The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future

Abstract

Foot ulcers are common complications of diabetes mellitus and substantially increase the morbidity and mortality due to this disease. Wound care by regular monitoring of the progress of healing with clinical review of the ulcers, dressing changes, appropriate antibiotic therapy for infection and proper offloading of the ulcer are the cornerstones of the management of foot ulcers. Assessing the progress of foot ulcers can be a challenge for the clinician and patient due to logistic issues such as regular attendance in the clinic. Foot clinics are often busy and because of manpower issues, ulcer reviews can be delayed with detrimental effects on the healing as a result of a lack of appropriate and timely changes in management. Wound photographs have been historically useful to assess the progress of diabetic foot ulcers over the past few decades. Mobile phones with digital cameras have recently revolutionized the capture of foot ulcer images. Patients can send ulcer photographs to diabetes care professionals electronically for remote monitoring, largely avoiding the logistics of patient transport to clinics with a reduction on clinic pressures. Artificial intelligence-based technologies have been developed in recent years to improve this remote monitoring of diabetic foot ulcers with the use of mobile apps. This is expected to make a huge impact on diabetic foot ulcer care with further research and development of more accurate and scientific technologies in future. This clinical update review aims to compile evidence on this hot topic to empower clinicians with the latest developments in the field.

The efficacy and safety of non‐surgical treatment of diabetic foot wound infections and ulcers: A systemic review and meta‐analysis

“…The evolving landscape of diabetic foot ulcer management, with ongoing advancements in wound care technologies and a deepening understanding of the disease's pathophysiology, has significant implications for treatment strategies. Our findings contribute to this evolving narrative by highlighting the potential of NSI in improving patient outcomes 24,25 …”

“…Our findings contribute to this evolving narrative by highlighting the potential of NSI in improving patient outcomes. 24,25 However, it's important to consider these findings in the context of the broader healthcare system and patient access to care. The effectiveness of non-surgical treatments also hinges on the availability of resources, patient compliance, and continued healthcare support, which can vary significantly across different healthcare settings and populations.…”

“…Our findings contribute to this evolving narrative by highlighting the potential of NSI in improving patient outcomes. 24 , 25 …”

Protocol for metadata and image collection at diabetic foot ulcer clinics: enabling research in wound analytics and deep learning

“…Although there have been general advancements in diabetes treatment, technologies to promote successful healing and recognizing biomarkers to identify non-healing patients and wound prognosis are still deficient [ 7 ]. To bridge the knowledge gap, aside from using molecular techniques to examine DFU biomarkers, researchers have begun to utilize artificial intelligence (AI) and advanced imaging tools to assess wounds’ severity and improve DFU management [ 7 , 18 ]. As the incidence of infection in diabetics with ulcers is most concerning, the ability to skillfully detect infected or ischaemic DFUs can reduce the risk of hospitalization and, subsequently LLAs.…”

Commentary: Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society

“…Somayaji et al (2017) reiterated that the screening and referral approaches must be consistent and well-integrated to be effective. More recently, Pappachan et al (2022) added that artificial intelligence can be used to improve the remote monitoring of diabetic foot ulcers with the use of mobile apps. Despite these interventions and to save the millions the NHS spends on DFUs, it was advised that everyone should pause and take one step at a time (Saving the NHS Millions, One Step at a Time, 2023).…”