Intergrated
Human Practice

Diabetic foot ulcers (DFUs) are one of the most severe complications of diabetes, often caused by a combination of neuropathy, poor glycemic control, and impaired blood circulation. These factors contribute to unnoticed minor injuries that can escalate into chronic ulcers, sometimes requiring amputation. DFUs not only drastically reduce patients' quality of life but also impose a heavy burden on families and healthcare systems.

To address this challenge, we launched Project AGEs ROBBER, aiming to target the underlying cause of chronic inflammation in DFUs, Advanced Glycation End-products (AGEs). Our solution includes a functional wound dressing designed to remove excess AGEs from the wound area, thereby reducing inflammation and promoting healing. Additionally, we developed a foot-monitoring device for high-risk individuals to detect early warning signs and prevent ulcer formation.

These innovations reflect our belief in prevention over treatment, and our ultimate goal is to reduce the incidence of DFUs in vulnerable populations.

To guide our Human Practices work, we created the INSPIRE framework—Identify problem, Network conversation, Solution, Problem, Iterative feedback, REfinement. This cycle emphasizes a structured and collaborative approach: each step encourages teams to identify real-world problems, actively engage with stakeholders, develop and test innovative solutions, continuously collect feedback, and refine interventions accordingly. By embedding these principles, INSPIRE provides a flexible yet rigorous workflow that ensures our work remains socially relevant, scientifically grounded, and serves as a model for future teams.

According to the data, “Approximately 18.6 million people worldwide are affected by a diabetic foot ulcer each year”. Diabetic Foot Ulcers (DFUs) are a growing global health concern, affecting millions of people with diabetes. These chronic wounds are notoriously difficult to treat due to fragile skin, impaired circulation, and weakened immune response. Without proper care, DFUs can lead to severe infection and, about 58.9% of patients, lower-limb amputation.

Current treatments mainly focus on antibacterial agents and exudate absorption. However, they often fail to address the toxic microenvironment, especially the buildup of Advanced Glycation End-products (AGEs). AGEs trigger chronic inflammation and tissue damage, trapping the wound in a non-healing cycle.

This reveals a key therapeutic gap: the need for treatments that actively alter the wound microenvironment to promote regeneration. We see this as an opportunity for synthetic biology to play a transformative role, by engineering systems that remove AGEs and enable effective healing, thereby reducing the physical, emotional, and economic burdens associated with DFUs.

Problem Points – Diabetic Foot Ulcers (DFUs)

1. High Prevalence: DFUs affect about 18.6 million of people with diabetes worldwide, and the numbers continue to rise.
2. Difficult to Heal: Fragile skin, impaired circulation, and weakened immune response make wounds in diabetic patients slow to heal. In addition, the accumulation of AGEs triggers chronic inflammation, further delaying the healing process and increasing the risk of complications.
3. Severe Consequences: Poorly treated DFUs can lead to serious infections, lower-limb amputation, and emotional trauma.
4. Low Patient Awareness: According to the resources, about 30%~78% of patients neglect foot care, and diabetes complications often mask early symptoms of DFUs.

In order to realize the real situation of the DFU patient’s world, we started up a series of interview from clinic to hospital, from experts to patients, gradually understand the holistic condition.

Why We Conducted Interviews
We began our investigation by visiting a local diabetes clinic, with the goal of understanding the real-world situation of diabetic foot ulcer (DFU) patients. Our aim was to identify that DFUs are indeed a significant and urgent health concern, and to highlight the widespread neglect of foot care among patients.

What We Learned

• DFUs are not just a local problem—they are a global health issue. Most patients are older adults with a long history of diabetes and multiple complications. Poor vision, limited mobility, and difficulty controlling blood sugar make foot care even harder.
• Many people, diabetic or not, rarely check their feet. They usually notice problems only when wounds or pain appear.
• By the time most DFU patients seek help at clinics, their condition is already severe, which makes treatment much more challenging.

Next Steps
Dr. Chen suggested that hospital doctors, especially in plastic surgery, would have more extensive clinical experience. Taking his advice, we planned follow-up interviews with hospital physicians to validate what we had observed and ensure our project is truly addressing patient needs.

