Najafi Bijan, Mishra Ramkinker
Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Medicina (Kaunas). 2021 Apr 14;57(4):377. doi: 10.3390/medicina57040377.
About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and multi-disciplinary prevention needed for those at-risk people and address the health care access disadvantage that people living in remote areas. This narrative review paper summarizes some of the latest innovations in three specific areas, including technologies supporting triaging high-risk patients, technologies supporting care in place, and technologies empowering self-care. While many of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease 2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies, and "hospital-at-home" care delivery model. These technologies will be quickly adopted at scale to improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in outpatient or inpatient clinics, and supporting acute or subacute care at home.
全球约有4.22亿人患有糖尿病，其中约三分之一的人存在糖尿病足溃疡的主要危险因素，包括因周围神经病变导致足部感觉减退和/或因外周动脉疾病导致足部血供不足。当前以已确诊足部疾病治疗为中心的医疗生态系统，往往未能充分控制关键的可逆转危险因素，以预防糖尿病足溃疡，导致足部疾病截肢率高得令人无法接受，溃疡第一年复发率达40%，且住院率高。因此，最新的糖尿病足溃疡指南强调，研究重点从孤立的医院治疗向创新的综合社区预防转变，对于应对糖尿病足溃疡的高负担至关重要。可穿戴和数字健康技术的广泛应用和接受，为及时监测与糖尿病足溃疡相关的主要危险因素、增强患者自我护理能力、有效为高危人群提供远程监测和多学科预防以及解决偏远地区居民的医疗服务获取劣势提供了一种手段。这篇叙述性综述文章总结了三个特定领域的一些最新创新，包括支持对高危患者进行分诊的技术、支持就地护理的技术以及增强自我护理能力的技术。虽然这些技术中的许多仍处于起步阶段，但我们预计，鉴于2019冠状病毒病大流行以及目前对足部疾病患者进行去中心化护理的未满足需求，我们将看到数字健康、智能可穿戴设备、远程医疗技术和“居家医院”护理模式领域的新一轮创新。这些技术将迅速得到大规模应用，以改善糖尿病足溃疡的远程管理，智能分诊需要在门诊或住院诊所就诊的患者，并支持在家中进行急性或亚急性护理。
