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Date:  Friday, November 3, 1995
FOR IMMEDIATE RELEASE
Contact:  Mark Roebuck, HRSA (301) 443-3376 			

The program, developed by the Health Resources and Services Administration (HRSA) within HHS, is designed "to remove a national scourge that is extremely costly, both in human and dollar terms," said HHS Secretary Donna E. Shalala.

Presently doctors perform some 54,000 amputations on diabetics each year, entailing up to $40,000 per amputation. That expense alone does not take into account the patients' lost productivity, increasing dependency on public assistance and other costs.

HRSA proposes to attack this problem with a program centered around a simple device costing under $10. The device, called a monofilament, consists of a nylon bristle mounted on a lucite handle. With a monofilament, and the proper training, a practitioner can determine quickly whether a patient has lost protective sensation in his or her foot -- a condition often leading to foot injuries that result in amputation.

The device and methodology, developed at the HRSA-administered Gillis W. Long Hansen's Disease Center in Carville, La., were intended originally to help patients with Hansen's disease -- i.e., leprosy -- which, like diabetes, causes loss of sensation in the feet. "Our experience with Hansen's disease patients has far exceeded our hopes," said HRSA Administrator Ciro V. Sumaya, M.D., M.P.H.T.M. "With the monofilament, up to 90 percent of Hansen's disease patients can avoid amputations. We want to apply this tremendous success record to the vastly larger number of Americans -- some 16 million -- who have diabetes."

"We now know that we can prevent most diabetes-related amputations through this simple, inexpensive, and yet highly effective technology," said Marilyn Gaston, M.D., director of HRSA's Bureau of Primary Health Care. "The prospect of reducing diabetes-related amputations by 90 percent, or even half that figure, translates to enormous savings and an incalculable social benefit for the patients, their families and their communities."

Through its Lower Extremity Amputation Prevention (LEAP) program, HRSA aims to introduce the device and methodology to the primary care setting -- where most at-risk patients receive their care, according to Dr. Sumaya. Today in Washington, D.C., HRSA convened a conference of leaders in the fields of diabetes and primary care to develop a strategy for implementing LEAP on a national scale. Organizations represented at the conference included the American Diabetes Association, the Health Care Financing Administration, and the National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Those who have utilized LEAP include the Department of Veterans Affairs and the Indian Health Service. HRSA also has introduced the program to over 700 community and migrant health centers and homeless projects -- through which HRSA serves almost nine million people. HRSA provides health services to the nation's underinsured and disadvantaged.

As part of its LEAP program, HRSA is disseminating kits that include explanatory literature, videos for practitionersand patients, and the monofilament itself. HRSA recommends that patients diagnosed with "insensitive foot" embark on a regimen of annual foot screening, patient education, appropriate footwear selection, daily self-inspection of the foot, and management of simple foot problems.

In November, which is National Diabetes Month as well as National Foot Awareness Month, a coalition of organizations will promote the LEAP program as part of a national educational effort. The coalition includes HRSA, the NIDDK, and the Department of Veterans Affairs.