August, 2021

AI revolution at Barts Health NHS Trust could help thousands of diabetes patients avoid leg and foot amputations

Clinithink artificial intelligence software takes just weeks to sift through data that would take a human more than a century – enabling quicker treatment that could save limbs

A new AI technology being trialled at a major NHS hosptial trust could transform treatment for diabetes patients by significantly reducing the need for limb and foot amputations. Barts Health NHS trust – which runs five hospitals in east and central London – has been testing Clinithink’s artificial intelligence software for about three and a half years, using it to analyse 14.2 million medical records and notes to identify patients with diabetic foot disease (DFD). The system could save thousands of patients from having their limbs or feet amputated, marking a “world-changing” shift in how patients with complicated conditions such as diabetes are treated. Using the software, called CLiX unlock, it identified 61,756 patients with diabetes – 3,119 of whom had diabetic foot disease – from Barts’ patient records in a matter of weeks. The task would have taken a single clinician more than 100 years to complete. It will help clinicians schedule earlier treatment that could help to avoid amputations further down the line.

As diabetic patients often also experience issues with their eyes, hearts and kidneys, treating DFD usually involves having to consult with specialists from a number different backgrounds, including diabetologists, heart and kidney experts, podiatrists and vascular surgeons, said Sandip Sarkar, consultant vascular surgeon at Barts Health.

“It’s really complicated, but we’ve traditionally gathered all the specialists together to see the patient and work out how to treat them,” he told i.

“This software allows me to type a note and it will trawl through records and say, ‘We’ve found that if you adjust the blood pressure of a patient in exactly the same situation by X, it increases their longevity by Y per cent.’”

Why is amputation an issue for diabetes patients?

The NHS reports that people who have diabetes are 15 times more likely to undergo amputations than other people without the condition.

Diabetes is the leading cause of non-traumatic limb amputation, with the equivalent of more than 176 leg, toe or foot amputations taking place every week in England, according to charity Diabetes UK.

Diabetes can lead to blood circulation problems which reduce blood flow to the legs and feet.

It can also cause nerve damage which can prevent a sufferer from feeling pain. This means patients may not realise they have a wound or ulcer on their legs or feet.

Untreated, these can grow and become infected – and the poor blood flow can slow the healing of the wound or sore.

If the infection cannot be stopped or the damage is irreparable, amputation may be necessary.

For this reason, diabetes sufferers are advised to take extra care of their legs and feet. They should look for any signs of damage – cuts, sores, burns, blisters or ulcers – and undergo regular examinations.

Fore more information visit diabetes.org.uk

He thinks the new system could help to save tens of thousands of diabetic patients from future amputations.

“Worldwide, a leg is amputated from a diabetic patient every 20 seconds, that’s the scale of this problem. This is the most promising software that I’ve ever seen, and I’d like to help more than the 3,119 people from this project – I’d like to commit to helping tenfold that, just in east London.”

Dr Sarkar carried out the project with Dr Charles Gutteridge, chief clinical information officer at Barts Health, and data analyst Dr Sophie Williams.

The software could easily be applied to other multi-faceted health conditions, including chronic obstructive airways disease, which affects the heart as well as the lungs, or even elderly care, Dr Sarkar said.

The team now hopes to be able to access electronic records for primary healthcare in north-east and east London, as more data means higher accuracy.

“I wouldn’t be surprised at all if it’s borrowed and mirrored for what we do nationally and internationally,” he added. “This is world-changing because almost everything we do in complex medicine is based on individual experience rather than us knowing what to do.

“This will change that to bespoke evidenced medicine and that will be absolutely brilliant and will change the way we do medicine, because it allows us to consider what has previously happened to patients when experts make those interventions.”