Access to diabetic peripheral neuropathy screening for underserved communities

SUMMARY Health inequities pose serious threats to people in minority groups through exposure to greater socioeconomic risks and less access to healthcare. The economic burden of these inequities is estimated in the hundreds of billions of dollars. Many people in minority groups do not know that they have diabetes, but even among those who are aware of their diabetes, the lack of compliance with recommended annual foot exams is well documented. A shortage of providers—from nurses to specialists—also creates barriers to preventative care and treatment, especially in rural areas. Yet research has shown that screening contributes to better medical and economic outcomes. Diabetic peripheral neuropathy (DPN) is the most common comorbidity of diabetes, but a lack of standard screening protocols is an unmet need in resource limited settings, and no single tool objectively measures the symptoms of DPN. Drawing from our experience in developing and commercializing diabetes-related screening technologies, we will create an accurate, comprehensive, and integrated system for the quantitative detection of DPN. This system will integrate a low-cost smartphone with thermal-imaging capabilities and an AI decision support system for use in primary-care settings, as well as mobile screening and outreach programs. DPN- Doc will combine thermal results with other critical information from a patient’s clinical exam and medical record to give the provider a recommendation for further care. Aim 1 – Identify a portable thermal imaging device. We will select a commercial, off-the-shelf mobile phone–based thermal imager that meets our cost and performance requirements. Aim 2 – Develop an AI classifier and test a smartphone-based user interface. Using our database of cases containing both thermal and clinical data gathered during standard diabetic foot exams, we will develop a classifier able to integrate a variety of data points and produce a recommendation for DPN care. We will incorporate this classifier into our smartphone-based thermal imaging system and test the effectiveness of the new device as compared with standard diagnostic tests for DPN. Aim 3 – Create educational materials that emphasize the importance of continuous foot care and periodic foot exams. In collaboration with graphic artists and medical experts, we will develop highly visual, bilingual (Spanish/English) educational materials in the form of a comic book or fotonovela, a technique we have used previously to address lack of adherence to eyecare screenings. Aim 4 – Evaluate user experience of smartphone-based device. We will evaluate our smartphone-based system and educational materials among 10 potential users who work with underserved populations to gather their feedback on ease of use and communicability.