Foot Intervention Study Utilizing Commercially Available Infrared Thermometers With Individuals With Diabetes Using a Mixed Methods Approach

Diabetes is a global health emergency, which is estimated to increase throughout the 21st century (Guariguata et al., 2014). The prevalence of diabetes in Canada is increasing; in 2014, 6.7% of Canadians and 9% of Newfoundlanders and Labradorians had diabetes (Statistics Canada, 2014). In 2020 the number of people in Canada with diabetes is expected to rise to 2.5 million people, or 9.9% of the population (Canadian Diabetes Association, 2009).

Patients with diabetes are at risk for poor foot health and the estimated lifetime incidence of a diabetic foot ulcer (DFU) for this population is 25% (Singh, Armstrong, & Lipsky, 2005). In Canada in 2011 DFUs and related care cost the healthcare system 547 million dollars (Hopkins, Burke, Harlock, Jegathisawaran, & Goeree, 2015). Complicated DFUs that do not heal can lead to amputation; an estimated 85% of amputations are the result of a DFU (Canadian Association of Wound Care, 2015).

The increasing number of people with diabetes will result in a rise in foot complications such as DFUs (Canadian Diabetes Association, 2009). Therefore, it is important to develop strategies for the prevention of DFUs. An important aspect of maintaining foot health is self-management (Boulton et al., 2008; Chang, Peng, Chang, & Chen, 2013). However, there is limited literature related to the experiences of diabetic patients with foot management (Delea et al., 2015). As a result, little is known of the factors that need to be addressed to ensure successful uptake of a self-management strategy. Further exploration of the issue of foot self-assessment and self-management with patients and health care providers is needed in order to develop and implement effective and sustainable interventions.

Interventions to prevent DFUs need to provide patients with strategies to prevent skin breakdown. Due to neuropathy individuals with diabetes do not recognize the inflammation that occurs prior to skin breakdown. In many instances, by the time individuals have identified a problem the ulceration had already occurred (Lavery et al., 2004). For patients with diabetes factors such as pressure can contribute to inflammation and increase plantar foot temperature. Commercially available-infrared thermometers (CAITs) can be used to detect this temperature increase before skin breakdown. Once the increase is identified, the individual can relieve pressure, for example by resting, until the temperature normalizes and inflammation decreases. If the temperature does not normalize in two days then a physician should be consulted. Therefore, self-management strategies that focus on identifying and addressing early signs of inflammation, such as a temperature increase, may be effective in preventing skin breakdown.

Various systematic reviews, which contained three randomized control trials (RCTs), have indicated that the use of personal temperature monitoring with a medical grade thermometer was an effective way to predict, and thus prevent DFUs (Arad, Fonseca, Peters, & Vinik, 2011; Houghton, Bower, & Chant, 2013; van Netten et al., 2015). These thermometers cost approximately $700, which can be prohibitively expensive. A recent study compared inexpensive CAITs, that cost under $100, to medical infrared thermometers and found them to be a reliable measure of skin temperature (Mufti, Coutts, & Sibbald, 2015). However, this technology has not been used as part of an intervention and it is unknown if the CAIT will result in the same positive results as the medical grade thermometer. This study will fill this empirical gap.