Adherence Over Time: The Course of Adherence to Customized Diabetic Insoles as Objectively Assessed by a Temperature Sensor

Faculty/Professorship: Clinical Psychology and Psychotherapy  
Author(s): Ehrmann, Dominic  ; Spengler, Monika; Jahn, Michael; Niebuhr, Dea; Haak, Thomas; Kulzer, Bernhard ; Hermanns, Norbert  
Title of the Journal: Journal of diabetes science and technology
ISSN: 1932-2968
Publisher Information: London : Sage
Year of publication: 2018
Volume: 12
Issue: 3
Pages: 695-700
Language(s): English
DOI: 10.1177/1932296817747618

Temperature sensors are an objective way to assess adherence to diabetic footwear. Good adherence is essential for the prevention of diabetic foot problems. Little is known about the long-term course of adherence in patients at risk for diabetic foot problems.


A temperature sensor was incorporated into the specialized footwear of patients with type 2 diabetes after their first plantar ulceration. Kaplan-Meier curve was used to analyze when patients started to become nonadherent (not wearing the footwear for two straight weeks). Gender effects on adherence were also analyzed.


26 patients with a mean observation time of 133.5 days could be analyzed. Mean wearing time of diabetic footwear was 4.2 ± 3.6 h/day (Mdn = 3.4 h/day; interquartile range = 0.5-7.0 h/day) and on 51% of the days patients did not wear their footwear at all. Kaplan-Meier curve revealed that the mean time of adherence was 27.5 weeks. Men achieved a mean time of adherence of 30.5 weeks, while women only achieved 14 weeks. However, due to the small sample size, this difference was not statistically significant.


Temperature sensors revealed a low long-term adherence to diabetic footwear. Women seemed to be at a higher risk for earlier nonadherent behavior. Adherence to diabetic footwear should be closely monitored and tailored intervention strategies should be developed.
Keywords: adherence, temperature sensor, diabetic foot problems, gender effects
Peer Reviewed: Ja
International Distribution: Ja
Open Access Journal: Ja
Type: Article
Year of publication: 19. August 2019