Each year, more than 150,000 of the 37 million people diagnosed with diabetes in the U.S. undergo a lower extremity amputation, according to the Centers for Disease Control and Prevention — a consequence of the frequent foot wounds associated with the disease. To help avoid this fate, patients and their physicians must keep a close eye on these wounds, typically through frequent clinic visits. Although such appointments can help save lives and limbs, says Johns Hopkins vascular surgeon Caitlin Hicks, they can also be a tremendous burden on patients and their families.

“Patients with diabetic foot wounds usually need transportation and support, as they rarely attend these visits alone. That means that their caregivers may have to miss time at work, pay for gas and parking, and navigate an unfamiliar hospital environment. It’s a tough ask for many patients, especially those negatively affected by socioeconomic disparities,” Hicks says.

But technology may eventually help make these frequent visits a thing of the past, she adds. She and her colleagues are testing a smartphone app developed by a health care technology company that allows providers to track diabetic foot wounds through photos taken by patients. The app scrutinizes these photos using colorimetry, computer vision and artificial-intelligence algorithms to provide wound healing and characteristics over time, helping clinicians make care decisions that maximize outcomes without patients needing to be seen in person.

A number of apps already on the market track diabetic foot wounds, Hicks explains, but they are used exclusively by health care professionals. To look for changes over time, she says, clinicians photograph wounds during office visits, or home health care professionals take photos during home visits. Hicks and her colleagues recently completed a feasibility study on the new app to determine whether photos taken exclusively by patients could fulfill the same purpose. This small pilot study of 25 patients shows that they could halve their clinic visits — coming in just once a month — and achieve similar outcomes to patients coming in every two weeks to have their wounds assessed. The team reported these results as an abstract at the Vascular Annual Meeting (June 14-17) in National Harbor, Maryland, and as a manuscript in Frontiers in Endocrinology.

Hicks and her colleagues were awarded a $189,000 grant from the National Institutes of Health to test the app in a larger, randomized controlled feasibility study involving 120 patients. Half of the volunteers will receive standard care, requiring them to come to in-person appointments every two weeks to have their diabetic foot wounds assessed. The other half will use the app at home, uploading weekly wound photos that are subsequently analyzed by the app and their providers. Results and instructions delivered through the app will inform patients on their progress and whether they need to make a change in their care or schedule a clinic visit.

To make sure this clinical trial is as equitable as possible, Hicks says, study participants without a smartphone will be supplied one. Although the trial will begin at Johns Hopkins, she adds, the plan is for it to expand to more sites nationwide.

“Patients who have already used this app tell us that they really appreciate being able to reduce the number of in-person visits, but also that they feel more engaged in their own care,” Hicks says. “This technology has the potential not only to improve outcomes and lower costs, but also to improve patient satisfaction, which ultimately keeps our patients happier and healthier.”

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