Tuesday , November 21 2017
Home / Specialties / Podiatry / Telemonitoring of Diabetic Foot Ulcers Might Lead to More Death

Telemonitoring of Diabetic Foot Ulcers Might Lead to More Death

Study finds higher mortality incidence in telemedical monitoring group compared with standard outpatient-monitoring group…

Telemonitoring of diabetic foot ulcers involves remotely monitoring patients who are not at the same location as the health care provider. Patients communicate with a specialized ulcer nurse or physician at an outpatient clinic through telephone or other monitoring devices. Even though telemedicine is growing rapidly, its role in diabetic foot ulcer care is uncertain. A group of researchers from Denmark conducted a randomized controlled trial to compare telemedical and standard outpatient monitoring in diabetic foot ulcers.

In their study, a total of 401 patients with diabetic foot ulcers were selected and randomly assigned to receive either telemonitoring or outpatient monitoring. Telemonitoring consisted of two consultations in the patient’s own home and one consultation at the outpatient clinic, and standard practice consisted of three outpatient clinic visits. All participants were similar at baseline and demographically. All patients were followed until the ulcer healed, amputation or death.

According to the results posted in the study, there was no difference in individuals monitored through telemedicine regarding wound healing (hazard ratio 1.11 [95% CI 0.87, 1.42], P = 0.42) or amputation (0.87 [0.54, 1.42], P = 0.59). However, higher mortality incidence was found in the telemedical monitoring group when compared with the standard outpatient group (8.68 [6.93, 10.88], P = 0.0001).

The study results suggest that telemedicine may lead to more death than standard outpatient care. According to Dr. Knud B. Yderstraede, one of the study authors, “Conventional clinical decision-making telemedicine should be used with caution in these frail patients with multiple co-morbidities. Until further research is accessible, we cannot recommend general dissemination of telemedicine in all patients with diabetic foot ulcers.”

Practice Pearls:

  • Telemonitoring of diabetic foot ulcers involves remotely monitoring patients who are not at the same location as their health care provider.
  • Complete healing rates and the amputation rate were no different in both the telemonitoring group and usual care group. Higher mortality incidence was found in the telemedical-monitoring group.
  • Conventional clinical decision-making suggests that telemedicine should be used with caution in frail patients with multiple co-morbidities.

Rasmussen BS, Froekjaer J, Bjerregaard MR, Lauritsen J, Hangaard J, Henriksen CW, Halekoh U, Yderstraede KB. “A Randomized Controlled Trial Comparing Telemedical and Standard Outpatient Monitoring of Diabetic Foot Ulcers.” Diabetes Care. 2015 Jun 26. pii: dc150332.