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Copyright (c) 2026 Dr Samera A Mugharbil, Dr Atif K. Rawas, Dr. Jamala A. Bawahab, Dr. Saeed A. Youldash, Dr. Abdullaha Beiruty, Dr Suhad A. Aljuhani, Dr Nora D. Alnofie, Ms Fatin S. Alahmadi, Ms Layan H Alshardi, Ms Mada A. Awam
This work is licensed under a Creative Commons Attribution 4.0 International License.
Enhancing Early Detection of Diabetic Foot Complications: Evidence from a Specialized Diabetes Center in King Abdulaziz Hospital at Jeddah First Health Cluster (J1), 2026
Corresponding Author(s) : Dr Samera A Mugharbil
Saudi Journal of Medicine and Public Health, Vol. 3 No. 1 (2026)
Abstract
Background: Diabetic foot complications are a major cause of ulceration, infection, hospitalization, amputation, and reduced quality of life. Early identification of neuropathic, vascular, and thermal abnormalities may strengthen preventive diabetic-foot care.
Aim: To assess demographic, clinical, thermal, and risk-classification findings among patients attending the Diabetic Center at King Abdulaziz Hospital, Jeddah First Health Cluster, and to describe six-month progression among moderate- and high-risk patients.
Methods: A retrospective observational study used routinely documented medical records and available thermal-imaging reports. Baseline demographic, clinical, IWGDF risk-classification, and thermal-imaging data were assessed cross-sectionally. TFScan-generated patient risk classification was available for all 105 participants, whereas complete detailed thermal parameters required for the thermal findings analysis were available for 102 participants. An exploratory six-month retrospective review of documented outcomes was conducted only among patients classified at baseline as having moderate or high diabetic-foot risk, comprising 25 patients. No patient was contacted, prospectively assessed, or subjected to a research intervention by the research team.
Results: Most participants were aged 46–60 years (46/105, 43.8%), male (66/105, 62.8%), had Type II diabetes (99/105, 94.2%), and had diabetes for 11 years or more (49/105, 47.6%). Obesity and overweight affected 43 (40.9%) and 37 (35.2%) patients, respectively. Retinopathy occurred in 74/102 (72.5%), neuropathy in 69/102 (67.6%), and poor HbA1c control in 45/102 (44.1%). TFScan-generated patient risk classification was available for all 105 participants; moderate and high risk were assigned to 18/105 (17.1%) and 7/105 (6.7%), respectively. Detailed thermal findings were available for 102 participants, among whom thermal asymmetry was identified in 7/102 (6.9%), hyperthermia in 6/102 (5.9%), and hypothermia in 4/102 (3.9%). During follow-up, 19/25 (76.0%) patients remained stable, while 3/25 (12.0%) developed a new wound or ulcer.
Conclusion: The study identified a substantial burden of diabetic-foot risk factors. AI-supported thermal screening may support early risk stratification when combined with comprehensive clinical assessment and multidisciplinary follow-up.
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- Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.
- Armstrong DG, Boulton AJ, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376:2367–2375.
- Sen P, Demirdal T, Emir B. Meta-analysis of risk factors for amputation in diabetic foot infections. Diabetes Metab Res Rev. 2019;35:e3165.
- Armstrong DG, Swerdlow MA, Armstrong AA, et al. Five-year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13:16.
- Ilo A, Romsi P, Mäkelä J. Infrared thermography and vascular disorders in diabetic feet. J Diabetes Sci Technol. 2020;14:28–36.
- Dros J, Wewerinke A, Bindels PJ, et al. Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review. Ann Fam Med. 2009;7:555–558.
- Wang F, Zhang J, Yu J, et al. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: a systematic review and meta-analysis. J Diabetes Res. 2017;2017:8787261.
- Crawford F, Welch K, Andras A, et al. Ankle-brachial index for the diagnosis of lower-limb peripheral arterial disease. Cochrane Database Syst Rev. 2016;9:CD006887.
- Bhasin N, Scott DJA. Ankle brachial pressure index identifying cardiovascular risk and improving diagnostic accuracy. J R Soc Med. 2007;100:4–5.
- Casey SL, Lanting SM, Chuter VH. The ankle brachial index in people with and without diabetes intra-tester reliability. J Foot Ankle Res. 2020;13:42.
- Eiberg JP, Rasmussen JG, Hansen MA, et al. Duplex ultrasound scanning of peripheral arterial disease of the lower limb. Eur J Vasc Endovasc Surg. 2010;40:507–512.
- Collins R, Cranny G, Burch J, et al. A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic lower limb peripheral arterial disease. Health Technol Assess. 2007;11:iii–iv, ix–184.
- Amin N, Doupis J. Diabetic foot disease from the evaluation of the foot at risk to novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7:153–164.
- American Diabetes Association Professional Practice Committee. Retinopathy, neuropathy, and foot care standards of care in diabetes 2024. Diabetes Care. 2024;47:S231–S243.
- Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetes-related foot disease IWGDF 2023 update. Diabetes Metab Res Rev. 2024;40:e3657.
