Electrochemical skin conductance (ESC) is a non-invasive measurement of the sudomotor function. It measures sweat gland nerve supply and assesses disorders of the autonomic nervous system, which is part of the peripheral nervous system.
Why is ESC important?
A significant number of diabetes patients will be affected by diabetic peripheral neuropathy (DPN) in their lifetime, and the percentage of diabetes patients who might develop a diabetic foot ulcer (DFU) is also considerable. In addition, studies have shown that the 5-year mortality rate of DFU is comparable to cancer mortality. Given these urgent concerns, electrochemical skin conductance is a crucial tool for health care providers.
But this key measurement doesn’t just provide an essential health care solution. Consider the increased average medical costs for patients with diabetes, the billions of dollars in costs for patients with DFU in addition to the costs of the diabetes itself, and the tens of thousands of dollars in per-patient Medicare reimbursement and reimbursement per patient with diabetes-related foot amputation. It’s clear that electrochemical skin conductance can reduce the costs of diabetes patient care, as well as many of the risks to patient health.
Unfortunately, the current diabetes patient journey presents significant roadblocks, including the low percentage of diabetes patients who actually have an annual foot exam, the number of patients who are misdiagnosed due to unreliable tools, and the lack of patient monitoring. These issues highlight the need for connected health products that can measure ESC and other key biomarkers. These devices and systems can empower patients to take charge of their home health monitoring and motivate them to make beneficial lifestyle changes. They can provide care teams the consistent, accurate data they need to make the right treatment decisions, elevating overall care and improving health outcomes. And of course, they can lower care costs. The health risks to diabetes patients are real and significant — but real and significant solutions exist that can create positive impacts all around.
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Delivering a breakthrough biomarker in the at-home setting
An estimated 38.4 million people in the U.S. have diabetes, according to the Centers for Disease Control and Prevention. Up to 70% of people with diabetes will be affected by diabetic peripheral neuropathy, and nearly half have no symptoms to alert them that it’s happening. This often silent condition increases the risk of foot ulcers and potential amputations. Patients with diabetic foot ulcers have a two-fold greater increase in mortality.
Unfortunately, diabetic neuropathy is often not discovered until it is well advanced when it may be irreversible. Early diagnosis of diabetic peripheral neuropathy is critical for preventing further complications, but diagnostic tools have been lacking in identifying the condition in the asymptomatic early stages.
A common side effect of diabetes, peripheral autonomic neuropathy often is a result of poorly controlled blood sugar. The high blood sugar concentrations damage blood vessels, restricting their ability to deliver nutrients and oxygen to small nerves. This causes the nerves to die. Poor sweat gland function leads to drier skin and increased risk of cracking and wounds. Uncontrolled diabetes can affect circulation. The resulting poor circulation makes it more difficult for wounds to heal. In some cases, this leads to amputation.
To manage these issues, the American Diabetes Association recommends annual foot exams, but these appointments are often skipped by patients. Even when patients are compliant, their care teams have been reliant on invasive and frequently inaccurate methods of detecting diabetic peripheral neuropathy. They typically have relied on monofilament to press on the foot, which results in misdiagnosis 47% of the time.
The only other alternative was for patients to undergo painful skin biopsies, the prospect of which is not appealing to diabetic patients, who are at high risk of infections and lengthy wound healing.
Addressing the gaps in diagnosing diabetic peripheral neuropathy
Peripheral neuropathy is a common cause of diabetic foot ulcers. Early detection and appropriate treatment of foot ulcers may prevent up to 85% of amputations, according to the American Academy of Family Physicians.
That’s why it’s critical for the journey to diagnosing diabetic peripheral neuropathy to change. Addressing these serious complications much earlier will improve care teams’ ability to diagnose and provide higher quality care. Though there is no cure for diabetic peripheral neuropathy, diagnosing it early can help providers intervene and encourage patients to make lifestyle changes to slow the progression.
To provide a more reliable tool to healthcare providers, Impeto Medical - now part of Withings - invented SudoscanⓇ, a device that measures the sudomotor function. That is, the autonomic nervous systems’ control of sweat glands. Sudomotor dysfunction is one of the earliest signs of peripheral neuropathy in diabetes and other diseases. The test uses sweat production in the feet and then analyzes the body's response.
When a patient steps on the Sudoscan, it sends a small painless current to the feet using electrodes to stimulate the sweat glands and small nerve fibers. This causes an electrochemical reaction and induces a current that produces an Electrochemical Skin Conductance score indicating the level of sweat gland function loss.
The Sudoscan provides a quantitative measure of chloride conductance, serving as a biomarker to assess sweat gland function in relation to sweat gland innervation. High conductance means no dysfunction whereas low conductance is indicative of dysfunction of sweat glands and the presence of neuropathy.
