[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1666 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1666

To amend the Public Health Service Act to establish comprehensive State 
   diabetes control and prevention programs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 26, 2003

  Mr. Cochran (for himself and Mr. Kennedy) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to establish comprehensive State 
   diabetes control and prevention programs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Diabetes Prevention and Treatment 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Diabetes occurs in 2 forms, type 1 and type 2 diabetes. 
        Type 1 diabetes usually occurs during childhood or adolescence 
        and type 2 diabetes, which accounts for more than 9 out of 10 
        cases of diabetes, usually occurs after age 40. Type 1 diabetes 
        is a disease that results from the body's failure to produce 
        insulin, the hormone that ``unlocks'' the cells of the body, 
        allowing glucose, or sugar, to enter and fuel the cells. People 
        with type 1 diabetes must take daily insulin injections to stay 
        alive. Type 2 diabetes results from insulin resistance, a 
        condition in which the body cannot properly use insulin and 
        cannot make enough insulin to compensate for the increased 
        bodily need. Although some people with type 2 diabetes also 
        require daily insulin injections, often type 2 diabetes can be 
        controlled through healthy diet, nutrition, and lifestyle 
        changes. If not, medication and insulin shots may be used to 
        control diabetes.
            (2) There are approximately 17,000,000 individuals in the 
        United States with diabetes, almost \1/3\ of whom are unaware 
        that they have the disease.
            (3) Diabetes is the sixth leading cause of death in the 
        United States, contributing to over 200,000 deaths every year.
            (4) Another 16,000,000 individuals in the United States 
        have a condition known as ``pre-diabetes'', or impaired glucose 
        tolerance. Unless treated, ``pre-diabetes'' dramatically 
        increases the risk for developing type 2 diabetes and increases 
        the risk of heart disease by nearly 50 percent.
            (5) Prevention efforts against type 2 diabetes that 
        consisted of diet and exercise (such as cutting fat and 
        calories and walking at least 30 minutes, 5 days a week, 
        resulting in a 5- to 7-percent weight loss) lowered the 
        incidence of type 2 diabetes by 58 percent.
            (6) There is a growing epidemic of type 2 diabetes in 
        children and adolescents that may be linked to obesity and 
        physical inactivity. Type 2 diabetes now accounts for between 8 
        and 46 percent of all new cases of diabetes among children who 
        are referred to pediatric centers for care.
            (7) Diabetes is also a major contributor to heart disease, 
        stroke, and high blood pressure. In adults, diabetes is the 
        leading cause of new blindness, end-stage renal failure, and 
        nontraumatic lower limb amputations. People with diabetes are 2 
        to 4 times more likely than the general population to have 
        heart disease or to suffer a stroke.
            (8) Diabetes disproportionately affects communities of 
        color. Type 2 diabetes is prevalent at rates 2.6 times higher 
        among American Indians and Alaska Natives than among whites. 
        African-American adults have a 100-percent higher rate, and 
        Hispanics a 90-percent higher rate, of type 2 diabetes than 
        whites.
            (9) The African-American and Hispanic death rates from 
        diabetes are twice that for whites. Among American Indians and 
        Alaska Natives, the death rate from diabetes is 3 times higher 
        than for whites.
            (10) More than 1 out of every 10 health care dollars, and 
        at least 1 out of 4 dollars provided under the medicare program 
        carried out under title XVIII of the Social Security Act, are 
        spent on individuals in the United States with diabetes.
            (11) The economic cost of diabetes is conservatively 
        estimated at $132,000,000,000 annually. This includes 
        $92,000,000,000 in direct medical expenditures and 
        $40,000,000,000 attributable to disability and premature 
        mortality.
            (12) Reducing the progression of pre-diabetes to diabetes 
        with the level of success achieved by the National Institutes 
        of Health's Diabetes Prevention Program could save 
        $4,290,000,000 annually.

