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. 2023 Jul 27;23(15):6712.
doi: 10.3390/s23156712.

Preventative Sensor-Based Remote Monitoring of the Diabetic Foot in Clinical Practice

Evan Minty  1 , Emily Bray  2 , Courtney B Bachus  2 , Breanne Everett  2 , Karen M Smith  2 , Emily Matijevich  2 , Maryam Hajizadeh  2 , David G Armstrong  3   4   5   6 , Brock Liden  7
Affiliations

Preventative Sensor-Based Remote Monitoring of the Diabetic Foot in Clinical Practice

Evan Minty et al. Sensors (Basel). .

Abstract

Diabetes and its complications, particularly diabetic foot ulcers (DFUs), pose significant challenges to healthcare systems worldwide. DFUs result in severe consequences such as amputation, increased mortality rates, reduced mobility, and substantial healthcare costs. The majority of DFUs are preventable and treatable through early detection. Sensor-based remote patient monitoring (RPM) has been proposed as a possible solution to overcome limitations, and enhance the effectiveness, of existing foot care best practices. However, there are limited frameworks available on how to approach and act on data collected through sensor-based RPM in DFU prevention. This perspective article offers insights from deploying sensor-based RPM through digital DFU prevention regimens. We summarize the data domains and technical architecture that characterize existing commercially available solutions. We then highlight key elements for effective RPM integration based on these new data domains, including appropriate patient selection and the need for detailed clinical assessments to contextualize sensor data. Guidance on establishing escalation pathways for remotely monitored at-risk patients and the importance of predictive system management is provided. DFU prevention RPM should be integrated into a comprehensive disease management strategy to mitigate foot health concerns, reduce activity-associated risks, and thereby seek to be synergistic with other components of diabetes disease management. This integrated approach has the potential to enhance disease management in diabetes, positively impacting foot health and the healthspan of patients living with diabetes.

Keywords: activity monitoring; chronic disease management; diabetes complications; diabetes healthspan; diabetic foot ulcers (DFU); healthcare costs; integrative foot care; remote patient monitoring (RPM); sensor-based monitoring; sensor-enhanced DFU prevention.

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Conflict of interest statement

Evan Minty is under a consulting agreement with Orpyx Medical Technologies Inc. (in capacity as Medical Director of their RPM service) and discloses equity ownership in Orpyx Medical Technologies Inc. Evan Minty has family members in the employ of Orpyx Medical Technologies Inc. Breanne Everett is a co-founder of, and serves as the CEO for, Orpyx Medical Technologies Inc. Karen Smith, Emily Bray, Courtney Bachus, Emily Matijevich, and Maryam Hajizadeh are employees of Orpyx Medical Technologies Inc. Brock Liden sits on the Clinical Advisory Board of Orpyx Medical Technologies Inc. David Armstrong is under a consulting agreement with Orpyx Medical Technologies Inc. and provides both advisory and collaborative contributions.

Figures

Figure 1
Figure 1
Physiologic parameters contributing to tissue damage on a preventative spectrum. Pressure is the first physiologic parameter that provides insights into formation of a DFU or pre-ulcerative lesion and, thus, is deemed preventative when addressed. Following increased levels of sustained pressure, tissues become inflamed and wound precursors develop. Actions surrounding temperature rooted in DFU or pre-ulcerative lesion formation are considered reactive in nature due to the underlying tissue damage that has taken place and led to the temperature increase being detected.
Figure 2
Figure 2
Simplified DFU causal pathway and RPM intervention opportunities.
Figure 3
Figure 3
Suggested clinical actions for patients with concerning trends in pressure, temperature, or adherence domains, or across multiple domains.
See this image and copyright information in PMC

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References

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