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One of the main symptoms of diabetes mellitus patients is the lack of feeling in their feet. The lack of protective pain perception means that diabetics can easily develop foot ulcers, which can lead to amputation. Diabetics have a 20 times greater risk of foot amputation. Now an IST project, Diafoot has developed an enhanced method of monitoring diabetic patients' feet using advanced data logging and communication technologies. With some 50 to 60 million people across Europe likely to suffer type 2 diabetes in the coming years, the resulting impact on the economy of national health services can be severe. The partners in Diafoot have developed a system for remote monitoring of patients' feet, not just within the clinic but while they go about their everyday lives. Using a specially designed insole with embedded measuring devices, the system is capable of monitoring pressure at various points on the soles of the feet, foot temperatures and humidity. This data is logged using small portable devices that patients wear on their clothing, and which can then be connected to a PC or mobile phone to upload the data to the clinic for further analysis. Advantages for both patient and clinic According to project manager Enrique Montiel Parreno, of INESCOP in Alicante, this new technology represents a significant advance on earlier systems. "Diafoot is a true monitoring system compared to other products which are solely for diagnostic use within the clinic. We can now monitor patients in real-life, and measure the pressures on different areas of their feet as they go about their daily activities." The second key advantage, he believes, is the improvement in the clinical support offered. "We can correlate all this data with the efficiency of the insole design. We can examine the efficiency of the materials used to manufacture the insole, and refine the design and specifications to improve the protection these insoles offer to patients." For the diabetic patient, the advantages of the system are very real. At present, diabetics have to visit the hospital regularly every 45 and 60 days, and during this period no information about possible problems is available until the next visit. Now they can enjoy extended periods without direct visits, using the Diafoot system to update the clinician on their progress. Health providers also benefit. Diafoot is expected to reduce the number of amputations required by around 20 per cent, which apart from the human cost could mean a saving for healthcare services of 30,000 euros per patient in minor amputations and 60,000 euros in major amputations. In addition, the savings in costs of prosthesis manufacture, rehabilitation and associated hospitalisation expenses should be factored in. Such savings in treatment costs directly impact the efficacy of the hospital management budget. Integrating different technology elements The technology behind Diafoot is based on integrating a number of separate elements to provide new procedures for the remote monitoring of patients with diabetes, as well as new sensor and data acquisition/analysis techniques. The key elements are: Specific micro-sensor systems that are non-aggressive both to the human foot and as regards radio frequency. Temporary data-logger units that store the appropriate data files. A base unit, that link the data-logger via TCP/IP, modem, GSM and/or GPRS to the central service. A central server at the clinic for data input, storage and analysis. The various project partners have all played their part in the design and development of the system. They include the Virgen del Consuelo Clinic, part of the Nisa Hospital Group in Valencia; the Miguel Hernandez University in Elche; the University of Pisa and the CGS industrial consultancy in Pisa. Clinicians at these organisations are now involved in testing the system on patients and finding ways to further refine the technology. Results will influence footwear designs The technologies developed in Diafoot can bring an enormous benefit to diabetic patients in terms of continuous monitoring and consequent improved support from clinics. However the results of the project have also contributed towards the creation of a standard diabetic foot protocol, based on the use of telematic applications and a wider coverage of at-risk patients (some 25 per cent of all diabetic patients). Diafoot results are also highly relevant to the insole manufacturers, and are likely to influence existing materials and footwear as well as those products designed to meet the specific requirements of individual patients. Promoted by the IST results Service.