          TITLE I--CENTERS FOR DISEASE CONTROL AND PREVENTION

SEC. 101. COMPREHENSIVE STATE DIABETES CONTROL AND PREVENTION PROGRAMS.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by striking section 316 and inserting the 
following;

``SEC. 316. STATE DIABETES CONTROL AND PREVENTION PROGRAMS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and in consultation with 
appropriate agencies, shall support comprehensive diabetes control and 
prevention programs by awarding grants to eligible entities to provide 
public health surveillance, prevention, and control activities, and to 
assure affordable, high-quality diabetes care.
    ``(b) Eligibility.--A State or territory is an eligible entity 
under this section.
    ``(c) Use of Funds.--Consistent with the comprehensive diabetes 
control and prevention plan submitted under subsection (d), an eligible 
entity that receives a grant under this section may use funds received 
under such grant to--
            ``(1) conduct health and community research, including 
        research on behavioral interventions, to prevent type 1 and 2 
        diabetes (including the development of related complications) 
        and the onset of type 2 diabetes in persons with pre-diabetes 
        or persons at high risk for developing diabetes;
            ``(2) conduct demonstration projects, including community-
        based programs of diabetes control and prevention, and similar 
        collaborations with academic institutions, hospitals, community 
        centers, health insurers, researchers, health professionals, 
        and nonprofit organizations;
            ``(3) conduct public health surveillance and 
        epidemiological activities relating to the prevalence of type 1 
        and 2 diabetes and assessing disparities in diabetes control 
        and prevention, including such disparities in underserved 
        populations;
            ``(4) provide public information and education programs; 
        and
            ``(5) provide education and training for health 
        professionals, including allied health professionals.
    ``(d) Application.--An eligible entity that seeks funding under 
this section shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the Secretary may 
require, including a comprehensive plan for diabetes-related prevention 
and control strategies and activities to be undertaken or supported by 
the eligible entity, which--
            ``(1) is developed with the advice of stakeholders from the 
        public, private, and nonprofit sectors with expertise relating 
        to diabetes control, prevention, and treatment;
            ``(2) is intended to reduce the incidence, morbidity, and 
        mortality of type 1 and 2 diabetes, with a priority on 
        preventing and controlling diabetes in at-risk populations and 
        reducing disparities in underserved populations; and
            ``(3) describes the diabetes-related services and 
        activities to be undertaken or supported by the eligible 
        entity.''.

SEC. 102. CDC DIABETES CONTROL AND PREVENTION ACTIVITIES.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) (as amended by section 101) is further amended by inserting 
after section 316, the following:

``SEC. 316A. DIABETES CONTROL, PREVENTION, AND RESEARCH ACTIVITIES.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, and in collaboration 
with appropriate agencies, shall conduct, support, and promote the 
coordination of research, including translational and preventive 
investigations and studies, demonstrations and pilot programs, training 
and studies relating to surveillance, control, and prevention of type 1 
and 2 diabetes (including the development of related complications) and 
the onset of type 2 diabetes in persons with pre-diabetes or persons at 
high risk for developing diabetes.
    ``(b) Activities.--Activities that the Secretary shall conduct, 
support, and promote as described in subsection (a) shall include--
            ``(1) the collection, analysis, and publication of biennial 
        data on the prevalence and incidence of type 1 and 2 diabetes 
        and of pre-diabetes, in coordination with activities undertaken 
        under section 317H;
            ``(2) the development of uniform data sets for public 
        health surveillance and clinical quality improvement 
        activities;
            ``(3) the identification of evidence-based and cost-
        effective public health best practices, including practices and 
        models developed through grants awarded under section 316;
            ``(4) the development of early detection and prevention 
        programs, such as screening to identify diabetic retinopathy 
        and to prevent blindness, as well as neuropathy, nephropathy, 
        peripheral vascular disease, podiatric examinations to prevent 
        foot ulcers, and lower extremity amputations; and
            ``(5) the establishment and operation of a national 
        diabetes laboratory to develop and improve laboratory methods 
        to assist in the diagnosis, treatment, and prevention of 
        diabetes, including the development of less invasive ways to 
        monitor blood glucose, such as nonmydriatic retinal imaging, 
        and to prevent hypoglycemia, and the improvement of existing 
        glucometers that measure blood glucose.
    ``(c) Priority.--The Secretary shall give priority to programs and 
activities to reduce disparities in diabetes prevention, diagnosis, 
management, and care for high-risk or underserved populations. Such 
programs and activities may include--
            ``(1) refinement of the National Health and Nutrition 
        Examination Survey to address the lifestyle of such 
        populations;
            ``(2) enhanced efforts to develop culturally appropriate 
        interventions; and
            ``(3) strategies to enhance the quality, accuracy, and 
        timeliness of diabetes-related morbidity and mortality data for 
        such populations.
    ``(d) Collaborative Activities.--The activities described in 
subsection (b) may be conducted in collaboration with eligible entities 
that are awarded a grant under section 316.
    ``(e) Training and Technical Assistance.--The Secretary may provide 
training, technical assistance, supplies, equipment, and services, and 
may detail any officer or employee of the Department of Health and 
Human Services, to State and local health agencies, or to any public or 
nonprofit entity designated by a State health agency, with respect to 
the planning, development, and operation of any program or service 
carried out pursuant to subsection (a) or in lieu of grant funds 
provided under section 316.
    ``(f) Improvement of Mortality Data Collection.--
            ``(1) Assessment.--The activities described in subsection 
        (b)(1) shall include an assessment of diabetes as a primary or 
        underlying cause of death and analysis of any under-reporting 
        of diabetes as a primary or underlying cause of death in order 
        to provide an accurate estimate of yearly deaths related to 
        diabetes.
            ``(2) Death certificate additional language.--In carrying 
        out the activities described in subsection (b)(1), the 
Secretary may promote the addition of language to death certificates to 
improve collection of diabetes mortality data, including adding 
questions for the individual certifying to the cause of death regarding 
whether the deceased had diabetes and whether diabetes was an 
immediate, underlying, or contributing cause of or condition leading to 
death.
    ``(g) Report.--
            ``(1) In general.--The Director shall submit to the 
        Committee on Health, Education, Labor, and Pensions of the 
        Senate and the Committee on Energy and Commerce of the House of 
        Representatives annual reports describing the activities 
        undertaken under this section and section 316.
            ``(2) Content.--The reports shall include an--
                    ``(A) evaluation of the accuracy of data regarding 
                the incidence, prevalence, complications, and costs of 
                diabetes; and
                    ``(B) projections regarding trends in each of the 
                areas described in subparagraph (A).
            ``(3) Availability.--The Director shall make such reports 
        publicly available in print and on the Centers for Disease 
        Control and Prevention website.

