How Technology Is Revolutionizing Diabetes Prevention with Gary Rothenberg, Director of Medical Affairs at Podimetrics

[00:00:01] This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency. Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945.

[00:00:30] Hey everybody, Saul Marquez with the Outcomes Rocket. I want to welcome you back to our podcast today. I have the privilege of hosting the outstanding Dr. Gary Rothenberg. He is a board certified podiatrist, a certified diabetes care and education specialist, and a certified wound specialist who currently holds an adjunct clinical faculty appointment with the endocrinology division at the University of Michigan School of Medicine in Ann Arbor, Michigan.

[00:00:58] He also serves as the Director of Medical Affairs at Podimetrics, a rising company in the diabetes-related foot complication prevention space. I'm excited to have him here. Dr. Rothenberg, thank you so much for joining us. No, thank you for having me. It's a pleasure to be here with you this morning. Yeah, for sure. And look, this is a well-known space, right? We have a lot of problems with the cascade of degradation that comes with diabetes,

[00:01:25] one of them being foot ulcers and the challenges that happen there. So I'm excited to dig into this area with you. Before we do, though, I'd love to get to know you a little bit better and get the listeners to get to know you a bit better. Tell us what inspires your work and innovation in healthcare. So I am a practicing podiatrist. I appreciate the kind introduction. I've been practicing for about 25 years now, and I've practiced in different locations. I did my residency in San Antonio, Texas. I did some private practice experience in Atlanta.

[00:01:54] I was in Miami, Florida for a while running a residency program at the VA hospital. And now I'm actually in Ann Arbor, Michigan. So I've had a bunch of different practice types. But I think the common denominator, you're asking what inspires me. There's two things. One is that I've typically practiced in communities with underrepresented minorities, and I have witnessed racial disparities in healthcare. I have witnessed the roles that social determinants of health have played in, unfortunately, developing diabetes-related complications.

[00:02:23] Obviously, my particular passion is avoiding amputations and wounds. The second thing that inspires me is actually my son. You mentioned several of my titles. Probably the most important title that I have is dad. And my 18-year-old son, Evan, is living with type 1 diabetes for the past 10 years. He was diagnosed at 8. So this is both very personal and professional for me. And so I just want folks living with diabetes to avoid the significant complications.

[00:02:53] And again, I've learned more in living as a family with diabetes because it very much is a family disease. So I think it's one in four Americans has diabetes. Is it one in four? I think that's what I heard. So it's a significant percentage. We know it's about 11% of the U.S. population has diabetes. But the bigger problem is pre-diabetes. And we can talk about some special populations. We know, again, I mentioned the underrepresented minorities. They have diabetes at the highest rates, even higher than Caucasian Americans.

[00:03:21] But the bigger problem, as I started to mention, is really pre-diabetes. And if we can keep all these folks who are teetering on the fence from tipping into full-blown diabetes, that would make a huge impact. So I'm more about prevention, hopefully, than treatment of these complications in the disease process. It is a significant financial burden. Thank you for clarifying that. So more like 11%, but still significant. And then there's this whole pre-diabetes population. It's closer to us than we think. And, you know, I love the work that you guys are doing.

[00:03:51] So why don't you give us an overview of the problem Podometrics solves for and how you guys are doing it specifically with technology and services? Yeah. So Podometrics is a remote temperature monitoring company. We're really kind of, I believe, an innovative, mission-driven company. So we use some very sound science and technology. There were three randomized clinical trials in the early 2000s that showed if you monitor

[00:04:17] temperature in feet, that it can be predictive of future complications. So just like any disease process, you get, unfortunately, COVID or the flu, you always develop a fever. The foot can do that too. So if an infection or a wound is brewing in the foot, then it will develop signs of inflammation. And the Podometric Smart Mat program is where patients step on a bath mat. Essentially, it looks like a bath mat. And there are temperature sensors embedded in that mat.

[00:04:46] And then we are remotely monitoring the temperature, looking for asymmetry or escalations, right foot compared to left. And then the beauty or what I call the secret sauce of the program is actually our care management nurses. And there's an established protocol that when there is asymmetry, our nurse, that's a prompt. And we have the escalations or it takes 20 seconds to do a scan. Those are sent through cellular-based technology. And then our nurses are monitoring for asymmetry.

[00:05:16] And if there is asymmetry noted, then they will call the patients. It's really a prompt to say, hey, Mr. Jones, you know that mat you're stepping on? Your right foot is lighting up like a Christmas tree. What's going on? Can you take a look at it? Can your spouse or significant other take a look at it at your foot? Because many of these people have neuropathy, they don't have good ceiling, which is a problem. So we escalate to the patients and give them some advice about simple kind of low-cost interventions, reducing your step count, elevate your feet.

[00:05:46] You know, it's not time to do your Christmas shopping because there may be something brewing in your foot. And the research and studies show that we can detect 97% of pending wounds at five weeks lead time. So the foot starts to heat up five weeks in advance. And I know it sounds a little over the top, but I always say you can change destiny for people if you have that data and you can make an intervention and avoid the complications. That's significant quality of life impairment for our patients.

