1803-LB: Improving Diabetic Foot Ulcer Management with Electrochemical Skin Conductance

Introduction: Addressing the challenges in diabetic foot ulcer (DFU) management is critical, given the high morbidity, mortality, and healthcare costs associated with this devastating complication of diabetes. This study introduces an innovative strategy for DFU risk stratification using Electrochemical Skin Conductance (ESC) measurements from the Sudoscan device. It is a quick, non-invasive, painless, reproducible technique that does not require fasting or stopping treatment.

Methods: The study involved 2157 diabetic patients from four French hospitals, evaluating the association between ESC measures and DFU risk stratification scores based on 10g monofilament testing.

Results: Multivariate analysis affirmed the association, independently of others covariate (age, sex), between the ESC and the DFU grades. ROC curve analysis demonstrated good predictive power for DFU grades 3, 2, and 1 (AUC=0.82/0.62/0.62.) but revealed limitations for grade 0 (AUC=0.34) due to the wide range of ESC values. Heatmap analysis showcased ESC's granularity within low-grade patients, suggesting potential subgroups not captured by the standard grading system.

Conclusion: With a quantifiable association between ESC measures and high DFU grades while revealing differences for low DFU grade, this approach offers an avenue for improving precision in risk assessment at early and reversible diabetic peripheral neuropathy stages therefore fostering early clinical intervention.

Healthcare Equity: The standardized and objective nature of ESC measurements while having a low cost contributes to more equitable healthcare delivery. By reducing disparities in risk identification, this approach ensures consistent and accurate assessments, regardless of geographical location or healthcare provider.