Tchero H, Noubou L, Becsangele B, Mukisi-Mukaza M, Retali GR, Rusch E, et al.
The international journal of lower extremity wounds. Date of publication 2017 Dec 1;volume 16(4):274-283.
1. Int J Low Extrem Wounds. 2017 Dec;16(4):274-283. doi: 10.1177/1534734617739195.
Epub 2017 Nov 23.
Telemedicine in Diabetic Foot Care: A Systematic Literature Review of
Interventions and Meta-analysis of Controlled Trials.
Tchero H(1), Noubou L(1), Becsangele B(1), Mukisi-Mukaza M(2), Retali GR(3),
Rusch E(4).
Author information:
(1)1 Centre Hospitalier de Saint Martin, Saint Martin, Guadeloupe, France.
(2)2 Polyclinique, Pointe-à-Pitre, Guadeloupe, France.
(3)3 Department of Health Economics, Paris, France.
(4)4 Unité de recherche interdisciplinaire EES, Éducation Éthique Santé, ESS,
Université François-Rabelais de Tours, France.
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.
DOI: 10.1177/1534734617739195
PMID: 29168418 [Indexed for MEDLINE]