[00:06:14] And it's obviously cost savings for the healthcare system. There are significant complications that come with not addressing these things, letting them go down the degradation path. And then next thing you know, you're amputating. And that's not what we want, right? That's right. That's not what we want at all. You highlighted social determinants of health, the lesser represented populations, Gary. Can you discuss how these social determinants of health play into severe complications from diabetes?

[00:06:42] And maybe highlight some specific populations that you've seen. We're very mission-driven to end avoidable amputations. And the studies will show probably upwards of 85% of amputations can be avoided by doing early interventions in preventative care. But we do know, again, I've been in practice for 25 years. And I know when I was in school 30 years ago, nobody was talking about social determinants of health.

[00:07:06] At least we're having the conversations now about how the things like your built environment, where you live, where you grow up, where you work, and your access, as well as the quality of health care within your community, we do know that that is a significant factor in outcomes. So first of all, we're having the conversation, which I think is good. Podometrics, again, we're very committed to understanding the populations that we serve. Actually, just two weeks ago, we released the results of a study on the Native American

[00:07:35] population that was released on Indigenous Peoples Day very intentionally. The Native American population specifically has the highest percentage of diabetes. We mentioned overall in the U.S., there's 11% incidence of diabetes. In the Native American population, it's closer to 15%. And they are particularly burdened with complications, including amputations and the other ones associated with diabetes as well, eye disease, kidney disease.

[00:08:01] But the theme that we found in the survey from the Native American population and through my clinical experience for practicing, there are three main social determinants of health or themes that come out. One is going to be that are problematic, especially for people of color or underrepresented minorities. One is access. That's probably the biggest issue is people having access to health care, to their providers. Two is going to be cost and they don't go to the

[00:08:27] physician's office or the providers because of co-pays or because they're going to be prescribed medications that are too costly. And the third, especially in the Native American populations and minority populations, is trust in the health care system. And obviously that's very historically rooted, but we see those three themes of access, cost, and trust in the health care system come out all the time as the strongest predictors of outcome in plaguing people of color today.

[00:08:54] And there are a lot of care deserts out there that sort of get passed by or cost too much, to your point. Talk to us about, so the problem's there. How is Podometrics helping with some of that? Whether it's the Native American populations or I know you guys have a pretty strong presence with the VA. Right. So a lot of our original research was done in the VA, which is where I was introduced to Podometrics 10 years ago, participating in some clinical trials. And veterans continue to be among the

[00:09:23] most important clients that we serve for sure because of their predisposition to diabetes, chronic disease, and complications. So veterans are very near and dear to my heart for sure. So what are we trying to do? Well, we do support the American Diabetes Association and the Amputation Prevention Alliance. These are organizations that are really have a tripartite mission of educating patients, educating providers, and educating payers. Probably the most significant things that we can do

[00:09:53] is get preventative care services paid for. We also are trying to really support those underserved communities by getting involved with meeting the patients literally where they are. Our technology does not depend on Wi-Fi or patients having a smartphone. As long as you can get the mat into your home and that you step on it for 20 seconds a day, we can get cellular technology to work.

[00:10:18] So even on Indian reservations, again, everybody has these cell phones. Everybody has cell phones today, right? If you have a cell phone and it works, our technology can work too. But we need equal access for the underserved communities, especially to preventative care. And that's most important, I think. We don't want amputations done without attempts at limb salvage. If we know 85% of limbs can be prevented, which lead to amputations, why aren't we doing the good

[00:10:45] things like providing shoes, doing temperature monitoring, quality education, having patients see foot care specialists on a routine basis? Those are the things that can really make a huge impact. I think it's powerful work that you and the team at Podometrics are up to, Dr. Rothenberg. I appreciate you guys coming on to share it with us. If you had to leave the listeners with a closing thought, what would you leave them with? Yeah. So I'll pull back to the study that we just released again two

[00:11:13] weeks ago among that Native American population. One of the statistics that really stuck out to me when the team showed me the data was that 51% of Native Americans self-rated their current health as poor or okay. Yet 67% of that same population thought that their healthcare would improve over the next 12 months. So that was an interesting paradox to me. And I thought, well, I had to come to the conclusion

[00:11:39] that it's hope and that the Native American population, hopefully that's cultural, but there is hope. Now, what is the hope in? I believe it's probably in the generation of technology and faith in providers and what's AI going to do to healthcare, right? So I would leave the listeners and the viewers with the idea that there is hope that we can make a change as long as we're talking about this. And I think the underrepresented minority populations who have traditionally not received the same care,

[00:12:08] and I mentioned my son who has diabetes and I want him to live a long, healthy life. I think there's hope. And what we can do for prevention can really make a difference. That's great. Well, look, with the work that you guys are doing, we certainly have hope grounded in work and technology. So Dr. Rothenberg, I appreciate you jumping on to share with all of us. And folks, you're listening to this today. If something from today's interview with Gary rose to the top and

[00:12:35] created curiosity, take action. I always say, don't stop at listening. If you want to jump on the rocket and get those outcomes, take action. Gary, thanks for taking action today and being with us. I really appreciate it. What a pleasure. Thank you, Saul. Thank you so much.

[00:13:00] This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency. Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945. Outcomes Rocket.