Used by hospitals for more than a decade, the Sudoscan has been proven in comparison with the existing methods. It soon became the gold standard for diagnosing diabetic peripheral neuropathy at its earliest stages. However, since it was only available at hospitals, care teams were limited to monitoring patients’ progress only once or twice a year.
Bringing the gold standard to patients’ homes
Withings embedded Sudoscan’s breakthrough technology in its Body Pro 2 cellular scale. This one-of-a-kind device complements in-hospital monitoring with the ability to track patients’ progress day to day from the convenience of their own homes. Body Pro 2, CE marked in Europe and available upon prescription in the US, has been tested to validate that it offers the same accuracy level as the Sudoscan.
With this move, Withings Health Solutions pioneered a modular approach to in-home monitoring devices, offering the Electrochemical Skin Conductance Score as its first biometric measurement in a cellular scale.
Supporting early interventions and lifestyle changes
Body Pro 2 contributes to early detection of peripheral autonomic neuropathy. The device allows for consistent remote monitoring of patients on a daily basis to identify any deterioration in sudomotor function. By facilitating easy, daily screening, it helps care teams to track patients’ risk of diabetic peripheral neuropathy, allowing for early intervention with coaching, diet and exercise changes, medications, vitamin prescriptions, and other measures to slow and hopefully prevent complications.
Similarly, if a patient has already been diagnosed with peripheral autonomic neuropathy, the device can help in the follow-up by monitoring disease progression or improvement. Patients can follow their own progress as well, helping to motivate them to continue making lifestyle changes to reduce their chances of complications.
Improving patient outcomes
Body Pro 2’s ability to support healthcare professionals better care for patients with diabetes is a major turning point for the healthcare industry. Electrochemical Skin Conductance is a breakthrough measurement that provides physicians access to the health data they need to make critical decisions about their patient’s health. Body Pro 2 will transform a traditionally underdiagnosed condition to one that can be regularly monitored from the patient’s home.
As further modules are released, care teams will be able to gain a holistic view of patients for better disease management and improved patient outcomes.
[post_title] => Pioneering Real Change in Diabetes Care
[post_excerpt] => Up to 70% of people with diabetes will be affected by diabetic peripheral neuropathy, and nearly half have no symptoms to alert them that it’s happening. This often silent condition increases the risk of foot ulcers and potential amputations. Patients with diabetic foot ulcers have a two-fold greater increase in mortality.
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Calls have been growing louder to more effectively address the related problems of diabetes-related foot ulcers (DFUs) and amputations, two of the most serious consequences of diabetes-related peripheral neuropathy (DPN). Health associations like the American Diabetes Association® (ADA), patient advocacy groups, patients, and providers all see the need to improve the detection of DPN, earlier intervention, and more effective treatments to combat an amputation problem that disproportionately impacts communities of color and lower economic status.
Unfortunately, there is not a large body of research related to the question of simple compliance with the ADA’s standard of an annual foot exam for people with diabetes. However, a study published in Clinical Nursing Research journal in 2017 indicated only 16% of patient charts reviewed in a specialty clinic met the ADA’s standard for an annual foot exam. Clinicians regularly report seeing patients who present with serious DFUs who have never had a proper foot examination.
With the goal of promoting patient education on diabetes-related foot health, earlier detection of neuropathy, and regular diabetes-related foot exams, Withings has partnered with the ADA’s Project Power to put smart scales in the homes of approximately 2,305 participants in 849 cities with particularly high-risk and vulnerable communities. Project Power’s goal is to reduce diabetes risk factors and improve diabetes health literacy, self-care behaviors, and glycemic management. The program is conducted with a combination of in-person and remote sessions that focus on topics such as nutrition, exercise, emotional health, heart health, glucose monitoring, and foot health.
Sherry Hill, program director for Project Power, commented, “We are excited to be working with Withings to bring the Project Power participant experience to the next level. By bringing smart scale technology into our participants’ homes, we hope to provide personalized solutions to achieve healthier living goals to reduce the risk for type 2 diabetes and help prevent or delay its complications.”
For Withings, Project Power is one of the many examples of how its sophisticated health technology is being used to better connect patients and their health coaches with appropriate care from a clinician. By flagging potential issues earlier and setting up regular monitoring, patient health outcomes can be improved. Through early interventions, lifestyle changes have a better chance of slowing complications.
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[post_title] => The ADA and Withings Join Forces to Reduce Diabetes Risk and Complications
[post_excerpt] => Peer-reviewed studies have shown that only a fraction of people with diabetes comply with the American Diabetes Association (ADA) standard of annual foot exams. The ADA is now using Withings smart scales in its signature Project Power program to promote regular foot exams and better foot health for people at high-risk for diabetes
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According to the Centers for Disease Control and Prevention (CDC), over half (51.8%) of U.S. adults have at least one diagnosed chronic condition, including arthritis, asthma, diabetes, and hypertension. Connected health devices have an important role to play in helping patients with chronic illnesses improve their quality of life. In this article, we explore how these devices can help physicians and patients manage their chronic conditions and make the lifestyle changes needed to realize their wellness goals. We’ll wrap up with three real-life use cases that highlight how connected health devices are being used to empower patients and improve health outcomes.
