Technology support for diabetes

Digital support for diabetes

We also want to support people with diabetes at home. After all, good care doesn’t stop at the doctor’s surgery. It is particularly important to take action early on when it comes to foot problems. By checking their feet regularly themselves, people can spot small changes sooner. In this way, we can help prevent serious foot wounds.

Reason

Diabetes is a common chronic condition. A serious complication is the development of foot ulcers. Another term for ‘foot ulcer’ is ‘ulcus’. A foot ulcer can develop as a result of nerve damage, reduced blood flow, or an infection. Foot ulcers often lead to hospital admissions and sometimes even to amputations. This has a major impact on quality of life. It also places a heavy burden on the healthcare system. That is why it is important to identify risks as early as possible.

The Diabetes Foot Check app

To help people check their feet regularly, we developed the Diabetes Foot Check app during the first wave of the coronavirus pandemic in 2020. This enabled us to ensure continuity of care even during a period when face-to-face healthcare appointments were limited. The app sends users a reminder to check their feet. In this way, the app helps to make self-monitoring a regular habit.

In the app, users are given guidance on what to look out for, such as cuts, discolouration or swelling. They also answer screening questions about their feet. Sometimes we ask them to send a photo. This is assessed by a team of diabetic podiatrists. If we notice anything unusual in the photo or in the answers, we will contact them for advice or to arrange an appointment.

Project Technology Support for Diabetes

We saw that the app can help people take an active approach to their health. At the same time, we noticed that continued use is not a given. That is why, together with Eindhoven University of Technology, Fontys University of Applied Sciences and Stofloos, we launched the research project ‘Technology Support for Diabetes’.

This two-year study was funded by Regieorgaan SIA. The aim was to further improve the app and make it more user-friendly. The result is the latest version of the Voetencheck app. With these improvements, we aim to help prevent serious foot problems.

Results

Following the further development of the app, we investigated how users and podiatrists experience the app.

Most participants were positive. They see the Voetencheck app as a practical tool for regularly checking their feet for signs of a foot wound. In particular, the ease of carrying out the check and the simplicity of sending a photo were cited as key benefits. During the study, we observed three patterns of use:

1. Consistent usage
2. Common usage
3. Rarely or never used

These differences highlight what helps and what makes usage more difficult. What helps is that the app is easy to use and that contacting the podiatrist is straightforward. Support from those around the user also appears to be important. What makes usage more difficult are limited digital skills and difficulty in maintaining regular use.

Podiatrists report that the app enables them to receive early warnings of potential problems more quickly. It also allows them to monitor clients remotely. It remains important to actively discuss the app during consultations.

Follow-up examinations

The evaluation study highlighted a number of issues. To address these, follow-up studies have been launched. By further improving the Voetencheck app, we can strengthen self-care. This can also help to reduce the workload for healthcare professionals.

MEDIS project

The first follow-up study is the MEDIS project. Within this project, we are investigating how support from others helps people to continue using the app. We are looking at the role of informal carers and healthcare professionals. We are also investigating how the app can provide them with practical support.

Foot Check AI project

The Voetencheck AI project is also currently underway. In this project, we are investigating how artificial intelligence can assist with the use of the app. This includes support for taking photos of feet and help with assessing risks. This enables podiatrists to identify serious situations more quickly and focus their time on those at the highest risk.

Through these studies, we continue to work towards healthcare that is safe, accessible and well-founded.

Supporting partners

This research project is supported by a network of national and international partners. They contribute ideas and advise on progress and further development. By working together, we link practice, research and policy. In this way, we contribute to better prevention and support for people with diabetes.

The supporting partners are:

• Dutch Diabetes Federation
• Diabetes Fund
• Dutch Diabetes Association
• Gelderse Vallei General Practitioners
• Gelderse Vallei Hospital
• Regiozorg.nu
• Ketenzorg West Friesland
• FIP-IFP
• Global French-speaking Digital University
• Zilveren Kruis
• CZ Group
• Knowledge Institute for Podiatric Care
• Dutch Association of Podotherapists