Machine Learning in the Prevention, Diagnosis and Management of Diabetic Foot Ulcers: A Systematic Review

Diabetic foot ulcers (DFUs) are a serious complication for people with diabetes. They result in increased morbidity and pressures on health system resources. Developments in machine learning (ML) offer an opportunity for improved care of individuals at risk of DFUs, to identify and synthesise evidence about the current uses and accuracy of ML in the interventional care and management of DFUs, and, to provide a reference for areas of future research. PubMed, Google Scholar, Web of Science and Scopus were searched using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines for papers involving ML and DFUs. In order to be included, studies needed to mention ML, DFUs, and report relevant outcome measures regarding ML algorithm accuracy. Bias in included studies was assessed using the quality assessment tool for diagnostic accuracy (QUADAS-2). 37 out of 3769 papers were included after applying eligibility criteria. Included papers reported accuracy measures for multiple types of ML algorithms in DFU studies. Whilst varying across the ML algorithm used, all studies reported at least 90% accuracy compared to gold standards using a minimum of one reported ML algorithm for processing or recording data. Applications where ML had positive effects on DFU data analysis and outcomes include image segmentation and classification, raw data analysis and risk assessment. ML offers an effective and accurate solution to guide analysis and procurement of data from interventions which are designed for the care of DFUs in small samples and study conditions. Current research is limited, and, for the development of more applicable ML algorithms, future research should address the following: direct comparison of ML applications with current standards of care, health economic analyses and large scale data collection. There is currently no evidence to confidently suggest that ML methods in DFU diagnosis are ready for implementation and use in healthcare settings.