Study Gives High Marks to Telehealth in Managing Diabetic Foot Ulcers

A telehealth platform that enables providers to remotely monitor diabetic foot ulcers of patients at home helped eliminate major amputations and halve hospital admissions, according to a recent study by Kaiser Permanente.

The study, recently published in BMJ Open Diabetes Research & Care, highlights the value of connected care platforms in improving care management outside the hospital, clinic or doctor’s office. It also comes at a crucial time, with in-person visits curtailed by the coronavirus pandemic and patients with chronic conditions hesitant to connect with their doctors for check-ups or other services.

In the study, roughly 80 patients living with diabetes who’d had recently healed foot ulcers were enrolled in a year-long ulcer recurrence prevention program through Foot and Ankle Specialists of the Mid-Atlantic and the Mid-Atlantic Permanente Medical Group, both based in Rockville, MD. Those patients were given a telemedicine mat developed by Podimetrics, which allowed them to track foot temperature every day at home and share that data with their care providers.

For people living with diabetes, foot ulcers are common and particularly dangerous. Untreated or not properly monitored, they can lead to infections, amputations and death. Lower-limb amputations account for roughly a third of all annual diabetes health expenses in the US, with each incidence costing as much as $100,000, and at least half of those who’ve had a diabetic amputation die within the next five years.

“Diabetic amputations are some of the most devastating and costliest complications afflicting people with diabetes. They have plagued some of our most vulnerable members and continue to cost the US health care system billions of dollars,” Timothy Swartz, DPM, a board-certified foot and ankle surgeon and a chief of Podiatry with the Mid-Atlantic Permanente Medical Group, said in a press release prepared by Podimetrics. “It’s a game-changer to dramatically reduce these complications and do so in a way that lets our patients go about their lives and, more recently, remain home and safe from COVID-19.”

Through the study, which also evaluated foot-related outcomes and resource use for two years before the program and a year after it ended, no major amputations were reported among participants, and all-cause hospital admissions dropped by 52 percent.

In addition, emergency department visits dropped 40 percent, and outpatient treatment dropped 25 percent.

The researchers also noted that the program encouraged patients to be more diligent about their health, to the point that they communicated with care providers by phone or text more often.

“These additional healthcare interactions, and encouragement to establish a daily routine around preventive foot care by use of the study device, may have resulted in improved self-care for the foot conditions and more broadly,” the study concluded. “The additional interactions may also have prompted the participants to seek care for foot-related and other conditions earlier than they otherwise would have. The observer effect may also have contributed to the broad impact we observed.”

While it targets a very specific intervention, studies like these show the value of remote patient monitoring programs that can track patients at home and give providers the opportunity to adjust care management when necessary – rather than when the patient comes into the office or clinic for a checkup or calls in when he or she doesn’t feel well.