Why We Conducted Interviews
Dr. Chen pointed out that many DFU patients arrive at clinics with already severe ulcers and often need to be referred to hospitals for advanced care. To better understand the treatment side of the problem, we reached out to Dr.Hsu, Honda, a plastic surgeon specializing in DFU management. Our goal was to explore whether foot care is widely neglected, and how common DFUs are.

What We Learned

• The number of DFU patients has not decreased in recent years. This is especially true among older adults, who often have a long history of diabetes, face difficulties controlling their condition, and tend to delay seeking medical care—making their wounds worse.
• Many people, with or without diabetes, rarely pay attention to their feet and only notice issues when pain or wounds appear. For diabetic patients, neuropathy and macular degeneration make it even harder to detect changes in their feet.
• Current treatment products still have limitations. For example, ointments can mix with wound exudate, making it harder for doctors to assess wound conditions. Most products also cannot simultaneously absorb exudate, promote granulation tissue growth, provide antimicrobial action, and maintain moisture.

Next Steps
After understanding the challenges on the treatment side, we plan to interview patients directly to learn about their personal experiences, the difficulties they face during treatment, and what improvements they truly hope to see.

Why We Conducted Interviews
We wanted to truly understand what patients go through while living with diabetic foot ulcers (DFUs) and whether they had indeed neglected foot care before the ulcers developed. We were also interested in uncovering the root causes that led them to such a severe condition, as well as what they genuinely need during their treatment journey.

What We Learned

• He admitted that he rarely checked his feet, regardless of his diabetes, because he had to work long hours to support his family and had no time for careful foot care.
• Having someone assist with care makes the dressing changes much easier and reduces the risk of improperly applied dressings due to poor visibility, which can help speed up the healing process.
• During treatment, he tried using a medical ointment, but it was extremely expensive—around $300 per tube. He eventually switched to using poultices. However, the slow healing process left him frustrated and discouraged, as he saw little improvement over time. As he got older, reduced mobility and poor eyesight made it even harder for him to check his wounds by himself.

Next Steps
After gaining insight into the patients’ experiences, we aimed to understand the perspectives and feelings of their caregivers throughout the healing process, in order to gain a more comprehensive view of the impact of this disease.

Why We Conducted Interviews
In addition to hearing from patients, we wanted to understand the experiences and emotions of caregivers who support DFU patients throughout the healing process. As doctors pointed out, most DFU patients are elderly and often cannot change dressings on their own, which places significant responsibility on their caregivers.

What We Learned

• Patients and their families often need to travel back and forth to the hospital, spending both time and money, yet they rarely see significant improvement. Over time, this takes a heavy emotional toll, with some even developing symptoms of depression.
• Caregivers, on the other hand, cannot be by the patient’s side 24/7. They still have their own jobs and lives to manage, and the prolonged physical and mental strain leaves them exhausted. Many of them are eager for better solutions that can speed up wound healing and ease the suffering for both patients and families.

Next Steps
After hearing about the challenges patients and caregivers face, and the real-world clinical situation, we are determined to make a change. To address the limitations of current treatments, we decided to develop a patch that not only accelerates wound healing but also provides antibacterial protection and is waterproof, addressing the limitations of current treatments. For high-risk individuals and patients in the early stages of DFU, we also aim to create a device that allows them to monitor their feet on their own and catch problems early.

To address the persistent inflammation in diabetic foot ulcers, we proposed a two-part solution.
Patch (AGE-Thwart):
First, we aim to restore the wound microenvironment by targeting and removing Advanced Glycation End-products (AGEs), key inflammatory factors that delay healing. By reducing AGEs, we hope to transform the chronic wound environment into one more similar to that of healthy individuals, thereby accelerating recovery. (Learn more on our Design page)
Detection machine:
Second, as mentioned in the problem definition, diabetes complications such as neuropathy can block pain sensation and delay detection of injuries. To tackle this, we designed a smart foot-monitoring device to help patients detect wounds at an early stage, before deterioration begins. (Learn more on our Design page)

During the product development process, we wanted to create solutions that not only address clinical pain points but also truly meet user needs. As our design progressed, we realized there were several key challenges that required further discussion and refinement.

