Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations
3 min read
This article is based on our November 1, 2024 interview with Dr. Solomon Tesfaye.
When Solomon Tesfaye was a 16-year-old boy in Addis Ababa, Ethiopia, a military regime closed his school and forced the students into national service. Tesfaye, who had by then developed a true passion for learning, desperately hoped to continue his intellectual development and academic journey.
On the urging of his brother, he took a chance and applied for an international scholarship to the prestigious Sevenoaks School in Kent, England. Sevenoaks, a storied boarding school founded in 1432, may have seemed like an unlikely next home for Tesfaye. But they also decided to take a chance on him. Those bets ultimately paid off.
Dr. Tesfaye is now a globally recognized diabetes expert at the University of Sheffield whose research has played a significant role in understanding diabetic nerve damage, how to identify it earlier, and how to potentially treat it before the complications become debilitating. In September, Dr. Tesfaye was honored with a Lifetime Achievement Award at the 34th NeuroDiab annual meeting in recognition of his pioneering research in the field. Tesfaye credits his experience at Sevenoaks School as having kindled his interest in science and his enduring passion for grappling with difficult problems, like diabetic peripheral neuropathies (DPN).
Fast forward to today and Dr. Tesfaye is leading some of the most exciting work on early diagnosis of DPN and clinical strategies for altering its relentless progression. His team at University of Sheffield recently presented findings at The American Diabetes Association Scientific Sessions that found the use of point-of-care testing devices by clinicians (Withings’ Sudoscan in combination with DPNCheck) could significantly improve the detection of DPN over current standard of care methods and provide a rapid, reproducible, and quantitative assessment for busy clinicians.
“For diabetic retinopathy, we’ve been successful using technology to improve diagnosis and care,” said Tesfaye. “But for neuropathy, we’re using these Stone Age implements. With a monofilament, even the best doctors cannot diagnose neuropathy the same two days in a row. Meanwhile, fifty percent (of patients) die within 5 years, it costs more than breast or colon cancer, and is devastating because it’s so painful patients can’t sleep. Sadly, advanced neuropathy is the strongest risk factor for diabetic foot ulceration that results in fifty percent mortality within 5 years, and costs more than breast, colon and prostate cancers, combined. Neuropathy also is devastating as it can also cause distressing foot and leg pain that interferes with sleep.”
Tesfaye is now immersed in a major new study with 160 participants – called OCEANIC – that seeks to determine whether early diagnosis, coupled with robust, early intervention can alter the course of DPN for the better. OCEANIC is using Withings Body Pro 2 smart scales with Electrochemical Skin Conductance (ESC) technology, wearable sensors, and activity trackers, to monitor and share patient progress on metrics including body fat, muscle mass, and ESC score, with the aim of reinforcing lifestyle changes. The study group will receive personalized diabetes education and exercise programs, and weight loss interventions including GLP-1s, to significantly reduce HbA1C.
“Our goal is to explore whether these intensive strategies to manage risk factors can halt or even reverse diabetes-related nerve damage when it is identified at an early stage,” said Dr. Tesfaye. “We want to do for neuropathy what early and routine screening has done for retinopathy – bringing better outcomes to millions of people with diabetes.”
If Solomon Tesfaye’s history is any guide, achieving clear answers to the big questions in the OCEANIC study will be but a waypoint on his journey. He credits a mentor, the late Professor John Ward, with encouraging him to tackle the most meaningful problems. “He told me not to worry about publishing too many studies, but rather focus on a few big questions that will fundamentally change people’s lives.”
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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[post_title] => What is Electrochemical Skin Conductance?
[post_excerpt] => 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.
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Smart Scales have traditionally been used by consumers to track their personal wellness metrics. However, Withings saw an opportunity to use highly sophisticated technologies in an at-home setting that provide critical data for providers to make more timely and informed care decisions. Body Pro 2 is that type of technology - a scale that adds both nuance and robustness to at-home health management and has the potential to improve the early detection of diabetic peripheral neuropathies (DPN).