``SEC. 316B. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to carry out sections 316 
and 316A, $120,000,000 for fiscal year 2004, and such sums as may be 
necessary for each of fiscal years 2005 through 2008.''.

    TITLE II--IMPROVING THE QUALITY OF DIABETES PREVENTION AND CARE

SEC. 201. DIABETES CARE QUALITY IMPROVEMENT GRANTS.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) (as amended by section 102) is further amended by inserting 
after section 316B the following:

``SEC. 316C. IMPROVING QUALITY OF DIABETES PREVENTION AND CARE.

    ``(a) In General.--After completion of activities under subsection 
(d), the Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, and in collaboration with the Director 
of the Agency for Healthcare Research and Quality, shall award 
competitive grants to eligible entities to apply the best practices 
identified by the Secretary under subsection (d) for diabetes 
prevention and control.
    ``(b) Eligibility.--An entity is eligible for a grant under this 
section if such entity is--
            ``(1) a State, territory, Indian tribe, tribal 
        organization, public or nonprofit entity; or
            ``(2) a partnership of an entity described in paragraph (1) 
        and an appropriate private sector organization.
    ``(c) Priority.--In awarding grants under this section, the 
Secretary shall give priority to eligible entities that propose to 
carry out programs to reduce disparities in diabetes prevention and 
control for high-risk or underserved populations.
    ``(d) Best Practices.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of this section, the Secretary shall identify 
        evidence-based best practices, evidence-based guidelines and 
        other effective models for diabetes prevention and control, 
        which may be adopted and applied by eligible entities under 
        this section.
            ``(2) Specific best practices.--Best practices, as 
        described in paragraph (1), may include--
                    ``(A) State or community-based interventions, 
                school-based screening, care and prevention programs, 
                health systems improvement strategies, and health and 
                environmental policies that promote improved nutrition 
                and physical activity;
                    ``(B) case management or disease management quality 
                improvements programs;
                    ``(C) appropriate communication, training, or 
                regional outreach and health promotion initiatives, 
                including Internet-based initiatives; or
                    ``(D) models developed or validated by diabetes 
                research and training centers established under section 
                431.
    ``(e) Application.--An eligible entity that seeks funding under 
this section shall prepare and submit to the Secretary an application 
at such time, in such manner, and containing such information as the 
Secretary determines to be necessary, including information regarding 
how such entity would use funds received under this section to 
supplement activities carried out under such entity's comprehensive 
diabetes control and prevention plan under section 316.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $50,000,000 for fiscal year 
2004, and such sums as may be necessary for each of fiscal years 2005 
through 2008.''.

