a healthcare professional (HCP); (2) reduce daily steps by 50%. We assess adherence to this and HFTM upon detecting a recurrent hotspot.
PubMed and Google Scholar were searched until 9 June 2023 for English-language peer-reviewed HFTM studies which reported adherence to HFTM, daily step reduction or HCP hotspot notification. The search returned 1030 results excluding duplicates of which 28 were shortlisted and 11 included.
Typical adherence among HFTM study participants for >3 days per week was 61%-93% or >80% of study duration was 55.6%-83.1%. Monitoring foot temperatures >50% of the study duration was associated with decreased ulcer risk (Odds Ratio: 0.50, p < 0.001) in one study (n = 173), but no additional risk reduction was found for >80% adherence. Voluntary dropout was 5.2% (Smart mats); 8.1% (sock sensor) and 4.8%-35.8% (infrared thermometers). Only 16.9%-52.5% of participants notified an HCP upon hotspot detection. Objective evidence of adherence to 50% reduction in daily steps upon hotspot detection was limited to one study where the average step reduction was a pedometer-measured 51.2%.
Ulcer risk reduction through HFTM is poorly understood given only half of the participants notify HCPs of recurrent hotspots and the number of reducing daily steps is largely unknown. HFTM adherence and dropout are variable and more research is needed to determine factors affecting adherence and those likely to adhere.
对于中高危足溃疡风险的人群，建议进行家庭足部温度监测（HFTM）。如果检测到足部（热点）之间的温差>2.2°C，则建议（1）通知医疗保健专业人员（HCP）；（2）减少每天的步数 50%。在检测到复发热点时，我们评估对这一建议和 HFTM 的依从性。
在 2023 年 6 月 9 日之前，我们在 PubMed 和 Google Scholar 上检索了以英语发表的关于 HFTM 的同行评审研究，这些研究报告了 HFTM、每日步数减少或 HCP 热点通知的依从性。检索结果排除重复项后返回 1030 项，其中有 28 项被列入短名单，11 项被纳入。
HFTM 研究参与者每周至少 3 天的典型依从率为 61%-93%，或研究持续时间的>80%为 55.6%-83.1%。一项研究（n=173）表明，在研究持续时间内监测足部温度>50%与溃疡风险降低（优势比：0.50，p<0.001）相关，但>80%的依从性并没有发现额外的风险降低。自愿退出率为 5.2%（智能垫）、8.1%（袜子传感器）和 4.8%-35.8%（红外温度计）。只有 16.9%-52.5%的参与者在检测到热点时通知了 HCP。在检测到热点时，只有一项研究记录到每日步数减少 50%的客观证据，平均减少量为计步器测量的 51.2%。
由于只有一半的参与者通知 HCP 出现复发性热点，而且每日减少步数的数量也大多未知，因此，通过 HFTM 降低溃疡风险的效果仍不清楚。HFTM 的依从性和退出率是可变的，需要进一步研究确定影响依从性的因素和可能依从的因素。
