New Smart Socks Study How Diabetics Walk To Prevent Devastating Nerve Damage

GWANGJU, South Korea — In the future, even our clothes will be life-saving. A newly designed electronic sock is capable of detecting unhealthy walking styles linked with diabetes and poor circulation. The new piece of footwear’s designers, based out of Chonnam National University Hospital, say the apparel shows promise in the prevention of both foot ulcers and amputation. All in all, the sock may benefit countless diabetes patients living with clogged arteries in their legs.

“Diabetes can affect the way people walk, also known as their gait. Patients with diabetes tend to put pressure on the metatarsal area of the foot, rather than the heel. This way of walking encourages ulcers, which can become infected and lead to amputation. Identifying walking issues early using an electronic sock would enable patients to learn a healthy walking style and prevent serious foot problems,” says study author Dr. Ki Hong Lee of Chonnam National University Hospital in a media release.

Current estimates show that about one in 10 people (537 million) have diabetes. A diabetes diagnosis means a two to four-fold higher risk of coronary artery disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. Foot problems are also common among diabetics. High blood sugar can damage nerves and blood vessels, with common symptoms including numbness, tingling, pain, and a general loss of feeling. Symptoms are frequently tough to detect in the earliest stages, which means cuts and ulcers may develop and become infected. A detrimental combination of an infection and poor blood flow can make healing much harder, eventually promoting gangrene and amputation.

For this study, researchers focused on whether a sock fitted with a ballistocardiogram (BCG) sensor could successfully differentiate between healthy people and patients with diabetes. A BCG detects body motion as the heart ejects blood, meaning it is capable of gauging heart rate and pressure exerted on one’s feet while walking.

close up view of pair of socks
Researchers from Chonnam National University Hospital believe socks with a ballistocardiogram sensor attached could help prevent both foot ulcers and amputation for diabetes patients. (Photo by Lum3n from Pexels)

This project included 20 patients with diabetes and 20 healthy control patients without diabetes. All 40 participants wore their BCG socks for 40 seconds while standing and then for another 40 seconds while walking to gauge heart rate and assess pressure distribution on their feet. While wearing the electronic sock, everyone also underwent an electrocardiogram (ECG) assessment of heart rate using a small patch attached to the wrist, and a single electrode adhered to the chest. ECG is the consensus gold standard tool in cardiology for measuring heart rate.

The main aim of the heart rate measurement was to assess the accuracy of the BCG sock as a measurement tool relative to the gold standard method (ECG). Researchers compared ECG values for each study participant (patients and controls) with BCG values in the same participant. This led to the finding that the heart rate measurements by the BCG sock and ECG were nearly identical.

💡Severe Health Complications Caused By Diabetes:

  1. Cardiovascular Disease: Increased risk of heart disease, stroke, and hypertension.
  2. Nerve Damage: Especially in the feet and legs.
  3. Kidney Damage: This can lead to kidney failure or irreversible kidney disease.
  4. Retinopathy (Eye Damage): Can cause blindness, cataracts, and glaucoma.
  5. Diabetic Foot: Due to poor circulation and nerve damage, injuries do not heal well.
  6. Skin Conditions: Increased susceptibility to skin infections and disorders.
  7. Ketoacidosis (DKA): Especially in Type 1 diabetes. The body produces high levels of blood acids called ketones, leading to potential coma or death.

The foot pressure distribution measurements, meanwhile, helped study authors determine if the BCG sock could detect differences between patients with diabetes and healthy controls and if the sock could detect differences between patients with diabetes according to whether or not they had damage to the nerves or blood vessels. Researchers classified nerve damage according to the Michigan Neuropathy Screening Instrument (MNSI), while blood vessel damage underwent classification using the ankle-brachial index (ABI).

As far as the BCG comparison between patients and healthy controls, this revealed that patients with diabetes exerted higher pressure in the metatarsal area of their feet while walking in comparison to participants without diabetes. For the BCG comparison between patients with diabetes, researchers explain that compared to patients without blood vessel damage (ABI score of 0.9 or higher), others with blood vessel damage (ABI score less than 0.9) exerted significantly more pressure on the metatarsal area of their feet while walking and less pressure on their heels. There was no significant difference seen regarding foot pressure distribution measurements when comparing patients with or without nerve damage.

“The novel BCG sock produced accurate measurements of heart rate as indicated by the nearly identical values as ECG. The pressure measurements showed that the sock could identify patients with diabetes, and could also pinpoint patients with diabetes and poor circulation. Taken together, the results suggest that the electronic sock could be an easy, non-invasive way to find patients with diabetes who could benefit from gait training to prevent foot complications,” Dr. Lee concludes.

The study authors presented their research at EHRA 2024, a scientific congress of the European Society of Cardiology (ESC).

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John Anderer

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