The challenge

Diabetic foot ulcers are one of the most costly and devastating complications of diabetes. They are the leading cause of non-traumatic lower limb amputation globally, and they consume a disproportionate share of diabetes-related healthcare expenditure - yet they remain chronically underserved by innovation.

In 2008, ITI Scotland announced an intention to invest £7.9 million over three and a half years in the development of advanced point-of-care wound infection diagnostic technology specifically targeting diabetic foot ulcers. The clinical case was clear. But before committing that level of investment, ITI needed something the clinical literature alone could not provide: a rigorous commercial argument grounded in how diabetic foot care actually works in practice - across different health systems, different patient populations, and different clinical cultures.

ITI commissioned Umio to build that case and direct its technology development and investment strategy.

What we did

In fourteen weeks over Christmas 2009, Umio completed a detailed assessment of the diabetic foot care ecosystem across four countries - the US, UK, India, and Germany. Four countries chosen to capture the full range of health system structures, reimbursement environments, clinical cultures, and patient population characteristics that any technology entering this market would need to navigate.

We began by mapping the ecosystem - not just the clinical pathway but the full hierarchy of interactions, practices, and relationships shaping how diabetic foot care is actually delivered and experienced. We then spent time directly with patients and clinicians in each country, using our outcome-driven innovation methodology to surface deep insight into their needs, constraints, resources, and the outcomes they were trying to achieve but consistently failing to reach.

What emerged was a picture significantly more complex and more commercially interesting than the standard clinical literature suggested. We discovered four universal clinician practice segments - cutting across formal role definitions, pathway positions, and national boundaries - each with distinct values, priorities, unmet needs, and resource constraints. These segments were invisible to conventional market segmentation but determinative of how any new technology would be adopted, used, and valued in practice.

From that foundation we developed several new value propositions and solution concepts, each grounded in evidence of where unmet need was greatest and where the technology's capabilities most closely matched the conditions of actual clinical practice. We then integrated all of the insights into a custom multi-modal health economic and commercial model - drawing on QALY, Markov, and activity-cost methodologies with detailed patient use case scenarios and resource costings for each geographic market.

What we found

The project revealed several things that a purely clinical or epidemiological assessment of the market would have missed.

The diversity of clinical practice across and within countries was far greater than standard pathway analysis suggested. The same clinical problem - detecting wound infection in a diabetic foot ulcer - was being managed in radically different ways depending on the setting, the clinician's experience, the available resources, and the patient's own capacity to monitor and respond to their condition at home. A technology designed for one practice segment would fail in another not because it did not work clinically but because it did not fit the actual conditions of use.

What it means

Armed with a compelling and rigorously evidenced commercial case, ITI gained the reassurance it needed to proceed with its technology licensing programme. With Umio's assistance, ITI identified commercial partners with the capability to develop the first concepts the project had outlined. Early-stage technology was subsequently licensed to a top ten global medical device manufacturer for further commercialisation.

The project remains one of the clearest demonstrations in Umio's history of what happens when innovation strategy is grounded in the actual conditions of clinical practice and lived experience rather than in epidemiological data and clinical literature alone. The commercial argument was stronger, the opportunity landscape was more precise, and the technology pathway was more defensible — because the foundation it was built on was more real.