TempTablet: Temperature Monitoring for the Diabetic Feet

S www,diabeticfootonline.com

Diabetes confers a dramatically increased risk of foot ulceration:

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Prevention by identifying the individuals at high risk of ulceration remains the most
v ery a lim
effective way to address this complication. High temperature gradients between the E ds to
feet predict the onset of frank skin breakdown or ulceration. ec on due
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Introduction: Diabetes related amputations remain the single most factor leading to the high mortality is iabe
rates in this population. Apart from the socio-economic consequences, the disease pathology is d
irreversible. A person with diabetes related amputation is 50% likely to have another amputation within
2 years and 75% likely to die within 5 years. Despite a surprisingly high 5-year mortality associated with
this preventable scourge, the lay public and press seem largely unaware and policy-makers have failed
to appropriately respond. Prevention is an essential permissive factor to contain the disease pathology
leading to amputations. However, diabetes related foot complications (also termed as diabetic foot
disease) remain an orphan disease and the lay public, media, healthcare community and policy makers
throughout the world must join together in this battle to save limbs.

Limitations: Significant progress has been made key areas such as offloading, aggressive wound
healing and prevention to improve overall healthcare outcomes. Even with a very high success rate of
healing, “keeping these wounds healed” and preventing recurrences remains a challenge. Southern
Arizona Limb Salvage Alliance with it’s national/international collaborators has been working for more
than a decade now to address this issue. This has resulted in three federally funded randomized clinical
trails, all suggesting that home monitoring of foot temperatures reduces rates of re-ulceration by 4-10
times. A temperature difference of 2.2
Degree C or 4 Degree F is a cause
for concern as demonstrated by
these robust clinical studies. Skin
temperature palpation is a key
screening component in patient
assessments by podiatrists,
physicians, and endocrinologists.
Infrared Thermal Camera: Thermal images showing high risk However, manual palpitation is highly
“inflammed” areas. subjective and ineffective in
determining subtle temperature
differences.

Progress so Far: A wound is defined as frank skin ulceration or simply a breakdown of the skin tissue.
This increases the risk of contamination and subsequent infection, leading to a traumatic amputation.
These wounds are preceded by inflammation and therefore, “heat up” before the skin breaks down.
Over the last decade, we have seen a transition of clinic based
thermometry (beginning from infrared thermography and liquid crystal
thermography) to home monitoring modalities using handheld dermal
thermometers. This progress has enabled us to characterize disease
pathology, identify pre-ulcerous thermal patterns and develop
meaningful protocols to guide patients for self-monitoring. To
summarize, this concept of thermal monitoring is real, feasible and

“Wounds tend to heat up before they break down”; Measuring

temperature daily keeps a check on any pre-ulcerous inflammation and
helps modulate patients physical activity. Offloading or staying off feet
and dosing physical activity helps prevent diabetic foot ulcers much as
dosing insulin for diabetics.
Infrared Handheld Dermal
Thermometer validated, there is now room for advancing the knowledge (for example,
combining pervasive healthcare and thermal monitoring techniques),
innovation and outreach to developing nations. Why Temperature?

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 The Futuristic Solution: TempTablet
TempTablet is a microcontroller based sensor array, built similar
to weighing scale with special foot positioning and heel support
configuration to measure as well as compare same points on
both feet daily. It’s “diabetes” specific ergonomic design
includes, voice & visual prompts, intuitive design, minimal
instruction, little or no maintenance, water/shock resistance,
auto shut down, two year battery life (4 AA Alkaline,
rechargeable), remotely upgradable firmware via normal SD
card rotation, portability, self calibration, light weight (<1 Pound),
high response time (< 30 Seconds) per measurement and date/
time stamped data recording on
Top view of TempTablet with sensor
grouping. Ergonomic design with external memory card (SD Cards) upto four years. TempTablet
foot shape and heel support. provides both a visual and vocal annunciation of the daily status in
the language of choice (English, Hindi & Spanish are the first
available), but other other languages available on request. The data is archived in an easy to use
Windows application (Available free with the unit).

Device Features:
What’s distinctive about the TempTablet, is the ability for
pervasive computing and telemedicine for clinical purposes.
(Optional; Enhanced TempTablet) It can be easily included in
a Diabetes Disease Management program, where the
clinician can have data management performed centrally by
using the TempTablet’s Interchangeable communication
modules including landline, WiFi, WiMax, Bluetooth, Ethernet,
ANT and GSM and Base station gateway for other
telemedicine devices (ideally suited for in patients in a
hospital setting).

The device was designed primarily to produce a compact,

robust product at a price point allowing wide distribution to
patients in both developed and developing nations. However, Side view of TempTablet. Light weight,
Health Management Organizations (HMO’s), insurance robust and maintenance free design.
companies, and medical distribution groups could purchase
the basic/enhanced tablet in large quantities, for distribution
to their patients and clients.

“TempTablet” is a transition from a point based measure using handheld

dermal thermometer to a whole field thermal map of the plantar feet: It’s
simple, robust and futuristic.

TempTablet is the result of several years of progressive research and development in the field of
diabetic foot disease. The simplicity of this device is based on the use of 60 discrete sensors (30 for
each foot), measuring and mapping the temperature profile under the plantar surface of the feet.
Measurement cycle is typically completed in 30 seconds, current measurement compared with the
previous (daily, weekly or monthly) profile, data archived for viewing later and the ability to be sent
immediately to clinical center/disease management group using telecommunication modality (in
enhanced TempTablet). All sensors are grouped strategically for maximum coverage of the whole foot
with LED’s at the critical (high pressure areas, prone to inflammation) areas. TempTablet is a personal
foot buddy for patients with diabetes, helping them healthy by daily preventive temperature
measurement and dosing their physical activity based on these measurements.

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Conlusion: With the increasingly urban population and globalization, there is an increasing incidence of
diabetes and it’s subsequent lower extremity complications, resulting in important decrements in the
functioning and quality of life. Preventing these foot complications becomes an increasingly prominent concern.
Understanding the basic mechanisms involved in setting up prevention initiatives, health economics and
healthcare delivery, requires incremental research and guidance to set up effective programs and produce
feasible modalities. The by product of such a research initiative, TempTablet is relevant to the success of
preventing diabetic foot ulcers and subsequent amputations and therefore the well being of diabetic population.

TempTablet provides an ideal modality for in home use and facilitates potential life enhancement and cost
savings. Thirty sensors per feet provide a robust measure of temperature consistently as part of a daily routine,
with a bold Liquid Crystal readout, especially for diabetics with retinopathy or eye complications. This keeps
the user/patient engaged in self-care, provides excellent quality of the measurements and maintains the
chronological integrity of the logs, providing a high compliance rate for the diabetic patients.
May 1, 2009 Volume VII

TempTablet is a solution for all; It overcomes the barriers in healthcare delivery with a simple,
easy to use and portable design, that fits into the daily routine.
Caring for the feet has never been so easy!

It is important to emphasize that this development is not competitive, but rather collaborative and
complimentary to the existing temperature measurement as well as monitoring modalities. We hope to
continue to succeed in our mission and “Keep a few more legs on a few more bodies”!

Are your Feet in TempTablet?

TempTablet: Save limbs, Save Lives!