An interdisciplinary research team at Worcester Polytechnic Institute (WPI) has received a $1.2 million award from the National Science Foundation to develop a smart phone application that will help people with advanced diabetes and foot ulcers better manage their disease. The four-year project will be organized through WPI’s Healthcare Delivery Institute (HDI) in collaboration with diabetes and wound care specialists at the University of Massachusetts Medical School.
The proposed application, currently dubbed sugar would be installed on a smart phone and integrated wirelessly with a personal glucose meter and scale. The application would track and archive blood sugar levels and weight, and use the phone’s camera to capture and analyze images of lesions known as foot ulcers, which are potentially dangerous complications that affect people with advanced, uncontrolled diabetes.
“This is an ambitious project that we hope will create a useful tool for people who are dealing with advanced diabetes,” says Diane Strong, PhD, one of the project's leaders, who is a professor in WPI’s School of Business and a health information technology expert. “We appreciate the National Science Foundation’s support for our approach to combine technology development and clinical expertise into a unified team to address this challenge.”
The importance of managing weight and blood sugar to control diabetes is well known, and the application will have embedded data and algorithms drawn from clinical experience that will prompt patients with specific messages based on their weight and blood sugar readings over time. The application will also track the progress of a patient’s foot ulcers, which are often caused by neuropathy and reduced circulation to the extremities, common complications of advanced diabetes.
Left untreated, foot ulcers can develop into serious infections and lead to amputation. According to the American Diabetes Association, some 70,000 people with diabetes have lower-limb amputations each year, accounting for more than 60% of all non-traumatic lower-limb amputations in the United States. Nearly 80% of foot and leg amputations in patients with diabetes are complications from foot ulcers.
“The application will provide relevant, personalized feedback for the patient that encourages them to make good decisions,” says Bengisu Tulu, PhD, assistant professor at WPI’s School of Business, a health information technology expert and one of the leaders of the project. “The reality is that nearly all the management of a person’s diabetes is done by the patient, away from a doctor’s office or clinic. So we envision this new application as a way to help these patients achieve better outcomes.”
Strong and Tulu are founding members of HDI. Also working on the “sugar” project are HDI executive council member Emmanuel Agu, PhD, associate professor of computer science at WPI, who will lead the software development for the new application, and Peder Pedersen, PhD, professor of electrical and computer engineering at WPI, who will work with the HDI team and direct the image processing component of the application. Throughout the project, WPI students will participate in the research and development. “This is wonderful opportunity for our students to work together on teams with senior researchers and clinical partners, to help develop an exciting application that meets a real medical need,” Agu said.
Currently, treating chronic foot ulcers is a significant challenge because walking on ulcerated feet causes further trauma. Even the action of having affected patients come to a physician’s office for an examination can cause additional injury and stress. A novel aspect of the application would give patients more control over the care of their foot ulcers. The patient, or someone else in the home, would photograph the ulcers on a regular basis then use embedded tools in the application to monitor the ulcers’ status.
The application would deliver prompts with objective measures of the progress of their ulcers to help patients decide if staying home and dressing the wounds is sufficient or if a doctor’s visit is needed for further assessment.
“If the new application can provide helpful feedback to the patient, letting them know the ulcer is healing, or at least is stable, then it could limit the number of times these patients need to be transported to a doctor’s office or clinic, which is better for everyone involved,” Pedersen states.
The WPI team will work closely with four colleagues at UMass Medical School: David Harlan, MD, professor of medicine and pediatrics and Co-Director of the the Diabetes Center of Excellence at UMass Memorial Medical Center; Raymond Dunn, MD, professor of surgery and chief of plastic and reconstructive surgery at the medical center; Ronald Ignotz, PhD, adjunct professor of cell biology and research scientist in the Department of Surgery; and Sherry Pagoto, PhD, associate professor of medicine and a licensed clinical psychologist at the UMass Memorial Weight Center.
“Many with diabetes will tell you that managing their illness is like a second and demanding full time job. And that is especially true if complications, like foot ulcers, arise,” Dr. Harlan says. “All our clinical care delivery efforts are designed to support the patient so that much of their care can be delivered in the patient’s home, when it is convenient for them with their busy lives. Until we can eliminate any of our patients from suffering wound ulcers, which is our ultimate goal, we’re terrifically excited by the work we’re doing with the WPI team to facilitate proper wound care and thereby avoid amputations.”
The first two years of the project are slated for technology research and development, leading to a prototype for refinement. If the development phase proceeds as planned, the second two years of the project will test the new application in a clinical trial at UMass Medical School.