Maintaining adherence to offloading devices remains a major challenge in the management of diabetic foot ulcers (DFUs), particularly during periods when devices are removed during rest or daily activities. A prospective feasibility case series published in Diabetology evaluated whether real-time, context-aware feedback delivered through a sensor-integrated offloading system was associated with improved short-term adherence.

The study included eight adults with active DFUs who used a sensor-integrated offloading device paired with a smartwatch and mobile application. Notifications were delivered either on a fixed schedule or in response to real-time adherence patterns detected through sensor data. The primary outcome was a sensor-confirmed transition from nonadherent to adherent offloading within 60 minutes of notification delivery.

A total of 130 notifications were delivered during the study period, with 125 included in the behavioral response analysis.

Findings

• Context-aware notifications produced higher adherence transition rates than schedule-based reminders.
• Adaptive Reinforcement alerts showed the highest behavioral response rate at 77.4% (24/31).
• Clinical Course Correction alerts achieved a 71.4% response rate (20/28).
• Safety and Technical Assurance alerts were associated with a 40.7% response rate (11/27).
• Motivational Coaching alerts showed the lowest response rate at 30.8% (12/39).

The findings support further evaluation of context-aware feedback strategies for improving short-term offloading adherence in patients with DFUs.