Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer‐free days in remission

Abstract

The prevalent and long neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. Management of the DFU is multifaceted and requires constant monitoring from patients, caregivers, and healthcare providers. The alarmingly high rates of recurrence of ulcerations in the diabetic foot requires a change in our approach to care and to the vernacular in the medical literature. Our efforts should be directed not only on healing of open wounds, but also on maximizing ulcer‐free days for the patient in diabetic foot remission. The increasing development and use of technology within every aspect of our lives represents an opportunity for creative solutions to prevent or better manage this devastating condition. In particular, recent advances in wearable and mobile health technologies appear to show promise in measuring and modulating dangerous foot pressure and inflammation to extend remission and improve the quality of life for these most complex patients. This review article discusses how harnessing wearables and digital technologies may improve the management and optimize prevention of DFUs by identifying high‐risk patients for triage and timely intervention, personalizing prescription of offloading, and improving adherence to protective footwear. While still in their infancy, we envisage a future network of skin‐worn, jewellery‐worn, and implantable sensors that, if allowed to effectively communicate with one another and the patient, could dramatically impact measuring, personalizing, and managing how we and the patients we serve move through our collective world.

Recurrence rates suggest delayed identification of plantar ulceration for patients in diabetic foot remission

“…In two recent publications, Najafi and colleagues explored the goal of increasing ulcer-free days through the use of remote monitoring devices, wearable technologies, and mobile health technologies. 32 33 They suggest that the novel use of technology can help identify potential problems and triage patients for timely interventions. Many of these technologies can be considered an extension of telemedicine options or enable ‘eyes on the patient’ in the home to facilitate needed clinical interventions with minimal delays.…”

Sensor-Based Daily Physical Activity: Towards Prediction of the Level of Concern about Falling in Peripheral Neuropathy

“…Diabetes mellitus, cancer, and other noncommunicable diseases of decay are now leading causes of global mortality in both developed and developing countries, and are consuming most of the health care resources. Timely intervention is the key to improvement, and we believe that our results will contribute to this improvement by suggesting a potential of an eHealth application (i.e., outcomes from a smart wearable sensor) for continuously monitoring the level of concern about falling and eventually the risk of falling in people who have damages in sensory nerve [35]. While mounting evidence suggests that knowledge of intra-subject performance variation can significantly augment clinical judgement and care, the majority of available neuropsychological assessments for concern about falling are ill-suited to repeat testing within relatively short periods of time due to the effects of practice, mood, fatigue, and other influences.…”

The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease

“…Further developments are needed before this approach can be implemented in a remote management program. It should be noted that there is a paucity of commercially available sensors for monitoring adherence easily and accurately, and most of the aforementioned sensors have only been used in a research context [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”