SIGNIFICANCE & RATIONALE FOR PROPOSED PROJECT Foot problems are the most common complication in diabetics leading to hospitalization.1-5 Approximately one quarter of all hospital days for persons with diabetes are related to foot complications.4,5,8 In the United States there are approximately 120,000 non-traumatic lower extremity amputations performed each year.6,7 In the U.S., 45%-83% of all lower extremity amputations involve diabetics.1,9,5 Overall, patients with diabetes are 15-46 times more likely to have an amputation than patients without diabetes.11,14,15 It has been estimated that 5% to 15% of diabetics will have a lower extremity amputation in their lifetime.11 After their initial amputation 9-17% of diabetic patients will experience a second amputation within the same year12-17 and 25% to 68% of diabetics will have an amputation of the contralateral extremity within five years.18-20 The five-year survival rate after a lower extremity amputation ranges from 41% to 70%.19-21 Indeed, 10% of these patients die before leaving the hospital after a lower extremity amputation.7,9,20 National Initiatives: There are a number of initiatives by federal and state government organizations to prioritize efforts to reduce the burden of diabetes related amputations. Healthy People 2000 and Healthy People 2010 have set a goal of reducing the incidence of diabetes related amputation by 40%, and the U.S. Department of Health and Human Services has prioritized amputation reduction in minorities as one of its strategic Initiatives to Eliminate Racial and Ethnic Disparities in Health. Likewise, the Veterans Administration and Indian Health Service have prioritized amputation prevention for patients with diabetes. For instance, the VA has mandated the development of special programs to evaluate patients with diabetes, identify patients that fit a high-risk profile, and provide specialized treatment programs in order to decrease the impact of diabetes related complications within the Veterans Health Administration. Lower extremity complications in diabetics are common, costly and associated with a high rate of recurrence, morbidity and mortality. Several studies in the U.S. and Europe suggest that amputations and ulcerations can be prevented when special foot care and education are implemented. Despite these types of initiatives, increasing research knowledge, better re-vascularization and diagnostic procedures and an expanding armamentarium of new drugs and technology, the incidence of amputation has increased over the past few decades.15 Precursors to amputation: In diabetes, as in other chronic diseases, patient involvement to identify early warning signs of the disease process is imperative to reduce the incidence of complications and prevent morbidity. Many lower extremity complications involve sensory neuropathy as a pivotal component of the critical pathway for both the development of ulcers and amputations. Therefore, pain and loss of function, primary natural warning systems that alert us to take action and seek medical care, are faulty. Diabetic patients can hence sustain injuries that are not recognized until they are so severe that full thickness ulcerations result. The aim of this study was to further evaluate a tool to help high-risk diabetics identify areas on their feet that are inflamed and prone to ulceration before a wound develops at sites that would otherwise not be recognized as “symptomatic.” Results of the Phase I study indicated that high-risk patients with diabetes can effectively use an infrared temperature device to monitor foot temperatures. Patients who used the device had significantly fewer foot complications compared to patients who received education, therapeutic shoes plus insoles and regular foot evaluations alone.