Patient stepping on a Withings connected scale
Benefits of Connected Health Devices for Managing Chronic Illness
The nature of chronic conditions is that they can develop gradually over time. This is problematic because the deterioration can go undetected. Connected health devices can help patients and their healthcare providers more quickly identify the progress of diseases and better manage them for greater wellness. Here are five important benefits of using connected health devices.
Earlier detection of deteriorating health
Connected devices can help to increase the frequency of health checks in between in-office doctor visits, providing a more accurate view of patient health for providers to base treatment. Additionally, connected health devices act as an early warning system, alerting patients and approved medical providers when a patient’s health metrics aren’t ideal. They can also flag an unexpected sudden deterioration, limiting the risk of further complications. With vital health metrics monitored at frequent intervals, providers can intervene more quickly to prevent additional health complications, such as poorly-managed diabetes triggering hypertension.
Increase patient-provider bond
Remote patient monitoring (RPM) programs can create a stronger connection between patients and providers as patients have confidence that their conditions are being closely monitored. During office visits, providers have the opportunity to use the patient’s data as part of the shared decision-making process, allowing patients and providers to work together to create a care plan or fine-tune an existing one. Participation in an RPM program also provides physicians with an additional tool to track patient adherence to treatment plans.
Track progress toward health goals
Connected health devices empower patients to play a more active part in achieving their own wellness goals. When readings are taken daily or several times per week, patients can more easily track their progress. More frequent health measures help patients see how lifestyle choices like exercise and diet directly impact their health.
Share patient health data across a patient’s entire care team
With patient consent, health data from connected devices can be accessed by the patient’s entire care team. Especially for patients with complex health profiles, data from connected devices can foster greater collaboration between providers.
Expand provider capacity
Today, many healthcare systems are stretched thin. Remote patient monitoring empowers healthcare providers to be more proactive in managing patient care. Patients with well-managed chronic conditions are less likely to require more costly and resource-intensive acute care.
Use Cases for Connected Health Devices
The opportunities for remote patient monitoring and connected health devices are nearly endless, ensuring that conditions are detected early before complications can develop. This is even more important as all these conditions are linked with one another. To demonstrate how beneficial this technology can be, here are three ways RPM programs are being used successfully to improve health outcomes.
Diabetes prevention and obesity
Patients use a cellular- or Wifi-enabled digital scale to take frequent body weight measures, which can be automatically transmitted to the healthcare provider. Providers can use this data to spot trends, track adherence to a treatment plan, and evaluate the effectiveness of a weight management program. Frequent body weight measurements also help patients see how lifestyle choices directly impact their health.
Hypertension
Patients diagnosed with hypertension use a wireless blood pressure cuff to monitor their blood pressure regularly. This device automatically collects and transmits the reading, often with just the touch of a button. Using an RPM device for managing hypertension allows healthcare providers to track a patient’s blood pressure over time and can alert them to dangerous spikes in blood pressure that may require urgent intervention.
Sleep conditions
Sleep conditions like sleep apnea can be silent and are underdiagnosed. Using a sleep tracking mat helps to provide an objective measure to identify these conditions. Sleep specialists can use an under-mattress sleep mat to track a patient’s sleep patterns remotely, capturing metrics such as interruptions, time in bed before sleep, time to get out of bed in the morning, and other factors that can affect sleep quality. Some sleep mats, such as Withings’, can also detect snoring.
Withings Connected Devices for Managing Chronic Illness
Connected health devices are an important part of managing chronic illness. With over a decade of industry experience, Withings Health Solutions offers medical-grade devices that feature intuitive designs that encourage high user adoption and retention rates, including a sleep tracking mat, blood pressure monitor, and scale. And our physician dashboard offers intuitive, continuous access to patients’ critical health data in near-real time for actionable information to guide care.
Learn more about the Withings Health Solutions portfolio of smart health devices or request a demo.
Delivering a breakthrough biomarker in the at-home setting
An estimated 38.4 million people in the U.S. have diabetes, according to the Centers for Disease Control and Prevention. Up to 70% of people with diabetes will be affected by diabetic peripheral neuropathy, and nearly half have no symptoms to alert them that it’s happening. This often silent condition increases the risk of foot ulcers and potential amputations. Patients with diabetic foot ulcers have a two-fold greater increase in mortality.
Unfortunately, diabetic neuropathy is often not discovered until it is well advanced when it may be irreversible. Early diagnosis of diabetic peripheral neuropathy is critical for preventing further complications, but diagnostic tools have been lacking in identifying the condition in the asymptomatic early stages.
