Telemedical Treatment of Diabetic Foot Ulcer in Rural and Remote Areas: A Prospective Single Centre Randomised Controlled Clinical Trial

Objectives The role of telemedical treatment for patients with diabetic foot ulcers residing in rural areas remains uncertain. Therefore, our objective was to conduct a randomized controlled trial comparing the effectiveness of telemedical treatment in rural settings with the standard tertiary healthcare approach for managing diabetic foot ulcers. Methods The study was conducted between 2016 and 2022. Participants were randomly assigned 2:1 to either face-to-face usual care (UC) group or telemedical treatment group. The protocol for the telemedical treatment group involved fortnightly consultations conducted by a locally trained nurse in the patients’ rural hospital over 12 weeks compared to similar protocol for face-to-face podiatrist-treated UC group. The primary endpoints were complete healing of the ulcer or limb amputation while secondary outcomes included circulating markers of inflammation as a marker of wound healing. Results One hundred and fifty-one participants out of 232 met the inclusion criteria and 50 were randomised to telemedical treatment group and 101 to the UC group. The clinical and demographic characteristics of the participants were similar in both groups. Following 12 weeks of treatment, we observed that complete ulcer healing was achieved in 16 out of 50 individuals (32%) in the telemedical treatment group, while 28 out of 101 individuals (28%) in the UC group achieved the same outcome (p = 0.58). Conclusions Our study found no significant differences in wound healing and amputation outcomes between nurse-led telemedicine in rural settings and usual care for diabetic foot ulcers. This promising result suggests that telemedicine could be a viable option for rural patients; however, further research exploring other clinically relevant endpoints and vulnerable subgroups is needed to solidify its role.