SEC. 202. ENHANCEMENT OF DIABETES EDUCATION AND OUTREACH.

    Part P of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by adding at the end the following:

``SEC. 399O. NATIONAL DIABETES EDUCATION AND OUTREACH.

    ``(a) Purpose.--The Secretary, acting through the Diabetes Mellitus 
Interagency Coordinating Committee, shall coordinate a national 
diabetes education program to support, develop, and implement education 
initiatives and outreach strategies appropriate for both type 1 and 2 
diabetes. Such activities may include public awareness campaigns, 
public service announcements and community partnership workshops, as 
well as programs targeted at businesses and employers, managed care 
organizations, and health care providers.
    ``(b) Priority.--The Secretary shall emphasize translation of new 
scientific and clinical findings into utilizable information for health 
care providers and patients. The Secretary shall also give priority to 
reaching high-risk or underserved populations.
    ``(c) Collaboration.--In carrying out this section, the Secretary 
shall consult and collaborate with stakeholders from the public, 
private, and nonprofit sectors with expertise relating to diabetes 
control, prevention, and treatment.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $15,000,000 for fiscal year 
2004 and such sums as may be necessary for each of fiscal years 2005 
through 2008.''.

SEC. 203. DIABETES QUALITY MEASURES.

    Section 912 of the Public Health Service Act (42 U.S.C. 299b-1) is 
amended by adding at the end the following:
    ``(d) Quality Measures.--In carrying out subsection (a), the 
Director shall--
            ``(1) develop and periodically update, lists of 
        scientifically validated, evidence-based quality measures for 
        assessing and improving clinical services and counseling 
        related to diabetes; and
            ``(2) support the development and validation of needed 
        measures.''.

SEC. 204. DIABETES QUALITY IMPROVEMENT PROGRAM.

    (a) Diabetes Quality Improvement Program.--The Secretary of Health 
and Human Services, acting through the Director of the Centers for 
Disease Control and Prevention, shall establish a Diabetes Quality 
Improvement Program to disseminate and promote the widespread use of 
national performance measures for diabetes care and for quality 
improvement to all diabetes prevention and control programs under the 
authority of the Secretary. The National Diabetes Quality Improvement 
Program shall promote the adoption of these national performance 
measures to public and private health care systems providing care to 
persons with diabetes and expand the number and scope of public-private 
partnerships implementing such Program.
    (b) Evaluation.--The Secretary of Health and Human Services, acting 
through the Director of the Agency for Healthcare Research and Quality 
and the Director of the Centers for Disease Control and Prevention, 
shall undertake an evaluation of quality improvement initiatives 
supported under this section.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2004 through 2008.

SEC. 205. MONITORING THE QUALITY AND DISPARITIES IN DIABETES CARE.

    Part A of title IX of the Public Health Service Act (42 U.S.C. 299 
et seq.) is amended by adding at the end the following:

``SEC. 904. AREAS OF SPECIAL EMPHASIS.

    ``The Secretary, acting through the Director, shall incorporate 
within the annual quality report required under section 913(b)(2) and 
the annual disparities report required under section 903(a)(6), 
scientific evidence and information appropriate for monitoring the 
quality and safety of diabetes care and identifying, understanding, and 
reducing disparities in care.''.

                TITLE III--NATIONAL INSTITUTES OF HEALTH

SEC. 301. ENHANCEMENT OF DIABETES RESEARCH AND TRAINING CENTERS.

    (a) In General.--Section 431(a)(1) of the Public Health Service Act 
(42 U.S.C. 285c-5(a)(1)) is amended by striking ``Consistent with 
applicable recommendations of the National Commission on Diabetes,'' 
and inserting ``Consistent with applicable recommendations of the 
Diabetes Research Working Group and with updated strategic research 
plans developed through the Diabetes Mellitus Interagency Coordinating 
Committee,''.
    (b) Authorized Research.--Section 431(a)(1)(B)(i) of the Public 
Health Service Act (42 U.S.C. 285c-5(a)(1)(B)(i)) is amended by 
inserting ``basic, clinical, behavioral, translational, and 
preventative'' before ``research''.
    (c) Education and Training.--Section 431(a)(2) of the Public Health 
Service Act (42 U.S.C. 285c-5(a)(2)) is amended by striking ``paragraph 
(1)(B)(ii).'' and inserting ``paragraph (1)(B)(ii). Such funds may also 
be used for pre- and post-doctoral research fellowship training and for 
research career development, meeting such requirements as the Secretary 
may prescribe.''.