Challenges in Designing the Wound Patch:

• Inconsistent Wound Locations: Ulcer location varies from patient to patient, making it difficult to design a one-size-fits-all patch.
• Targeted Antimicrobial Strategy: Wounds harbor diverse bacteria; identifying key pathogens is essential for effective antimicrobial design.
• Multiple Functional Requirements: Besides accelerating healing, what additional functions should an ideal wound dressing provide?

Challenges in Designing the Detection Device:

• Placement Uncertainty: We need to decide whether the device should be used at home for daily monitoring or installed in community locations for shared access.
• Detection Coverage and Sensitivity: Ensuring the device can scan the entire foot and accurately detect small wounds or early-stage ulcers is a key technical hurdle.

After we designed and prototyped our innovative product, we encountered several challenges. To address these issues, we conducted two rounds of interviews with doctors, caregivers, and experts in the caregiving field. These consultations allowed us to seek professional advice, clarify our doubts, and refine our design based on their feedback. Through this iterative process, our product became more comprehensive and aligned with the real needs of stakeholders. This approach reflects the spirit of Integrated Human Practices (IHP), ensuring that our project is not only innovative but also responsibly developed with multi-perspective considerations.

Why We Conducted Interviews
After identifying these challenges, we first consulted Dr. Hsu, Honda online. As he was unable to meet with us directly, he recommended Dr. Huang, Shin-Ming from the Department of Cardiovascular Surgery. With his expertise in vascular reconstruction and ongoing research on diabetic foot ulcers, Dr. Hsu believed that he was well-positioned to provide concrete and highly relevant insights for our project.

What We Learned

• Ulcer locations vary among patients, but the most common sites are beneath the big toe, the first metatarsal, and the heel.
• Blood sugar control and circulation greatly affect the duration of treatment.
• Prevention is more important than treatment.
• Remote care is crucial for elderly individuals living alone. Since their children often work away from home, monitoring their condition helps ensure timely medical attention and reduces the risk of delayed treatment.

Next Steps
After our discussions with Dr. Huang, we clarified issues related to vascular health and wound healing but recognized that questions regarding wound infections and bacterial species required specialized expertise. We therefore consulted Dr. Ma, Rui-Shan, an infectious disease specialist, to gain deeper insight into the bacterial composition around wounds and its impact on healing. These insights guided the design of our product’s antimicrobial function, ensuring it better aligns with clinical needs.

Why We Conducted Interviews
To address concerns related to infections and bacterial colonization, we consulted Dr. Ma, Rui-Shan, a specialist in infectious diseases. Our goal was to gain a clearer understanding of which bacteria are most prevalent around wounds, allowing us to identify the key pathogens to target and guide the design of the antimicrobial function in our product.

What We Learned

• Ulcer locations vary among patients, but the most common sites are beneath the big toe, the first metatarsal, and the heel.
• Blood sugar control and circulation greatly affect the duration of treatment.
• Prevention is more important than treatment.
• Remote care is crucial for elderly individuals living alone. Since their children often work away from home, monitoring their condition helps ensure timely medical attention and reduces the risk of delayed treatment.

Next Steps
After our interviews with Dr. Huang, Shih-Ming, we reached out to Ms. Lü, Yu-Fang, an expert in the care and advocacy of diabetic foot ulcers. We aim to gain deeper insights into her observations and the challenges professional caregivers face in daily practice, and to explore how our product could make a meaningful impact and be further improved to better meet real-world needs.

Why We Conducted Interviews
After our interviews with the doctors, we began considering how to raise broader awareness about the importance of prevention over treatment. We then reached out to Ms. Lü, Yu-Fang, an experienced expert in diabetic foot ulcer care and advocacy, to gain guidance on which knowledge should be highlighted and how to effectively promote preventive practices.

