Improving quality of life and life expectancy in diabetes

There are at least 3.3 million people with diabetes in the UK, a number projected to rise to more than 5 million by 2025. In addition to complications with their eyes, people with diabetes are prone to serious, slow to heal ulcers in their feet (Diabetic Foot Ulceration, DFU), which can become infected and lead to amputation.

Mortality rates after DFU and amputation are high: up to 70% of people die within five years of an amputation and around 50% die within 5 years of developing an ulcer.

Besides the adverse effect on patients, it has been estimated that DFU and related complications currently cost the NHS between £972 million and £1.13 billion per year. These sobering statistics highlight that avoiding amputations is key to increasing the quality of life for diabetics and improving survival rates.

Up to 70% of people die within five years of an amputation

Detection of potential ulcer sites on the foot is critical to improving patient outcomes with DFU, enabling doctors to intervene to protect the foot before ulceration occurs. If DFUs are not prevented then there is significant danger of serious infection, which, if not rapidly treated, can lead to gangrene and amputation. Before any visible signs on the foot of possible ulceration, it has been found that in the vulnerable skin area temperatures can rise by more than 1 °C. NPL has exploited this knowledge and our world-leading expertise in thermal imaging metrology to produce a breakthrough medical imaging device, called DFIRST, that generates temperature maps (thermography) of patients’ feet, to provide early alerts of potential problems. Such early detection would give more than a week’s extra time to take preventative action, reducing or even eliminating the ulceration and associated risk of infection.

The research is the outcome of a £1.2 million project funded by the National Institute for Health Research (NIHR) Invention for Innovation (i4i) programme in 2012. Since the project’s inception we’ve gone on to develop four prototypes of the device, and conducted two clinical trials, recording the data of hundreds of patients.

Most modern clinical decisions, from diagnoses, to treatments, are based on advanced pieces of technology which take patient readings. To provide meaningful data on which life-saving decisions are made, these have to be reliable and trustworthy in their readings. Performance testing of the DFIRST device was conducted at NPL; our expertise in the field of quantitative thermal imaging meant that the device was been tested against rigorous standards ensuring it is as trustworthy as possible. Aligning with the trend in home monitoring, NPL’s DFIRST works fast and in a similar way to an ordinary camera meaning it is potentially suitable for home use, empowering patients in their own care and monitoring risk throughout the treatment pathway.

NPL is also working to make sure this breakthrough in medical thermography can benefit other healthcare sectors. The technology could be deployed in many areas where monitoring and mapping temperature is key, such as Charcot foot (another serious and potentially limb-threatening lower-extremity complication of diabetes), reconstructive surgery, gauging an organ’s viability for transplant and tackling chronic wounds.

The value of the global wound care market is expected to reach $20.4 billion by 2021. Using its innovation in DFU, a common chronic wound, as a starting block, NPL is now looking to transform this market and the lives of those that live with chronic conditions.

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