One of my favorite uncles, George, had Type 1 diabetes for many years. He was a stubborn old guy with bad habits. He smoked until he lost his larynx to cancer. He drank too much and ruined many family gatherings because of it. But the hardest thing we had to endure was watching him suffer as he gradually lost of one of his legs to diabetes. It started with an infected ulcer on one of his toes. It didn’t heal, so the toe was amputated. The stump didn’t heal, so they took a part of his foot. And, finally, he had below the knee amputation.

Uncle George passed away before many of the modern treatments for diabetes and peripheral vascular disease came on the scene. But despite the many advances since that time, too many people with diabetes are still losing their limbs because of neuropathy that leads to a loss of sensation in the feet and peripheral vascular disease that impedes healing of even minor wounds. According to the International Working Group on the Diabetic Foot, a limb is lost due to diabetes every 20 seconds.

There are currently 415 million people with diabetes. Forty percent them have lost the ability to feel pain in their feet. Something as simple as a small blister can easily become infected and escalate into an ulcer and lead to an amputation. Diabetic foot ulcers can have horrific consequences and they are costly to treat. It has been estimated that diabetic foot ulcers are more expensive than the five most expensive forms of cancer. But progression from a small sore to an ulcer to an amputation does not have to be inevitable. Preventive measures, like routine inspection of the feet and testing for loss of sensation in the feet, can help people with diabetes detect problems at an early stage when treatment is easier and more likely to be successful.


Innovating for the diabetic foot

I am a big fan of the potential for digital health to improve the lives of people with diabetes (in fact, I just returned from the first Digital Diabetes Congress put on by the Diabetes Technology Society). So, I was excited to learn about a startup innovating in the diabetes foot ulcer space. Siren Care, located in San Francisco, has created digital Smart Socks to help with early detection of diabetic foot ulcers. Founder and CEO, Ran Ma, sat down with me to tell me her company’s story. Here is the video:

As is the case with many entrepreneurs, passion plays a big role in getting a start-up going:

“I come from a family of doctors. Both my parents work in late-stage diseases, where the mortality rate is high. But I think there is so much that can be done in medicine before people have to see doctors and surgeons like my parents. And that’s what I’m passionate about—prevention. By combining data and next-generation wearables, we can prevent many complications before they escalate. Basically…I want to put my parents out of a job!”

She chose diabetic foot ulcers as her focus because not only are diabetic foot ulcers are a preventable problem, with severe social and financial consequences, she said, “there is also a proven clinical solution that has yet to be effectively translated into real-world use. Research has shown that home temperature monitoring can significantly reduce foot ulcers.

Together with Jie Fu (CTO) and Henk Jan Scholten (COO), the team began working on developing their solution, Smart Socks made with smart textiles that could detect changes in temperature in different areas of the foot that could indicate that a problem could be brewing. Eventually, they were able to create a novel way to embed electronics directly inside of yarn to create smart textiles that are flexible, washable, and seamless; and, importantly, can be produced on standard weaving machines.

Siren app (250 x 258)By incorporating an integrated human touch sensor into the socks, they can know when you put them on. They turn themselves on and then search for your phone to begin monitoring your feet via the Siren app. When an injury occurs, the body mounts an inflammatory response that generates heat. By scanning the feet for hot or warm spots, injuries can be detected early in people with neuropathy who are unable to feel pain. Currently, clinics use a device called the TempTouch to manually detect temperature differences, but it is hard for patients to use it at home. Further, the device is used intermittently as opposed to the continuous sensing possible with Siren’s injury detecting socks.

The Siren Smart Socks have undergone informal clinical testing at University of California, San Francisco, and the company is in the process of conducting a small, 30-patient trial right now. Meanwhile, Ran and Siren have been wowing the digital health world with their technology and racking up some impressive awards. They won Launch at last year’s Health 2.0 conference in Santa Clara and the TechCrunch Hardware Battlefield at CES—the latter earned them a gigantic check for $50,000.

Related Content:  How to Make Managing Diabetes a Good Habit

Siren’s vision for the future?

Ran told me they have the ability to incorporate any type of small electronics—such as thermistors, pressure sensors, moisture sensors, RFIDs, and even BLEs (Bluetooth low energy) and microcontroller units (MCUs)—seamlessly into yarn. Right now, they are only weaving thermistors into their smart fabric, but they hope to incorporate other sensors to expand to other market opportunities beyond diabetes in the near future. They are “looking forward to a time when all technology will be built into the objects we already wear every day and solve pressing problems such as monitoring health and preventing complications.

“At Siren, we believe your clothes are the only wearable you need.”

The first batch of Siren Smart Socks will be shipped in mid-2017! They are available for pre-order at

Patricia Salber, MD, MBA

Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.

Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.

She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.

She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.

She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.

Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.

Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.


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