A group of researchers assessing telemedical monitoring of diabetic foot ulcers (DFUs) in Denmark have found that, compared with standard outpatient care, it has similar outcomes in terms of amputation and wound healing rates; however, it is associated with an increased risk of death.
The authors, led by Knud B Yderstraede (Odense University Hospital, Denmark), randomised 374 individuals with a DFU to either telemedical monitoring (n=193) or standard care (n=181). Telemedical consultations were conducted by telephone or online with a specialist municipal nurse and physicians at the outpatient clinic, and were supplemented by an uploaded image of the DFU and a detailed written assessment through an online database. Participants stayed in the study until ulcer healing, amputation or death, or for 1 year.
There was no significant difference between the groups in terms of probability of wound healing (hazard ratio [HR], 1.11; 95% confidence interval [CI], 0.87–1.42) or amputation (HR, 0.87; 95% CI, 0.54–1.42). However, over the study period, eight participants in the telemedicine group died, compared with one in the standard group (HR, 8.68; 95% CI, 6.93–10.88). Investigation of comorbidities and other risk factors could not explain this difference.
While the rates of wound healing and amputation show some promise for telemedical monitoring, the authors caution against using it to replace standard outpatient monitoring given the increased risk of death.
The study can be read in full in Diabetes Care here.