A common side effect of diabetes, peripheral autonomic neuropathy often is a result of poorly controlled blood sugar. The high blood sugar concentrations damage blood vessels, restricting their ability to deliver nutrients and oxygen to small nerves. This causes the nerves to die. Poor sweat gland function leads to drier skin and increased risk of cracking and wounds. Uncontrolled diabetes can affect circulation. The resulting poor circulation makes it more difficult for wounds to heal. In some cases, this leads to amputation.
To manage these issues, the American Diabetes Association recommends annual foot exams, but these appointments are often skipped by patients. Even when patients are compliant, their care teams have been reliant on invasive and frequently inaccurate methods of detecting diabetic peripheral neuropathy. They typically have relied on monofilament to press on the foot, which results in misdiagnosis 47% of the time.
The only other alternative was for patients to undergo painful skin biopsies, the prospect of which is not appealing to diabetic patients, who are at high risk of infections and lengthy wound healing.
Addressing the gaps in diagnosing diabetic peripheral neuropathy
Peripheral neuropathy is a common cause of diabetic foot ulcers. Early detection and appropriate treatment of foot ulcers may prevent up to 85% of amputations, according to the American Academy of Family Physicians.
That’s why it’s critical for the journey to diagnosing diabetic peripheral neuropathy to change. Addressing these serious complications much earlier will improve care teams’ ability to diagnose and provide higher quality care. Though there is no cure for diabetic peripheral neuropathy, diagnosing it early can help providers intervene and encourage patients to make lifestyle changes to slow the progression.
To provide a more reliable tool to healthcare providers, Impeto Medical - now part of Withings - invented SudoscanⓇ, a device that measures the sudomotor function. That is, the autonomic nervous systems’ control of sweat glands. Sudomotor dysfunction is one of the earliest signs of peripheral neuropathy in diabetes and other diseases. The test uses sweat production in the feet and then analyzes the body's response.
When a patient steps on the Sudoscan, it sends a small painless current to the feet using electrodes to stimulate the sweat glands and small nerve fibers. This causes an electrochemical reaction and induces a current that produces an Electrochemical Skin Conductance score indicating the level of sweat gland function loss.
The Sudoscan provides a quantitative measure of chloride conductance, serving as a biomarker to assess sweat gland function in relation to sweat gland innervation. High conductance means no dysfunction whereas low conductance is indicative of dysfunction of sweat glands and the presence of neuropathy.
Used by hospitals for more than a decade, the Sudoscan has been proven in comparison with the existing methods. It soon became the gold standard for diagnosing diabetic peripheral neuropathy at its earliest stages. However, since it was only available at hospitals, care teams were limited to monitoring patients’ progress only once or twice a year.
Bringing the gold standard to patients’ homes
Withings embedded Sudoscan’s breakthrough technology in its Body Pro 2 cellular scale. This one-of-a-kind device complements in-hospital monitoring with the ability to track patients’ progress day to day from the convenience of their own homes. Body Pro 2, CE marked in Europe and available upon prescription in the US, has been tested to validate that it offers the same accuracy level as the Sudoscan.
With this move, Withings Health Solutions pioneered a modular approach to in-home monitoring devices, offering the Electrochemical Skin Conductance Score as its first biometric measurement in a cellular scale.
Supporting early interventions and lifestyle changes
Body Pro 2 contributes to early detection of peripheral autonomic neuropathy. The device allows for consistent remote monitoring of patients on a daily basis to identify any deterioration in sudomotor function. By facilitating easy, daily screening, it helps care teams to track patients’ risk of diabetic peripheral neuropathy, allowing for early intervention with coaching, diet and exercise changes, medications, vitamin prescriptions, and other measures to slow and hopefully prevent complications.
Similarly, if a patient has already been diagnosed with peripheral autonomic neuropathy, the device can help in the follow-up by monitoring disease progression or improvement. Patients can follow their own progress as well, helping to motivate them to continue making lifestyle changes to reduce their chances of complications.
Improving patient outcomes
Body Pro 2’s ability to support healthcare professionals better care for patients with diabetes is a major turning point for the healthcare industry. Electrochemical Skin Conductance is a breakthrough measurement that provides physicians access to the health data they need to make critical decisions about their patient’s health. Body Pro 2 will transform a traditionally underdiagnosed condition to one that can be regularly monitored from the patient’s home.
As further modules are released, care teams will be able to gain a holistic view of patients for better disease management and improved patient outcomes.
[post_title] => Pioneering Real Change in Diabetes Care
[post_excerpt] => Up to 70% of people with diabetes will be affected by diabetic peripheral neuropathy, and nearly half have no symptoms to alert them that it’s happening. This often silent condition increases the risk of foot ulcers and potential amputations. Patients with diabetic foot ulcers have a two-fold greater increase in mortality.
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