Definition of thermal indicators for the study of thermoregulation alterations in the foot of people living within diabetic peripheral neuropathy: A proof of concept

Aims: This study investigates how diabetic peripheral neuropathy is linked to impairment of thermoregulatory mechanisms using a thermal camera, spectral thermal analysis and a physical test. Methods: The plantar skin temperature of all participants was measured using a thermal camera following a 6min walking exercise. The data were subjected to frequency decomposition, resulting in two frequency ranges corresponding to endothelial and neurogenic mechanisms. Then, 40 thermal indicators were evaluated for each participant. ROC curve and statistical tests allowed to identify indicators able to detect the presence or absence of diabetic peripheral neuropathy. Results: The study included 33 participants living with diabetes. The results revealed that a 6-min walk exercise increased plantar foot temperature and highlighted a significant difference between people living with diabetes with and without peripheral neuropathy (p < 0.01). The results also revealed the advantages of using thermal images rather than single point measurements. Conclusions: Diabetic peripheral neuropathy is linked to impairment of thermoregulatory mechanisms. This link can be highlighted after a dedicated 6-min walk exercise, enabling to activate these mechanisms, and measuring with a thermal camera the temporal plantar skin temperature. Assessment of this link gave best results by filtering the thermal signal in the neurogenic range.