September 7, 2022
Brian M. Schmidt, DPM is a Clinical Associate Professor in the Division of Metabolism, Endocrinology & Diabetes and is one of eight faculty members on the Podiatry Service team at Michigan Medicine. Dr. Schmidt provides care for patients in all areas of podiatric medicine at the Michigan Medicine Comprehensive Wound Care Clinic and the VA Ann Arbor Medical Center. He conducts translational research focused on the end-stage diabetes complication of diabetic foot ulcers and diabetic foot osteomyelitis, and has published numerous papers on these topics. In addition, Dr. Schmidt is supported in his research by the National Institutes of Health (NIH) - National Institute of Diabetes and Digestive and Kidney Diseases for his work as a co-investigator for the Diabetic Foot Consortium.
Recently, Dr. Schmidt received a NIH Research Career Development (K) Award, a seminal achievement for the field of podiatry, Michigan Medicine, and Dr. Schmidt, as he is the first podiatrist in the United States to receive this award.
Learn more about Dr. Schmidt’s research project, what he hopes to achieve, and why this research is important.
What is your project about?
In brief, I will be evaluating the use of state-of-the-art metagenomic next-generation sequencing techniques to identify pathogens in tissue samples from diabetic foot ulcers to understand the relationships between pathogens and patient-related outcomes. This includes testing the clinical feasibility of using molecular pathogen detection to direct therapy in infected diabetic foot ulcers.
What do you hope to achieve with your research?
As the era of molecular microbiology expands, it is crucial to have well-designed studies to provide meaningful (and relevant) clinical data. My research efforts will guide the understanding of the information derived from next generation sequencing as it is applied in diabetic foot ulcers. I hope it will lead to incorporation of molecular pathogen detection into clinical decision-making clinical trials.
Why is this research important?
Diabetic foot ulcers (DFUs) are a prevalent diabetes complication, with a lifetime incidence of up to 35% of people with diabetes, and over half a million people in the United States develop a DFU each year. The healthcare and socioeconomic impacts of DFUs are staggering, with high rates of lower extremity amputations, downstream comorbidities, and up to 50% associated mortality. After decades of sustained decline, despite advances in diabetes care, new wound therapies, and establishment of DFU treatment standards, lower extremity amputations appear to be increasing.
Why are you interested in this area of research?
I am interested in this area of research because standard assessment of diabetic foot infection has not changed in decades, even though technologies to evaluate tissue culture have changed considerably during the same time. In fact, there is a compelling need to advance standards of care for persons with diabetic foot ulcers and in my position as a physician and a clinical researcher in the NIH-funded Diabetic Foot Consortium, I am well poised to investigate this area further. More specifically, an area ripe for improvement is time-to-pathogen-identification. Many patients, especially those hospitalized for a foot infection, wait many days for cultures to result. This delays optimal care and is a particularly inefficient allocation of resources. Utilizing next generation sequencing techniques to evaluate the tissue specimen potentially allows for pathogens to be more rapidly identified as compared to conventional culture. This reduction in time to pathogen identification may facilitate more rapid targeted therapy and may improve outcomes.
Is there anything else you would like to share?
I want to thank my many mentors and colleagues for their encouragement and critical feedback. I could not have achieved this accomplishment without them.