Telemedicine in Diabetic Foot Care: A Systematic Literature Review of Interventions and Meta-analysis of Controlled Trials

Abstract

The care of individuals with diabetic foot ulcers is costly and requires multiple hospital visits. Inadequate care leads to serious complications and a high risk of lower extremity amputation. In this review, we aimed at evaluating whether telemedicine can be effective in diabetic foot patient care. We searched Medline through Embase and PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant studies, published up to April 2017. The studies were summarized and discussed in a narrative method and a meta-analysis of 2 controlled trials was conducted using the fixed-effects model. The main outcomes, assessed in the retrieved studies were the healing rate and satisfaction of patients and health care personnel. Most of the studies showed that implementing telemonitoring programs increased the rate of complete ulcer healing, while the patients were highly satisfied. Two trials providing data on 213 patients on telemedicine and 301 patients on usual care were included for meta-analysis. Subjects in telemedicine, as well as control groups had statistically similar healing time (43 vs 45 days; P = .83), healing time ratio adjusted for age (1 vs 1.4; P = .1), unhealed ulcers or loss to follow-up (3 of 20 vs 7 of 120; P = .13), and amputations (12 of 193 vs 14 of 182; P = .59). Subjects in the telemedicine group experienced a significantly higher mortality rate (8 of 193 vs 1 of 181; P = .0001) due to unexplained factors. No adverse events were attributed to using the telemedicine technology. The odds of complete ulcer healing were statistically similar between the telemedicine group and controls (odds ratio = 0.86; 95% CI = 0.57-1.33; P = .53). Telemedicine care is promising for the management of diabetic foot patients as the results were comparable with usual care. However, further large-scale studies need to be undertaken before it can be implemented widely.

Telehealth and telemedicine applications for the diabetic foot: A systematic review

“…Additionally, this systematic review includes only studies on people with diabetes and therefore lacks data on the use of telehealth and telemedicine approaches in other patient populations (with or without foot ulcers) that may be informative. Tchero et al conducted a systematic review and meta‐analysis on telemedicine approaches and also included other than diabetes patients with (risk for) foot ulcers . We believe though that diabetic foot disease is a unique entity with its own characteristic aspects, physically and psychologically, that require a specific focus on this topic of interest.…”

“…Tchero et al conducted a systematic review and meta-analysis on telemedicine approaches and also included other than diabetes patients with (risk for) foot ulcers. 87 We believe though that diabetic foot disease is a unique entity with its own characteristic aspects, physically and psychologically, that require a specific focus on this topic of interest.…”

Motivational interviewing to improve adherence behaviours for the prevention of diabetic foot ulceration

“…This systematic review did not include telemedicine, telehealth, or mobile health apps as interventions within its search criteria. The use of telemedicine is reported within participants with diabetic foot ulceration, but its use has been directed toward ulcer detection and management, such as wound assessment via video conferencing, or the use of mobile devices for thermal imaging . However, telemedicine for the prevention of ulcer recurrence through motivational and behavioural change techniques has yet to be reported in the literature.…”

The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease

“…Telehealth is an established means of performing medical consultations [89]. The benefit of using telehealth for managing foot ulcers has been demonstrated in several meta-analyses and systematic reviews [90][91][92]. Most of the evidence comes from two clinical trials [93,94]: the first trial evaluated the effectiveness of a telehealth intervention made up of 2:1 online:standard outpatient consultations compared to a usual care intervention consisting of three standard outpatient clinic visits on ulcer healing in 374 people [93].…”