- Campbell JS, Mead MN. Human medical thermography. Boca Raton FL: CRC Press; 2022.
- Serbu G. Infrared imaging of the diabetic foot. In Proceedings of the 10th Conference on InfraMation 2009; October 19–22 2009; Las Vegas NV. Available from https://degroenezuster.nl/wp-content/uploads/2019/11/Thermography-of-Diabetic-foot.pdf
- Lahiri BB, Bagavathiappan S, Jayakumar T, et al. Medical applications of infrared thermography a review. Infrared Phys Technol. 2012;55:221–235.
- Schwartz RG, Brioschi M, Young O, et al. The American Academy of Thermology guidelines for neuro-musculoskeletal 2021 infrared medical thermology and sympathetic skin response studies. Pan Am J Med Thermol. 2021;1:1–13.
- Shara, Khansa et al. “Combining thermography and artificial intelligence in comparison with a diabetic foot nurse for diabetic foot ulcer detection: A diagnostic accuracy study.” Digital health vol. 12 20552076261416807. 19 Jan. 2026, doi:10.1177/20552076261416807
- Waller K, Ogrin R, Ngo QC, Polus B, Hanna S, Tint AN, MacIsaac RJ, Galligan A, Ekinci EI, Kumar D. Using Textural Analysis of Thermal Imaging to Predict Healing Status of Diabetes-Related Neuropathic Foot Ulcers: Protocol for a Co-Design and Longitudinal Study. JMIR Research Protocols. 2026 Feb 26;15(1):e69793.
- de Deus Passos M, Da Rocha AF. Evaluation of infrared thermography with a portable camera as a diagnostic tool for peripheral arterial disease of the lower limbs compared with color Doppler ultrasonography. Archives of medical sciences. Atherosclerotic diseases. 2022 Aug 8;7:e66.
- Khandakar, Amith et al. “Thermal Change Index-Based Diabetic Foot Thermogram Image Classification Using Machine Learning Techniques.” Sensors (Basel, Switzerland) vol. 22,5 1793. 24 Feb. 2022, doi:10.3390/s22051793
- Cruz-Vega, Israel et al. “Deep Learning Classification for Diabetic Foot Thermograms.” Sensors (Basel, Switzerland) vol. 20,6 1762. 22 Mar. 2020, doi:10.3390/s20061762
- Wara, S. Amplifai Health’s AI Diabetic Foot Scanner Gets SFDA Green Light. 2025. Available online via Amplifai Health’s AI Diabetic Foot Scanner Approved by SFDA
- Alwashmi MF, Alghali M, AlMogbel A, Alwabel AA, Alhomod AS, Almaghlouth I, Temsah MH, Jamal A. The use of AI-powered thermography to detect early plantar thermal abnormalities in patients with diabetes: cross-sectional observational study. JMIR diabetes. 2025 Jun 13;10:e65209.
- Qin Q, Nakagami G, Ohashi Y, Dai M, Sanada H, Oe M. Development of a self-monitoring tool for diabetic foot prevention using smartphone-based thermography: Plantar thermal pattern changes and usability in the home environment. Drug Discoveries & Therapeutics. 2022 Aug 31;16(4):169-76.
- Hernandez-Contreras DA, Peregrina-Barreto H, de Jesus Rangel-Magdaleno J, Renero-Carrillo FJ. Plantar thermogram database for the study of diabetic foot complications. Ieee Access. 2019 Nov 4;7:161296-307.
- Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X, Yang Y, Wang P. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: a systematic review and meta‐analysis. Journal of diabetes research. 2017;2017(1):8787261.
- Getson DO, Govindan S, Uricchio J, Bernton T, Brioschi M, Zhang HY. Guidelines for neuromusculoskeletal infrared thermography sympathetic skin response (SSR) studies. Pan Am. J. Med. Thermol. 2015;2:35-43.
- TekScan. Confirming Diabetic Foot Ulcer Treatment with F-Scan. 2025. Available online via Diabetic Foot Ulcer Treatment | F-Scan Diabetic Foot Scanner | Tekscan
References
Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.
Armstrong DG, Boulton AJ, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376:2367–2375.
Sen P, Demirdal T, Emir B. Meta-analysis of risk factors for amputation in diabetic foot infections. Diabetes Metab Res Rev. 2019;35:e3165.
Armstrong DG, Swerdlow MA, Armstrong AA, et al. Five-year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13:16.
Ilo A, Romsi P, Mäkelä J. Infrared thermography and vascular disorders in diabetic feet. J Diabetes Sci Technol. 2020;14:28–36.
Dros J, Wewerinke A, Bindels PJ, et al. Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review. Ann Fam Med. 2009;7:555–558.
Wang F, Zhang J, Yu J, et al. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: a systematic review and meta-analysis. J Diabetes Res. 2017;2017:8787261.
Crawford F, Welch K, Andras A, et al. Ankle-brachial index for the diagnosis of lower-limb peripheral arterial disease. Cochrane Database Syst Rev. 2016;9:CD006887.
