Continuous movement monitoring of daily living activities for prevention of diabetic foot ulcer: A review of literature

Abstract

Lower extremity ulcers represent the most ominous, feared, and costly complications of diabetes mellitus. The aim of this review is to highlight the role of daily life physical activities (PAs) and continuous movement monitoring (CMM) in the prevention of foot ulcers. Peripheral neuropathy and peripheral vascular disease are the main causes of foot ulceration and contribute, in turn, to the development of additional risk factors such as foot deformities and/or joint and muscular alterations. Moreover, a deficit of balance, posture abnormalities, followed by gait alterations, increases the risk of ulceration. PA can play a key role in the management of patients with diabetes and in the prevention of ulcers; however, even if it has been reported that some of these risk factors significantly improve after a few weeks of exercise therapy (ET), the real preventive role of ET has not yet been demonstrated. These uncertain results can occur due to some limitations in the management of the same relationship between PA and diabetic foot prevention. Technological advances during the last years enable timely management of overall daily PA. The use of these modern technologies and devices allows CMM assessment and description of daily PA even in the long term. The data collected from these devices can be used to properly manage patients’ PA and thus contribute to the prevention of foot ulcers.

Mobility advice to help prevent re‐ulceration in diabetes

“…6 Patients with DMPN without an ulcer walk about twice that per day and healthy controls walk 4-5 times as much ( Figure 1). [6][7][8] Despite the fact that high plantar pressures are clearly associated with neuropathic plantar foot skin breakdown, the daily cumulative plantar stress and overall activity level is considerably less for patients that ulcerate compared to patients with DMPN that do not ulcerate and healthy controls. 6,9,10 A likely explanation is that plantar skin tissues become less tolerant of physical stresses in this patient population over time due to the disease progression (i.e.…”

“…Technology and activity monitors may help measure stress during standing and walking, provide warnings to patients when they are approaching their typical daily static and dynamic weight-bearing levels, and help to prevent problems. 8,12,25 Monitoring plantar skin temperatures was introduced many years ago by Brand 2 and controlled trials have shown daily skin monitoring can help to prevent skin breakdown. 26,27 While temperature monitoring holds promise, one randomized controlled trial to increase activity in people with DMPN reported wide variations in patient skin temperature and frequent false positives.…”

“…Although reports vary, patients with DMPN and a history of ulcer take only about 2000 steps per day . Patients with DMPN without an ulcer walk about twice that per day and healthy controls walk 4–5 times as much (Figure ) . Despite the fact that high plantar pressures are clearly associated with neuropathic plantar foot skin breakdown, the daily cumulative plantar stress and overall activity level is considerably less for patients that ulcerate compared to patients with DMPN that do not ulcerate and healthy controls .…”

“…Therefore patients should be cautioned to avoid large variation in weight‐bearing activity. Activity monitors that currently are being developed may be able to help guide patients when they are approaching their own habitual average magnitude and variation of activity . Perhaps patients with very low walking tolerances should be encouraged to use wheelchairs and scooters to facilitate mobility during this transition phase.…”

A review of wearable sensors based monitoring with daily physical activity to manage type 2 diabetes

“…Reducing adverse impacts of gestational diabetes mellitus [95] Physical activity preferences of elderly people with T2D Determine the level of physical activity of elderly people with type 2 diabetes [96] Development of wearable physiologic monitoring devices for use in diabetes management Enhance continuous glucose monitoring [97] Designing an internet-of-things (IoT) and sensor-based in-home monitoring system for assisting diabetes patients Implementation of an internet-of-things (IoT) and wireless sensor system which patients use in their own homes to capture daily activity [98] Continuous movement monitoring of daily living activities Prevention of diabetic foot ulcer [99] Glucose monitoring in individuals with diabetes Long-term implanted sensor/telemetry system and model are used [100] Sensor-based method for glucose monitoring Accuracy, safety and acceptability of the glucose monitoring system in the paediatric population is proposed [101] Continuous glucose monitoring sensors Past and present algorithmic challenges of CGM sensors are introduced [102] Continuous glucose monitoring Use of CGM for adjustment of insulin dosing, and automated interpretation [103] Continuous glucose monitoring Reduce the risk of hypoglycemia [104] T2D management Big data technologies [105] T2D management Predictive models using big data analytics [106] The relationship between diet, physical activity, and T2D Regular PA is a primary component in management of T2D [107] The relationship between physical activity and T2D level of physical activity in people with T2D is analyzed [108] Physical activity and incident type 2 diabetes mellitus Dose-response meta-analysis of prospective cohort studies [109] Physical activity and risk of diabetes PA is associated with reduction in the risk of diabeties [110] Sensor based monitoring of PA to improve glucose management Non-invasive sensors using physiological parameters related to PA to improve glucose monitoring [111] Continuous -Big data, Bandwidth, and computational time: continuous monitoring provides a huge amount of data [115,116].…”