Diabetic foot ulcers (DFUs) need frequent reassessment, often weekly, yet many patients live far from specialist care, have limited mobility, or cannot easily attend clinic. Remote care, which includes video visits, photographs sent through secure platforms, and home nursing with specialist oversight, has expanded quickly. The clinical question is whether it heals wounds and protects limbs as safely as in-person care. This article reviews what randomized trials and systematic reviews published since 2015 show.
What Telemedicine Means in Diabetic Foot Care
Telemedicine in DFU care covers several models. In some, a community nurse visits the patient at home and transmits wound photographs and assessments to a specialist team. In others, patients photograph their own feet and send images for review, or clinicians hold scheduled video consultations. A 2023 overview of eight systematic reviews, covering 88 primary studies and 8,509 participants, found that remotely delivered care for diabetes-related foot disease was well received by patients and clinicians, but that its clinical effectiveness remained unclear (Drovandi et al., Journal of Diabetes Science and Technology). The authors called for higher-quality trials.
Evidence on Healing and Amputation
The most cited randomized trial, from Denmark, enrolled roughly 400 people with DFUs and compared telemedical monitoring with standard outpatient visits. In the telemedical arm, specialist-supported home nursing visits replaced some clinic attendance. Wound healing and amputation rates did not differ between groups (Rasmussen et al., Diabetes Care, 2015). The trial did report a higher mortality rate in the telemedicine group (hazard ratio about 8.7). The investigators considered this unlikely to be caused by the monitoring method itself, since follow-up of the wounds was otherwise similar, and the finding has not been replicated as a causal effect. It does show that these trials need adequate size and careful monitoring of safety outcomes.
A later systematic review and meta-analysis of telemedicine for chronic wounds examined 12 studies (6 randomized trials and 6 cohort studies) with 3,913 patients. It found that telemedicine met non-inferiority criteria compared with conventional care, with no significant difference in healing rates in the randomized trials. It also reported a lower amputation risk with telemedicine (relative risk 0.45) (Chen et al., JMIR mHealth and uHealth, 2020). Because that analysis combined cohort studies with trials and covered chronic wounds beyond diabetes, the amputation finding is best read as a signal for further study, not proof of benefit. The 2023 overview similarly noted that long-term healing and mortality did not differ significantly between telehealth and standard care, while one meta-analysis suggested fewer lower-limb amputations.
Implementation Matters
Results depend heavily on how a program is run. A French pilot trial of home-based telemedical monitoring, which was stopped early after enrolling 14 of 62 planned patients, identified three barriers: home nurses without specialized wound-care training, asynchronous image transmission that prevented clinicians from checking image quality, and additional technology that was time-consuming and prone to malfunction (Muller et al., Diabetes Care, 2016). The Danish model, by contrast, relied on nurses with wound-care expertise and structured specialist review. These accounts suggest that telemedicine works best as an extension of an organized multidisciplinary service, not a replacement for it.
Remote assessment also has inherent limits. Photographs and video cannot reliably show probe-to-bone findings, wound depth, tissue temperature, or the pedal pulses and neurovascular status that determine the next treatment step. Signs of deep infection or acute ischemia may be missed. For this reason, in-person assessment remains necessary at diagnosis, when a wound deteriorates, and when infection or arterial disease is suspected.
Clinical Takeaways
Current evidence suggests that, for appropriately selected patients and with trained staff, telemedicine can achieve healing and amputation outcomes comparable to standard outpatient care. The evidence is limited by small trials, mixed study designs, and uncertainty about safety outcomes such as mortality. Remote models appear most defensible for stable, uninfected wounds in patients with good vascular status who face real barriers to travel, with a clear pathway back to face-to-face review. Larger, high-quality randomized trials with long-term safety endpoints are still needed.
References
- Rasmussen BSB, et al. A randomized controlled trial comparing telemedical and standard outpatient monitoring of diabetic foot ulcers. Diabetes Care. 2015.
- Chen L, Cheng L, Gao W, et al. Telemedicine in chronic wound management: systematic review and meta-analysis. JMIR mHealth and uHealth. 2020.
- Drovandi A, Wong S, Seng L, et al. Remotely delivered monitoring and management of diabetes-related foot disease: an overview of systematic reviews. Journal of Diabetes Science and Technology. 2023.
- Muller M, David-Tchouda S, Margier J, Oreglia M, Benhamou P-Y. Comment on Rasmussen et al. Diabetes Care. 2016.
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