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www,diabeticfootonline.com

Diabetes confers a dramatically increased risk of foot ulceration: Prevention by identifying the individuals at high risk of ulceration remains the most effective way to address this complication. High temperature gradients between the feet predict the onset of frank skin breakdown or ulceration.

Introduction: Diabetes related amputations remain the single most factor leading to the high mortality rates in this population. Apart from the socio-economic consequences, the disease pathology is irreversible. A person with diabetes related amputation is 50% likely to have another amputation within 2 years and 75% likely to die within 5 years. Despite a surprisingly high 5-year mortality associated with this preventable scourge, the lay public and press seem largely unaware and policy-makers have failed to appropriately respond. Prevention is an essential permissive factor to contain the disease pathology leading to amputations. However, diabetes related foot complications (also termed as diabetic foot disease) remain an orphan disease and the lay public, media, healthcare community and policy makers throughout the world must join together in this battle to save limbs.

Limitations: Significant progress has been made key areas such as offloading, aggressive wound healing and prevention to improve overall healthcare outcomes. Even with a very high success rate of healing, “keeping these wounds healed” and preventing recurrences remains a challenge. Southern Arizona Limb Salvage Alliance with it’s national/international collaborators has been working for more than a decade now to address this issue. This has resulted in three federally funded randomized clinical trails, all suggesting that home monitoring of foot temperatures reduces rates of re-ulceration by 4-10

times. A temperature difference of 2.2 Degree C or 4 Degree F is a cause for concern as demonstrated by these robust clinical studies. Skin temperature palpation is a key screening component in patient a s s e s s m e n t s b y p o d i a t r i s t s , physicians, and endocrinologists. However, manual palpitation is highly s u b j e c t i v e a n d i n e f f e c t i v e i n determining subtle temperature

differences.

Progress so Far: A wound is defined as frank skin ulceration or simply a breakdown of the skin tissue. This increases the risk of contamination and subsequent infection, leading to a traumatic amputation. These wounds are preceded by inflammation and therefore, “heat up” before the skin breaks down.

Over the last decade, we have seen a transition of clinic based thermometry (beginning from infrared thermography and liquid crystal thermography) to home monitoring modalities using handheld dermal thermometers. This progress has enabled us to characterize disease pathology, identify pre-ulcerous thermal patterns and develop meaningful protocols to guide patients for self-monitoring. To summarize, this concept of thermal monitoring is real, feasible and

validated, there is now room for advancing the knowledge (for example, combining pervasive healthcare and thermal monitoring techniques),

innovation and outreach to developing nations. Why Temperature?

TempTablet: Temperature Monitoring for the Diabetic Feet S

Infrared Handheld Dermal Thermometer

Infrared Thermal Camera: Thermal images showing high risk “inflammed” areas.

“Wounds tend to heat up before they break down”; Measuring temperature daily keeps a check on any pre-ulcerous inflammation and

helps modulate patients physical activity. Offloading or staying off feet and dosing physical activity helps prevent diabetic foot ulcers much as

dosing insulin for diabetics.

Every

30 seconds a limb

is lost d

ue to

diabetes!

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The Futuristic Solution: TempTabletTempTablet is a microcontroller based sensor array, built similar to weighing scale with special foot positioning and heel support configuration to measure as well as compare same points on both feet daily. It’s “diabetes” specific ergonomic design includes, voice & visual prompts, intuitive design, minimal instruction, little or no maintenance, water/shock resistance, auto shut down, two year battery life (4 AA Alkaline, rechargeable), remotely upgradable firmware via normal SD card rotation, portability, self calibration, light weight (<1 Pound), high response time (< 30 Seconds) per measurement and date/time stamped data recording on

external memory card (SD Cards) upto four years. TempTablet provides both a visual and vocal annunciation of the daily status in the language of choice (English, Hindi & Spanish are the first

available), but other other languages available on request. The data is archived in an easy to use Windows application (Available free with the unit).

Device Features:What’s distinctive about the TempTablet, is the ability for pervasive computing and telemedicine for clinical purposes. (Optional; Enhanced TempTablet) It can be easily included in a Diabetes Disease Management program, where the clinician can have data management performed centrally by using the TempTablet’s Interchangeable communication modules including landline, WiFi, WiMax, Bluetooth, Ethernet, ANT and GSM and Base station gateway for other telemedicine devices (ideally suited for in patients in a hospital setting).

The device was designed primarily to produce a compact, robust product at a price point allowing wide distribution to patients in both developed and developing nations. However, Health Management Organizations (HMO’s), insurance companies, and medical distribution groups could purchase the basic/enhanced tablet in large quantities, for distribution to their patients and clients.

TempTablet is the result of several years of progressive research and development in the field of diabetic foot disease. The simplicity of this device is based on the use of 60 discrete sensors (30 for each foot), measuring and mapping the temperature profile under the plantar surface of the feet. Measurement cycle is typically completed in 30 seconds, current measurement compared with the previous (daily, weekly or monthly) profile, data archived for viewing later and the ability to be sent immediately to clinical center/disease management group using telecommunication modality (in enhanced TempTablet). All sensors are grouped strategically for maximum coverage of the whole foot with LED’s at the critical (high pressure areas, prone to inflammation) areas. TempTablet is a personal foot buddy for patients with diabetes, helping them healthy by daily preventive temperature measurement and dosing their physical activity based on these measurements.

Top view of TempTablet with sensor grouping. Ergonomic design with foot shape and heel support.

Side view of TempTablet. Light weight, robust and maintenance free design.

“TempTablet” is a transition from a point based measure using handheld dermal thermometer to a whole field thermal map of the plantar feet: It’s simple, robust and futuristic.

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May 1, 2009 Volume VII

Conlusion: With the increasingly urban population and globalization, there is an increasing incidence of diabetes and it’s subsequent lower extremity complications, resulting in important decrements in the functioning and quality of life. Preventing these foot complications becomes an increasingly prominent concern. Understanding the basic mechanisms involved in setting up prevention initiatives, health economics and healthcare delivery, requires incremental research and guidance to set up effective programs and produce feasible modalities. The by product of such a research initiative, TempTablet is relevant to the success of preventing diabetic foot ulcers and subsequent amputations and therefore the well being of diabetic population.

TempTablet provides an ideal modality for in home use and facilitates potential life enhancement and cost savings. Thirty sensors per feet provide a robust measure of temperature consistently as part of a daily routine, with a bold Liquid Crystal readout, especially for diabetics with retinopathy or eye complications. This keeps the user/patient engaged in self-care, provides excellent quality of the measurements and maintains the chronological integrity of the logs, providing a high compliance rate for the diabetic patients.

It is important to emphasize that this development is not competitive, but rather collaborative and complimentary to the existing temperature measurement as well as monitoring modalities. We hope to continue to succeed in our mission and “Keep a few more legs on a few more bodies”!

TempTablet is a solution for all; It overcomes the barriers in healthcare delivery with a simple, easy to use and portable design, that fits into the daily routine.

Caring for the feet has never been so easy!

Are your Feet in TempTablet?

TempTablet: Save limbs, Save Lives!