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

Abstract

Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene, is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed.

Harnessing Digital Health Technologies to Remotely Manage Diabetic Foot Syndrome: A Narrative Review

“…Typically, a diabetic person at high risk for DFU visits an outpatient clinic weekly or bi-weekly for regular podiatry evaluation [ 10 ]. However, frequent visits could easily overwhelm the existing healthcare system, which is already overburdened.…”

“…At least 70% of amputations are potentially preventable [ 9 ]. Randomized controlled trials (RCT) and meta-analyses show that DFU is preventable by controlling these key reversible risk factors using interventions such as appropriate foot care, footwear, daily monitoring plantar temperature, and medical management [ 10 , 11 , 12 , 13 ]. However, effective technology is still missing to facilitate monitoring DFU related risk factors on a daily basis, empower patients in self-care as well as engaging them to use these technologies, and effectively coordinate care among circles of care providers and caregivers.…”

The Role of Foot-Loading Factors and Their Associations with Ulcer Development and Ulcer Healing in People with Diabetes: A Systematic Review

“…This may explain the few associations found. With sensors becoming smaller and easier to use [60], we recommend to repeat measurements over time or to measure continuously, so to better investigate associations with ulcer outcomes. A limitation in comparing studies was that different outcome measures were used for the same foot-loading factor.…”

Monitoring of Dynamic Plantar Foot Temperatures in Diabetes with Personalised 3D-Printed Wearables

“…Wearable devices are becoming increasingly common for use in preventative medicine in areas such as cardiovascular health [ 6 ], motivating the creation of wearables for monitoring risk factors in DFU. In [ 7 , 8 , 9 ], the authors demonstrate that wearable and other smart devices could reduce the incidence of DFUs by providing continuous long-term monitoring and feedback, which may allow better long-term management of DFUs. Wearable devices can reduce the demand on clinics, the need to travel and the time lag between check-ups [ 8 ].…”

“…For example, the point-of-care Podimetrics SmartMat can alert to the potential onset of ulceration if the 2.2 °C threshold between identical sites on opposite feet is exceeded [ 27 ]. The pressing need for integrating this similar functionality into wearable devices has been highlighted by Golledge et al [ 9 ], who stated the need for more user-friendly sensors to automate home foot temperature monitoring. This need can be achieved by implementing temperature sensing into insole or shoe-based wearable devices; which can provide long-term and continuous measurements of foot temperature.…”