Monitoring IBD Through Wearable Devices Shows Great Promise in Several New Studies

Wearable devices have shown their ability to remotely and consistently monitor chronic conditions, particularly diabetes and high blood pressure. A Mount Sinai team of gastroenterologists is now pushing the technology into the realm of inflammatory bowel disease (IBD), where unpredictable and frequent flares have made disease management notoriously difficult for patients and physicians alike.

Several new studies from this team, led by Robert Hirten, MD, Associate Professor of Medicine (Gastroenterology), and Artificial Intelligence and Human Health, at the Icahn School of Medicine at Mount Sinai, highlight the enormous potential of digitally collected metrics from wearable technologies to identify and predict IBD flare episodes weeks in advance. In addition to capturing information from commonly used wearables, researchers are assessing the use of data from devices that collect easily accessible biofluids such as sweat to evaluate inflammatory markers and cytokines that may help monitor IBD activity.

“We found that physiological metrics collected from wearables, such as circadian patterns of heart rate variability, heart rate, and resting heart rate, were significantly altered when patients experienced an inflammatory or symptomatic flare compared to remission,” says Dr. Hirten, lead author of the IBD Forecast Study published in Gastroenterology. “Just as importantly, we learned that these metrics substantially changed over a seven-week period before the inflammatory or symptom flares were identified, suggesting their potential to serve as a novel biomarker of disease activity, including the worsening of chronic inflammation. Although further research is needed, our hope is these tools can be used in the future to allow patients and physicians to identify flares before they occur, allowing for interventions to mitigate or prevent their development.”

For the past several years, Dr. Hirten and his team have been investigating how different types of digital tools could improve the current mode of IBD monitoring, which depends heavily on patient-reported symptoms and assessments of inflammation using blood or stool testing, imaging, and colonoscopy, and which is limited to a single point in time. “Wearables can measure physiological metrics such as resting heart rate and heart rate variability in a continuous, or near-continuous, manner,” explains Dr. Hirten. “These are all metrics that are altered in chronic inflammatory disease.”

In the IBD Forecast Study, researchers outfitted 309 adult patients who have either Crohn’s disease or ulcerative colitis with an Apple Watch, Fitbit, or Oura Ring. In addition to longitudinal heart rate activity, the devices tracked daily steps and oxygenation to determine if these metrics could help identify IBD flares in advance. The researchers learned that they could not only accomplish that goal, but also determine whether underlying inflammation was present in individuals with symptoms, indicating that the disease was actively flaring. The study was not designed to identify differences in performance among the three devices.

“We view our study as a first step in showing that wearables can be widely used to identify and potentially predict if a chronic disease such as IBD or rheumatoid arthritis is active or will become active in the near future,” says Dr. Hirten. He is now kicking that technology and predictability up another notch by introducing artificial intelligence to the equation. To that end, he is developing and refining deep learning algorithms that can predict IBD exacerbations within the ensuing two months, bringing this predictive ability to the level of the individual patient.

Sweat-based monitoring also shows extraordinary opportunities to noninvasively monitor biomarkers important to health and disease. Here, Dr. Hirten has worked closely with scientists from the University of Texas at Dallas to study a first-of-its-kind device known as IBD AWARE that can detect inflammation through an inch-square biosensor taped to the body. This device can continuously measure, from passively expressed sweat, many proteins common to the pathophysiology of IBD and predictive of disease activity. These include tumor necrosis factor-alpha (TNF-α) and the cytokines interleukin-6 and interleukin-1.

In a study in Scientific Reports, the team reported that TNF-α levels in the sweat of participants with active IBD were significantly higher than in healthy controls as measured by IBD AWARE, highlighting a potentially unique method to monitor IBD and key markers of disease activity.

“While this technique requires additional studies, it underscores the importance of continuing to look for novel ways to manage and monitor patients with IBD,” says Dr. Hirten. “Wearable devices are showing great promise and, based on their success in other chronic conditions, could be a major step forward in improving the quality of life of our patients impacted by IBD.”