[Congressional Record Volume 149, Number 136 (Tuesday, September 30, 2003)]
[Extensions of Remarks]
[Page E1932]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




REGARDING THE DIABETIC FOOT COMPLICATION AND LOWER EXTREMITY AMPUTATION 
                         REDUCTION ACT OF 2003

                                 ______
                                 

                         HON. RICHARD H. BAKER

                              of louisiana

                    in the house of representatives

                      Tuesday, September 30, 2003

  Mr. BAKER. Mr. Speaker, as the Federal Government seeks to provide 
better healthcare to more Americans while reducing healthcare expenses, 
we must look at the benefits of preventive care programs. Education, 
screening and preventive treatments can save patients and government 
significant heartache and expense. One area where preventive care shows 
tremendous promise is the treatment of diabetic foot complications.
  There are an estimated 17 million Americans who have diabetes. This 
number represents an increase of 61 percent since 1990. As diabetes 
rates continue to rise, the cost of treating diabetes, already 
estimated at $132 billion, will certainly rise. One of the most serious 
complications diabetes patients face is poor circulation and infections 
in their lower extremities. In fact, diabetic foot infections are the 
most common reason for hospital admissions among persons with diabetes, 
accounting for one-quarter of all diabetic admissions in the United 
States. Loss of circulation and feeling present real challenges to 
people with diabetes and 15 percent of people with diabetes will 
experience a foot ulcer, and between 14 and 24 percent of those with a 
foot ulcer will require amputation.
  There are tremendous costs associated with treating foot ulcers and 
with lower extremity amputations. In fact, lower extremity amputations 
cost Americans $2 billion a year and the average cost of a lower 
extremity amputation is $60,000. Although private insurance bears some 
of the cost of diabetic foot complications, Medicare is saddled with 
many of these costs since these complications disproportionately affect 
the elderly. For example, analysis of the 1995 Medicare claims revealed 
that lower-extremity ulcer care accounted for $1.45 billion in Medicare 
costs and contributed substantially to the high cost of care for 
diabetics, compared with Medicare costs for the general population. In 
fact, the Medicare costs for diabetes patients with foot ulcers is 3 
times higher than for diabetes patients in general, and inpatient care 
accounts for 74 percent of diabetic ulcer-related costs.
  Fortunately, cost effective ulcer prevention and treatment 
interventions have proven effective at reducing foot complications and 
lower extremity amputations at only a fraction of the cost. There are a 
number of descriptive studies that show that a multidisciplinary 
approach, including preventive strategies, patient and staff education, 
and treatment of foot ulcers, can reduce amputation rates by 40 to 85 
percent. Nationwide reductions of this size would save Americans 
between $800 million and $1.7 billion a year. Of note, the LSU Health 
Sciences Center Diabetes Foot Program in Baton Rouge, Louisiana 
enrolled over 2,300 diabetes patients with published research 
demonstrating their prevention and treatment program resulted in an 89 
percent reduction in foot related hospitalizations, an 81 percent 
reduction in emergency room visits, and a 79 percent reduction in foot 
amputations at a cost of about 50 percent of standard care.
  With sound research showing the benefits of preventive care for 
people with diabetes, now is the time to commission a large, 
authoritative study on the issue. The results of this study will serve 
as solid evidence to public and private organizations of the need for 
preventive care to aid in the reduction of diabetes foot complications 
and will help foster technical and policy changes to healthcare 
programs. In addition, thousands of Americans who participate in this 
study will benefit from the education and treatment provided by this 
grant program.
  Mr. Speaker, I hope members will consider these facts and cosponsor 
the ``Diabetic Foot Complication and Lower Extremity Amputation 
Reduction Act of 2003.''

                          ____________________