Remote patient monitoring provides immediate, daily measurements to track and manage patient care for at-risk patients. As the creator of the original home smart scale, Withings has 15 years of experience in this field and hundreds of peer-reviewed studies of its products and measurements. In 2022 Withings acquired Sudoscan®, the FDA-cleared medical device for assessing DPN. We have now incorporated the Sudoscan® technology - which is already used by thousands of clinicians around the world - in our Body Pro 2 device.
Rather than hoping patients come for a regular foot exam, doctors and other health professionals can now monitor signs of diabetic peripheral neuropathy with daily readings to detect the earliest changes in small fiber neuropathy, at a stage when interventions can have the most profound effect. With 70% of patients with diabetes suffering from DPN at some point, regular assessment is critical. Unfortunately, annual comprehensive foot exams, as recommended by the ADA, have patient compliance issues and the conventional assessment techniques used by primary care practitioners (PCPs) often miss asymptomatic patients.
Body Pro 2 assesses small fiber nerves by emitting low voltage pulses to stimulate the sweat glands in the foot and measures reactivity to the impulse, providing a quantitative Electrochemical Skin Conductance (ESC) score. An equivalence study compared the ESC measurements of Withings’ at-home device with those of the Sudoscan device which has been used in specialty clinics and hospital settings for more than 10 years (1). The multi-center, cross-sectional study was carried out in four French university hospitals with 147 patients. Results demonstrated an almost perfect agreement in terms of sensitivity, specificity, and repeatability.
Within 60 seconds of stepping on the scale, patients and care teams receive feedback indicating whether small fiber neuropathy may be present. Care teams can then determine, based on the potential extent of the neuropathy, whether ongoing monitoring or immediate referral to a specialist is needed. The data are displayed on the screen and seamlessly transmitted to the care team by cellular, wireless, or bluetooth technology. This connectivity allows the physician to communicate with the patient and provide instructions for care.
Beyond the usual weight and BMI biomarkers, the Body Pro 2 is the first at-home cellular scale to measure body composition using multifrequency Bioelectrical Impedance Analysis (BIA). The body composition readings include fat mass, visceral fat, muscle mass, bone mass, and water percentage. A built-in algorithm, ProgramMemberID, assures that the data are coming from the patient - not a family member - and an engagement score helps a provider adjust advice to the patient accordingly.
Eric Carreel, Founder and President of Withings, commented, "Body Pro 2 allows for early detection of a largely underdiagnosed condition and therefore a better management of the diabetic foot. I also believe that providing access to longitudinal ESC data has the potential to help the industry rethink how we should care for patients with diabetes."
Riveline JP, Mallone R, Tiercelin C, Yaker F, Alexandre-Heymann L, Khelifaoui L, Travert F, Fertichon C, Julla JB, Vidal-Trecan T, Potier L, Gautier JF, Larger E, Lefaucheur JP. Validation of the Body Scan®, a new Device to detect small fiber neuropathy by assessment of the sudomotor function: agreement with the Sudoscan®. Front Neurol. 2023 Oct 31;14:1256984. doi: 10.3389/fneur.2023.1256984. PMID: 38020587; PMCID: PMC10644320
Amit Goel et al., « Comparison of Electrochemical Skin Conductance and Vibration Perception Threshold Measurement in the Detection of Early Diabetic Neuropathy », PLOS ONE 12, no 9 (7 septembre 2017): e0183973, https://doi.org/10.1371/journal.pone.0183973
Angelica Carbajal-Ramírez et al., « Early Identification of Peripheral Neuropathy Based on Sudomotor Dysfunction in Mexican Patients with Type 2 Diabetes », BMC Neurology 19, no 1 (31 mai 2019): 109, https://doi.org/10.1186/s12883-019-1332-4
Selvarajah D, Cash T, Davies J, Sankar A, Rao G, Grieg M, Pallai S, Gandhi R, Wilkinson ID, Tesfaye S. SUDOSCAN: A Simple, Rapid, and Objective Method with Potential for Screening for Diabetic Peripheral Neuropathy. PLoS One. 2015 Oct 12;10(10):e0138224
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[post_title] => Withings Introduces Body Pro 2, an Rx Device for Early Detection of DPN*
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What is Electrochemical Skin Conductance?
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.
Click the button below to download the infographic.