Telemedicine in Diabetic Foot Care: A Systematic Literature Review of Interventions and Meta-analysis of Controlled Trials
The care of individuals with diabetic foot ulcers is costly and requires multiple hospital visits. Inadequate care leads to serious complications and a high risk of lower extremity amputation. In this review, we aimed at evaluating whether telemedicine can be effective in diabetic foot patient care. We searched Medline through Embase and PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant studies, published up to April 2017. The studies were summarized and discussed in a narrative method and a meta-analysis of 2 controlled trials was conducted using the fixed-effects model. The main outcomes, assessed in the retrieved studies were the healing rate and satisfaction of patients and health care personnel. Most of the studies showed that implementing telemonitoring programs increased the rate of complete ulcer healing, while the patients were highly satisfied. Two trials providing data on 213 patients on telemedicine and 301 patients on usual care were included for meta-analysis. Subjects in telemedicine, as well as control groups had statistically similar healing time (43 vs 45 days; P = .83), healing time ratio adjusted for age (1 vs 1.4; P = .1), unhealed ulcers or loss to follow-up (3 of 20 vs 7 of 120; P = .13), and amputations (12 of 193 vs 14 of 182; P = .59). Subjects in the telemedicine group experienced a significantly higher mortality rate (8 of 193 vs 1 of 181; P = .0001) due to unexplained factors. No adverse events were attributed to using the telemedicine technology. The odds of complete ulcer healing were statistically similar between the telemedicine group and controls (odds ratio = 0.86; 95% CI = 0.57-1.33; P = .53). Telemedicine care is promising for the management of diabetic foot patients as the results were comparable with usual care. However, further large-scale studies need to be undertaken before it can be implemented widely.