Bhasin N, Scott DJA. Ankle brachial pressure index identifying cardiovascular risk and improving diagnostic accuracy. J R Soc Med. 2007;100:4–5.
Casey SL, Lanting SM, Chuter VH. The ankle brachial index in people with and without diabetes intra-tester reliability. J Foot Ankle Res. 2020;13:42.
Eiberg JP, Rasmussen JG, Hansen MA, et al. Duplex ultrasound scanning of peripheral arterial disease of the lower limb. Eur J Vasc Endovasc Surg. 2010;40:507–512.
Collins R, Cranny G, Burch J, et al. A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic lower limb peripheral arterial disease. Health Technol Assess. 2007;11:iii–iv, ix–184.
Amin N, Doupis J. Diabetic foot disease from the evaluation of the foot at risk to novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7:153–164.
American Diabetes Association Professional Practice Committee. Retinopathy, neuropathy, and foot care standards of care in diabetes 2024. Diabetes Care. 2024;47:S231–S243.
Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetes-related foot disease IWGDF 2023 update. Diabetes Metab Res Rev. 2024;40:e3657.
Campbell JS, Mead MN. Human medical thermography. Boca Raton FL: CRC Press; 2022.
Serbu G. Infrared imaging of the diabetic foot. In Proceedings of the 10th Conference on InfraMation 2009; October 19–22 2009; Las Vegas NV. Available from https://degroenezuster.nl/wp-content/uploads/2019/11/Thermography-of-Diabetic-foot.pdf
Lahiri BB, Bagavathiappan S, Jayakumar T, et al. Medical applications of infrared thermography a review. Infrared Phys Technol. 2012;55:221–235.
Schwartz RG, Brioschi M, Young O, et al. The American Academy of Thermology guidelines for neuro-musculoskeletal 2021 infrared medical thermology and sympathetic skin response studies. Pan Am J Med Thermol. 2021;1:1–13.
Shara, Khansa et al. “Combining thermography and artificial intelligence in comparison with a diabetic foot nurse for diabetic foot ulcer detection: A diagnostic accuracy study.” Digital health vol. 12 20552076261416807. 19 Jan. 2026, doi:10.1177/20552076261416807
Waller K, Ogrin R, Ngo QC, Polus B, Hanna S, Tint AN, MacIsaac RJ, Galligan A, Ekinci EI, Kumar D. Using Textural Analysis of Thermal Imaging to Predict Healing Status of Diabetes-Related Neuropathic Foot Ulcers: Protocol for a Co-Design and Longitudinal Study. JMIR Research Protocols. 2026 Feb 26;15(1):e69793.
de Deus Passos M, Da Rocha AF. Evaluation of infrared thermography with a portable camera as a diagnostic tool for peripheral arterial disease of the lower limbs compared with color Doppler ultrasonography. Archives of medical sciences. Atherosclerotic diseases. 2022 Aug 8;7:e66.
Khandakar, Amith et al. “Thermal Change Index-Based Diabetic Foot Thermogram Image Classification Using Machine Learning Techniques.” Sensors (Basel, Switzerland) vol. 22,5 1793. 24 Feb. 2022, doi:10.3390/s22051793
Cruz-Vega, Israel et al. “Deep Learning Classification for Diabetic Foot Thermograms.” Sensors (Basel, Switzerland) vol. 20,6 1762. 22 Mar. 2020, doi:10.3390/s20061762
Wara, S. Amplifai Health’s AI Diabetic Foot Scanner Gets SFDA Green Light. 2025. Available online via Amplifai Health’s AI Diabetic Foot Scanner Approved by SFDA
Alwashmi MF, Alghali M, AlMogbel A, Alwabel AA, Alhomod AS, Almaghlouth I, Temsah MH, Jamal A. The use of AI-powered thermography to detect early plantar thermal abnormalities in patients with diabetes: cross-sectional observational study. JMIR diabetes. 2025 Jun 13;10:e65209.
Qin Q, Nakagami G, Ohashi Y, Dai M, Sanada H, Oe M. Development of a self-monitoring tool for diabetic foot prevention using smartphone-based thermography: Plantar thermal pattern changes and usability in the home environment. Drug Discoveries & Therapeutics. 2022 Aug 31;16(4):169-76.
Hernandez-Contreras DA, Peregrina-Barreto H, de Jesus Rangel-Magdaleno J, Renero-Carrillo FJ. Plantar thermogram database for the study of diabetic foot complications. Ieee Access. 2019 Nov 4;7:161296-307.
Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X, Yang Y, Wang P. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: a systematic review and meta‐analysis. Journal of diabetes research. 2017;2017(1):8787261.
Getson DO, Govindan S, Uricchio J, Bernton T, Brioschi M, Zhang HY. Guidelines for neuromusculoskeletal infrared thermography sympathetic skin response (SSR) studies. Pan Am. J. Med. Thermol. 2015;2:35-43.
TekScan. Confirming Diabetic Foot Ulcer Treatment with F-Scan. 2025. Available online via Diabetic Foot Ulcer Treatment | F-Scan Diabetic Foot Scanner | Tekscan