SMARTPHONE-BASED AND INFRARED THERMOGRAPHY FOR HOME PREVENTION OF DIABETIC FOOT ULCERS: ACCESSIBILITY, ADOPTION, AND HEALTH-EQUITY PERSPECTIVE

Abstract

Home infrared temperature monitoring for diabetic foot ulcer (DFU) prevention is supported by multiple randomized controlled trials demonstrating reductions of roughly 60 to 90% in ulcer recurrence among high-risk patients (IWGDF risk categories 2 to 3) when compared with standard care without thermometry. These findings hold across diverse geographic and resource settings, including low-resource contexts in Indonesia and Peru. Technology platforms range from handheld infrared thermometers costing 30 to 100 US dollars to smartphone-attached thermal cameras, wireless thermometric mats, sensor-embedded socks rated 9 to 10 out of 10 for comfort, and wearable Internet-of-Things devices costing as little as 14.80 US dollars per unit. Adherence rates across technologies generally range from 70% to 88% over study periods of 6 to 24 months, and predictive systems can detect impending ulcers up to 37 days in advance with 97% sensitivity, though at the cost of a 57% false-positive rate at standard thresholds. Despite promising accessibility features, significant barriers remain, including physical limitations such as arthritis and vision loss, incorrect device use in nearly half of participants despite training, and reliance on assistance from others for interpreting results among older, low-income users, all of which disproportionately affect vulnerable populations. Critically, no study formally evaluated differential effectiveness by socioeconomic status, race or ethnicity, education level, or insurance coverage, leaving a substantial gap in the health-equity evidence base. The addition of mHealth reminders to thermometry did not improve adherence or outcomes beyond thermometry alone. While the technological and cost barriers to home thermometry are increasingly surmountable, the absence of equity-stratified analyses means that whether these tools reduce or inadvertently widen disparities in DFU outcomes cannot yet be determined from the available evidence.