Digital Health Technologies for Diabetic Foot Ulcers: A Systematic Review of Clinical Evidence, Access Inequities, and Public Health Integration

Tatiana Cristina Dias de Oliveira, Alana Ferreira de Oliveira, Laila de Castro Araújo, Maria Pantoja Moreira de Sena, Valéria de Castro Fagundes, Phelipe Augusto Rabelo Paixão, Stefani Gisele Bastos Dornas, Clarisse Andrade Sales, Ana Paula Simões Castro, Patricia Alves de Mendonça Cavalcante and Luann Wendel Pereira de Sena ()
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Tatiana Cristina Dias de Oliveira: Graduate Program in Family Health, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Alana Ferreira de Oliveira: Graduate Program in Family Health, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Laila de Castro Araújo: Graduate Program in Family Health, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Maria Pantoja Moreira de Sena: Postgraduate Program in Tropical Diseases, Federal University of Pará, Belem 66075-110, Brazil
Valéria de Castro Fagundes: Faculty of Medical Sciences of Pará, Para 38405-320, Brazil
Phelipe Augusto Rabelo Paixão: Graduate Program in Family Health, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Stefani Gisele Bastos Dornas: Graduate Program in Family Health, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Clarisse Andrade Sales: Postgraduate Program in Biodiversity and Biotechnology, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Ana Paula Simões Castro: Postgraduate Program in Biodiversity and Biotechnology, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Patricia Alves de Mendonça Cavalcante: Postgraduate Program in Biodiversity and Biotechnology, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil
Luann Wendel Pereira de Sena: Graduate Program in Family Health, Federal University of the South and Southeast of Pará, Maraba 68507-590, Brazil

IJERPH, 2025, vol. 22, issue 9, 1-18

Abstract: Diabetic foot ulcers are among the most severe complications of diabetes mellitus, disproportionately affecting populations in low- and middle-income countries. Digital health technologies have emerged as promising tools for prevention, diagnosis, and management; however, their effectiveness, usability, and applicability within public health systems remain insufficiently defined. This systematic review aimed to critically synthesize the clinical effectiveness, perceived usability, and methodological quality of digital interventions for the care of individuals with diabetes-related foot ulcers. A comprehensive search was performed in PubMed, Scopus, Web of Science, Embase, and Google Scholar for studies published between 2012 and 2024. Eighteen studies met the inclusion criteria, encompassing mobile health applications, wearable sensor devices, artificial intelligence-based tools, and telehealth platforms. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Artificial intelligence-driven approaches demonstrated high diagnostic accuracy, with sensitivity and specificity above 90% for ulcer detection and classification. Mobile applications showed positive effects on self-efficacy, glycemic control, and adherence to preventive foot care, while usability scores were consistently high. Wearable sensor devices demonstrated potential for reducing ulcer recurrence, though supporting evidence remains limited. Across studies, recurrent methodological limitations included small sample sizes, absence of control groups, lack of economic evaluations, and barriers related to digital literacy and interoperability between systems. Most investigations were conducted in high-income countries, with limited consideration of public health contexts such as the Brazilian Unified Health System. In conclusion, digital health technologies show promise in improving the care of individuals with diabetes-related foot complications but face significant challenges regarding scalability, equity of access, and integration into public healthcare systems. Future research should prioritize context-adapted designs, robust clinical trials, and economic evaluations to inform health policies and support the rational adoption of these tools within universal health coverage frameworks. PROSPERO registration number: CRD420251023152.

Keywords: diabetic foot; health technology; mobile health applications; digital health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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