What We Learned

• Maintenance is more important than treatment; regular foot care and monitoring can prevent complications before they occur.
• Tailor your communication—content, language, and approach—according to your audience.
• Everyone can be a caregiver or a patient; regular foot checks and proper care are essential.
• When caregivers have relevant medical knowledge, the patient’s recovery process can be significantly faster—often several times quicker—compared to those cared for by individuals without such expertise.
• Devices placed at home for remote care can play a vital role in monitoring and early intervention.

Next Steps
We will continue engaging with patients’ family members to better understand whether our product effectively supports them in daily care. These insights will guide us in refining and optimizing our design, ensuring it remains user-centered and addresses real-world needs.

Why We Conducted Interviews
After completing our second round of interviews with doctors and professional caregivers, we conducted follow-up discussions with the family members of patients with diabetic foot ulcers. Our goal was to understand the challenges, and practical needs they face in daily care, and to explore how our product could provide meaningful support. Insights from these conversations allow us to refine and optimize our design, ensuring it addresses real-world needs and truly centers on the users.

What We Learned

• They see our efforts as an opportunity to create real change.
• Shortening the healing process is crucial not only for patients but also for caregivers.
• They believe that having the device placed at home would make it easier to monitor patients’ conditions effectively.

Next Steps
We aim to further refine our product while actively promoting the importance of prevention, regular foot checks, and proper foot care to broader communities. At the same time, we will continue to optimize our design to better meet the needs of relevant stakeholders, ensuring that our solution is both practical and impactful in real-world settings.

Through conversations with physicians, patients, caregivers, and field experts, we refined our product based on their insights. This allowed our design to evolve beyond a laboratory concept into a solution shaped by ongoing dialogue with society. Our vision extends beyond treatment alone—we aim to build a comprehensive pathway that covers prevention, monitoring, and ultimately, therapy. From this, we developed three interconnected concepts: a diagnostic patch, a monitoring device, and community outreach initiatives.

Therapy: Patch (AGE-Thwart) Learn more on our Design page
Monitoring: Detection machine Learn more on our Design page

Prevention:
From our interview with Ms. Lü, Yu-Fang, we learned that a patient’s wound healing is closely linked to family involvement, and anyone can become a caregiver. Based on this, we aim to spread knowledge of diabetes and foot ulcer prevention to a wider audience.
Our outreach is tailored by age group: young people learn through educational games; adults through folk activities that integrate preventive practices with culture; and older adults via community centers for direct knowledge delivery. Through these practical approaches, we hope to raise awareness of foot care, reduce neglect and delays, and ultimately lessen the impact of diabetic foot ulcers.

iGEM week
With diabetes increasingly affecting youth, many still underestimate its complications, particularly diabetic foot. To address this, we designed interactive activities during iGEM Week that turned health education into engaging experiences. Through a Monopoly-style game, participants combined movement with answering questions about risk factors and prevention; in the Footprint Scroll, they left painted footprints to symbolize the importance of mobility and the need for daily cleaning and inspection; and through the Plaster Foot Care Wall, they shared messages of encouragement, representing collective support for prevention and treatment. These activities guided participants from play to reflection, helping them recognize that daily self-care is essential for avoiding long-term complications. The experience not only raised individual awareness but also extended to families and communities, reinforcing the message that health is an asset requiring continuous care, and neglect in youth can lead to greater risks in the future.

Mazu pilgrimage
To reach middle-aged and adult audiences, we joined Taiwan’s major religious event—the Baishatun Mazu Pilgrimage—where faith and community offered a meaningful setting to share health knowledge. Along the journey, we prayed for patients with diabetes and engaged participants in conversations that revealed gaps in awareness of daily management, such as the impact of meal order on blood sugar and the importance of foot hygiene. By providing practical prevention tips and emphasizing small but crucial daily habits, we helped participants recognize that self-care is key to avoiding long-term complications. This experience combined the warmth of community faith with scientific guidance, reinforcing the message that prevention in everyday life can protect health and give people the confidence to walk forward safely.

