Adults with diabetic foot ulcers who consulted with clinicians by telephone or email experienced similar outcomes when compared with adults with diabetic foot ulcers monitored in an outpatient clinic setting, according to research in Diabetes Care.
In a study of Danish adults with diabetic foot ulcers randomly assigned to monitoring by telemedicine or outpatient clinic visits, researchers found both groups saw similar levels of complete ulcer healing and ulcer-related amputations. However, although low overall, mortality was significantly higher in the telemedicine arm.
Benjamin S. B. Rasmussen, MD, of Odense University Hospital in Denmark, and colleagues analyzed data from 401 adults with a diabetic foot ulcer. Researchers randomly assigned 193 participants to telemedicine monitoring — two consultations by telephone or email, along with uploaded images of the ulcer and detailed written assessments through an online database, and one consultation at an outpatient clinic — and 181 participants to only outpatient clinic monitoring. The telemedicine arm spent an average of 74 days in the study; the control arm spent an average of 91 days.
Researchers found no differences between the two groups with respect to ulcer healing. Within the cohort, 72% of the telemedicine group experienced complete ulcer healing; 73% of the control arm also experienced complete ulcer healing.
Researchers also found no differences between groups with respect to ulcer-related amputations. In the telemedical group, 21 participants underwent amputation compared with 26 participants in the control group.
Researchers found a significant difference in mortality between groups. In the telemedicine group, eight participants died; one participant died in the control group (HR = 8.68; 95% CI, 6.93-10.88). All participants who died had chronic heart disease; four had chronic kidney disease and one had prostatic cancer.
“The significant difference in mortality between the telemedical and standard outpatients monitoring groups could not be explained by the selected variables,” the researchers wrote. “Further investigation of comorbidities and other possible reasons has been undertaken.”
Further studies are needed to investigate the effects of telemedicine on mortality, as well as to identify patient subgroups that may have a poorer outcome from telemedicine monitoring, according to researchers.
“The findings of no significant difference regarding amputation and healing seem promising; however, for telemedical monitoring, a higher mortality throws into question the role of telemedicine in monitoring diabetic foot ulcers,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.