SEC. 302. DIABETES RESEARCH PLANNING AND COORDINATION.

    Section 429 of the Public Health Service Act (42 U.S.C. 285c-3) is 
amended by adding at the end the following:
    ``(d) The Diabetes Mellitus Interagency Coordinating Committee 
shall develop and periodically update a strategic research plan for 
diabetes, building upon and updating the overall scientific guidance 
provided by the 1999 Strategic Plan of the congressionally established 
Diabetes Research Working Group. In engaging in strategic research 
planning for diabetes, the Committee shall address broad, multiple 
avenues of current and emerging research needs and opportunity, 
including clinical research in diabetes, the genetics of diabetes, 
diabetes in children and youth, and diabetes in underserved or high-
risk populations. The Committee shall also coordinate the efforts of 
the National Diabetes Education Program.''.

SEC. 303. GENETICS OF DIABETES.

    Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) 
is amended by inserting after section 430 the following:

``SEC. 430A. GENETICS OF DIABETES.

    ``The Diabetes Mellitus Interagency Coordinating Committee, in 
collaboration with the Directors of the National Human Genome Research 
Institute, the National Institute of Diabetes and Digestive and Kidney 
Diseases, and the National Institute of Environmental Health Sciences, 
and other voluntary organizations and interested parties, shall--
            ``(1) coordinate and assist efforts of the Type 1 Diabetes 
        Genetics Consortium, which will collect and share valuable DNA 
        information from type 1 diabetes patients from studies around 
        the world; and
            ``(2) provide continued coordination and support for the 
        consortia of laboratories investigating the genomics of 
        diabetes.''.

SEC. 304. RESEARCH AND TRAINING ON DIABETES IN UNDERSERVED AND MINORITY 
              POPULATIONS.

    (a) Research.--Subpart 3 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285c et seq.) is amended by adding at the end 
the following:

``SEC. 434B. RESEARCH ON DIABETES IN UNDERSERVED AND MINORITY 
              POPULATIONS.

    ``(a) In General.--The Director of the Institute, in coordination 
with the Director of the National Center on Minority Health and Health 
Disparities and other appropriate institutes and centers, shall expand, 
intensify, and coordinate research programs on pre-diabetes, type 1 
diabetes and type 2 diabetes in underserved populations and minority 
groups.
    ``(b) Research.--The research described in subsection (a) shall 
include research on--
            ``(1) behavior, including diet and physical activity and 
        other aspects of behavior;
            ``(2) environmental factors related to type 2 diabetes that 
        are unique to, more serious, or more prevalent, among 
        underserved or high-risk populations;
            ``(3) research on the prevention of complications, which 
        are unique to, more serious, or more prevalent among 
        minorities, as well as research on how to effectively translate 
        the findings of clinical trials and research to improve methods 
        for self-management and health care delivery; and
            ``(4) genetic studies of diabetes, consistent with research 
        conducted under section 430A.
    ``(c) Definition.--In this section, the term `minority group' has 
the meaning given the term `racial and ethnic minority group' in 
section 1707.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated for purposes of carrying out this section $20,000,000 for 
fiscal year 2004 and such sums as may be necessary for each of fiscal 
years 2005 through 2008.''.
    (b) Division Directors.--Section 428 of the Public Health Service 
Act (42 U.S.C. 285c-2) is amended--
            (1) in subsection (b)(1), by inserting ``(including 
        research training of members of minority populations in order 
        to facilitate their conduct of diabetes-related research in 
        underserved populations and minority groups)'' after ``research 
        programs''; and
            (2) by adding at the end the following:
    ``(c) Definition of Minority Group.--In this section, the term 
`minority group' has the meaning given the term `racial and ethnic 
minority group' in section 1707.''.

SEC. 305. AUTHORIZATION OF APPROPRIATIONS.

    Subpart 3 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285c et seq.) (as amended by section 304(a)) is amended by 
adding at the end the following:

``SEC. 434C. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out this subpart with respect to the 
programs of the National Institute of Diabetes and Digestive and Kidney 
Diseases, other than section 434B, there are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2004 through 2008.''.

          TITLE IV--REDUCING DIABETES AMONG CHILDREN AND YOUTH

SEC. 401. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by striking section 317H and inserting the 
following:

``SEC. 317H. DIABETES IN CHILDREN AND YOUTH.