Elderly center
Research and physician interviews show that diabetes and diabetic foot ulcers mainly affect middle-aged and older adults, many of whom only seek help after wounds worsen—sometimes discovering diabetes for the first time. Because aging slows healing, early awareness and care for even minor wounds are critical.
To address this, we organized two community events combining professional guidance with interactive experiences. Physical therapists explained diabetes risks and prevention, then led safe stretches to improve circulation. We also designed engaging activities, such as passing tissue with toes to simulate glucose transport and improve dexterity, and kicking a ball to boost lower-limb circulation.
Finally, participants drew “the place they most wish to visit,” symbolizing how healthy feet support life’s journeys. Many joined in creating a collaborative artwork expressing hope and gratitude. Feedback showed that participants better understood foot care and realized that while past neglect cannot be changed, it is never too late to start preventive habits.

Local health center
Through our interactions with older adults, we found that many still lacked awareness of diabetes prevention and foot care. To address this, we collaborated with local community health centers, using a familiar environment to make health education approachable. We introduced a Monopoly-style board game where each step incorporated key messages such as proper meal sequencing, the importance of daily foot inspection, and methods for keeping feet clean and moisturized. This interactive format made learning enjoyable and practical, while post-activity feedback showed that many seniors understood for the first time the value of daily checks and moisturizing. By also providing lotion to encourage habit formation, we helped translate professional guidance into concrete daily actions. The experience showed how community-based education can turn knowledge into practice, fostering preventive awareness and reducing the risks of diabetic foot.

The Journey of the Plaster Foot：Carrying Blessings into the Clinic
After the iGEM Week activity, our Plaster Foot Care Model was covered with sticky notes from participants. These included not only heartfelt blessings and words of encouragement but also reflections on synthetic biology.
To ensure the messages could truly reach patients, we first removed the notes related to synthetic biology knowledge and kept those filled with encouragement and healing words. We then contacted Dr. Hsu, Honda, and with his support, delivered the model to his clinic, where it was placed in the waiting room.
Through this effort, we hoped that patients could see these warm messages while waiting for their appointments, feel the care and support from the wider community, and be reminded that they are not alone. The model thus became more than just an educational tool—it transformed into a symbol of blessings, encouragement, and solidarity. We wished that every patient could draw strength from it, hold on to hope, and find the courage to face their illness while moving toward recovery and a better life.

Social media
To promote diabetes and diabetic foot ulcer prevention, we used social media as a key channel, sharing visually engaging and easy-to-understand posts on platforms like Instagram (@ccu_igem). These posts transformed preventive concepts into practical reminders for daily self-care while extending the impact of our community events and senior center activities beyond physical boundaries. Social media also supported our outreach to younger generations, helping introduce foot health awareness early and fostering peer learning, while enabling cross-team collaboration to enrich our project. More than a record of activities, social media became a platform for sustained dialogue, embedding preventive health practices into everyday life and embodying the IHP spirit of addressing societal needs through accessible, community-based education.

In the long term, we plan to partner with NGOs and public health organizations to extend our outreach to more communities. By combining synthetic biology, engineering innovation, and community engagement, we aspire to build an accessible, preventive healthcare solution that alleviates the global burden of diabetic foot ulcers.

Throughout our project, we adhered to the core principles of Integrated Human Practices (IHP): grounding our work in science, engaging with society, collecting feedback, and iteratively refining our solutions to address real-world needs.
We reviewed literature on diabetic foot ulcers (DFUs) to understand their clinical and public health impact and conducted interviews with physicians, experts, patients, and caregivers to capture real-world challenges. These insights guided both our interventions and product design.
In product development, we optimized fit and usability, reducing patient and caregiver burden, and created monitoring devices for early wound detection to prevent severe DFU outcomes.
In education, we emphasized foot care and self-inspection, using community events and interactive activities to make health knowledge accessible and encourage behavioral change.
This iterative process—from identify problem, network conversation, solution, probe, iterative feedback, to refinement—embodies the IHP spirit, integrating science, healthcare, and societal needs to reduce suffering and benefit as many people as possible.