    ``(a) Surveillance on Type 1 Diabetes.--The Secretary, acting 
through the Director of the Centers for Disease Control and Prevention 
and in consultation with the Director of the National Institutes of 
Health, shall develop a sentinel system to collect data on type 1 
diabetes, including the incidence and prevalence of type 1 diabetes and 
shall establish a national database for such data.
    ``(b) Type 2 Diabetes in Youth.--The Secretary shall implement a 
national public health effort to address type 2 diabetes in youth, 
including--
            ``(1) enhancing surveillance systems and expanding research 
        to better assess the prevalence and incidence of type 2 
        diabetes in youth and determine the extent to which type 2 
        diabetes is incorrectly diagnosed as type 1 diabetes among 
        children;
            ``(2) standardizing and improving methods to assist in the 
        diagnosis, treatment, and prevention of diabetes including 
        developing less invasive ways to monitor blood glucose to 
        prevent hypoglycemia such as nonmydriatic retinal imaging and 
        improving existing glucometers that measure blood glucose; and
            ``(3) developing methods to identify obstacles facing 
        children in traditionally underserved populations to obtain 
        care to prevent or treat type 2 diabetes.
    ``(c) Long-Term Epidemiological Studies on Diabetes in Children.--
The Secretary, acting through the Director of the Centers for Disease 
Control and Prevention and the Director of the National Institute of 
Diabetes and Digestive and Kidney Diseases, shall conduct or support 
long-term epidemiology studies in children with diabetes or at risk for 
diabetes. Such studies shall investigate the causes and characteristics 
of the disease and its complications.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $20,000,000 for fiscal year 
2004 and such sums as may be necessary for each of fiscal years 2005 
through 2008.''.

SEC. 402. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

    Subpart 3 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285c et seq.) is amended by striking section 434A and 
inserting the following:

``SEC. 434A RESEARCH ON DIABETES IN CHILDREN AND YOUTH.

    ``(a) In General.--Consistent with the Pediatric Research 
Initiative established under section 409D, the Director of the 
Institute shall expand, intensify, and coordinate research programs and 
efforts of the National Institutes of Health to treat, cure, and 
prevent diabetes in children.
    ``(b) Clinical Trial Infrastructure; Innovative Treatments.--The 
Secretary, acting through the Director of the National Institutes of 
Health, shall support clinical research centers and testing of 
innovative treatments for the prevention, detection, treatment, and 
cure of diabetes. Such treatments may include testing of islet cell 
transplantation, new insulin preparations, insulin delivery methods, 
and blood sugar monitoring devices.
    ``(c) Prevention of Diabetes.--The Secretary, acting through the 
appropriate agencies, shall provide for a national effort to prevent 
diabetes. Such effort shall provide for a combination of increased 
research and development of prevention strategies, such as 
consideration of vaccine development, coupled with the appropriate 
ability to test the effectiveness of such strategies in clinical 
trials, including strategies to prevent the onset and progression of 
type 1 diabetes.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2004 through 2008.''.

                            TITLE V--REPORTS

SEC. 501. SURGEON GENERAL'S REPORT ON THE PUBLIC HEALTH IMPACT OF 
              DIABETES.

    (a) In General.--The Surgeon General may prepare a report on 
diabetes, including the prevalence of diabetes and the adequacy of data 
collection and analysis concerning diabetes.
    (b) Contents.--The report described in subsection (a) shall--
            (1) set forth recommendations to address underserved and 
        high-risk populations;
            (2) set forth recommendations to reduce the morbidity, 
        mortality, and prevalence of diabetes in the United States; and
            (3) contain an action plan to implement the recommendations 
        under paragraphs (1) and (2).
    (b) Issuance of Report.--Not later than 3 years after the date of 
enactment of this Act, the Surgeon General shall submit to the 
Committee on Health, Education, Labor, and Pensions of the Senate and 
the Committee on Energy and Commerce of the House of Representatives 
the report described in subsection (a).
    (c) Definition of Diabetes.--In this section, the term ``diabetes'' 
means type 1 diabetes and its complications, type 2 diabetes and its 
complications, and pre-diabetes or impaired glucose tolerance.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $1,000,000 for fiscal year 2004, 
and such sums as may be necessary for each of fiscal years 2005 and 
2006.
                                 <all>