[Congressional Record Volume 169, Number 99 (Wednesday, June 7, 2023)]
[Senate]
[Pages S2008-S2009]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Mrs. Shaheen):
  S. 1855. A bill to reauthorize the Special Diabetes Program for Type 
1 Diabetes and the Special Diabetes Program for Indians; to the 
Committee on Health, Education, Labor, and Pensions.
  Ms. COLLINS. Madam President, I rise today to introduce the Special 
Diabetes Program Reauthorization Act of 2023 with Senator Jeanne 
Shaheen, my colleague from New Hampshire and cochair of the Senate 
Diabetes Caucus. Our bipartisan bill would reauthorize and strengthen 
vital type 1 diabetes research happening at the National Institutes of 
Health and renew critical treatment, education, and prevention programs 
for at-risk populations, specifically Native American and Alaska Native 
communities, who experience type 2 diabetes at nearly three times the 
national average. Together, these programs have become the Nation's 
most strategic and effective effort to combat diabetes and its 
complications, but, without an extension, both programs are at risk of 
expiring on September 30, 2023.
  For more than 25 years, the Special Diabetes Program--comprised of 
the Special Statutory Funding Program for Type 1 Diabetes Research and 
the Special Diabetes Program for Indians, SDPI--has delivered 
meaningful resources and research breakthroughs for those with type 1 
diabetes and also for Native Americans and Alaska Natives. This 
research has also led to advancements to the broader community, 
including the 37 million Americans with diabetes and 96 million with 
prediabetes. Our bill would continue these investments in the research 
aimed at developing a cure for diabetes and support the programs that 
help prevent and treat the disease and its complications.
  In one of my very first meetings as a new Senator, I met a young 
Mainer with type 1 diabetes. I will never forget this 10-year-old boy 
looking up at me and telling me that he wished he could take just 1 day 
off from having diabetes--his birthday or Christmas--but of course he 
could not. This meeting led me to start the bipartisan Senate Diabetes 
Caucus and to begin fighting for a cure for this devastating disease.
  Since then, we have made tremendous progress thanks to investments 
like the Special Diabetes Program. From new technologies that are 
making these children's lives easier to manage to treatments that can 
potentially delay the clinical diagnosis of type 1 diabetes, this 
program has generated a strong return on investment. Renewal of the SDP 
is absolutely critical to accelerating the progress we have made over 
the past two decades to treat and one day cure type 1 diabetes. Today's 
research represents tomorrow's cure.
  As the cochairs of the Senate Diabetes Caucus, Senator Shaheen and I 
recently led a letter signed by 60 Senators advocating for the 
program's reauthorization and outlining why investing in the Special 
Diabetes Program is a cost-effective investment toward improving lives 
and reducing healthcare expenditures. The driving force behind this 
program is curing one of the United States' most costly diseases in 
both human and economic terms.
  Our bill would reauthorize both components of the SDP through 
December 2025 at an annual funding level of $170 million per program. 
Congress has reauthorized the SDP with bipartisan support numerous 
times since the program's inception in 1997. Yet funding has not 
increased since fiscal year 2004. During this time period, the cost of 
research has increased, as has the size of the Indian Health Service 
population and the cost of medical care. For that

[[Page S2009]]

reason, our bill also proposes a $20 million increase per program. This 
would be the first increase for this program in 20 years.
  The two programs in this reauthorization bill have had transformative 
effects on diabetes care. The first program is the Special Statutory 
Funding Program for Type 1 Diabetes Research, which provides funds to 
NIH's National Institute of Diabetes and Digestive and Kidney Diseases, 
NIDDK, for life-changing preventive diabetes research. For example, 
SDP-funded research laid early groundwork for artificial pancreas, AP, 
systems--or closed-loop ``all-in-one'' diabetes management systems--
that have shown great promise in improving glucose monitoring and 
insulin delivery. Advances in technology have helped reduce costly and 
burdensome complications and improved the quality of life for those 
with the disease. There are now multiple FDA-approved artificial 
pancreas systems, enabling individuals with type 1 diabetes and their 
doctors to choose the system that works best for them. According to one 
study, the use of AP systems in adults could save Medicare roughly $1 
billion over 25 years.
  SDP research has also helped researchers identify genes and 
environmental factors linked with type 1 diabetes, led to changes in 
clinical practice guidelines for diabetic eye care, and supported 
clinical trials on therapeutics to prevent and treat the disease. For 
example, landmark research conducted by SDP-funded TrialNet 
demonstrated for the first time ever that early preventive treatment 
with a drug targeting the immune system delayed onset of clinical-type 
1 diabetes for 2 years. This drug has since been approved by the FDA 
and is the first ever disease modifying therapy for type 1 diabetes.
  Continued investment in this program is essential to continue large-
scale trials, plan next steps for research programs, conduct outreach 
and education, and allocate research resources effectively. As Dr. 
Griffin Rodgers, Director of the NIDDK, said when testifying at a 
Senate Aging Committee hearing I chaired in 2019, ``with continued 
research, it is possible to imagine that people could lead a life free 
of the burden of Type 1 diabetes and its complications.''
  Our bill would also provide $170 million per year to sustain a second 
program, the Special Diabetes Program for Indians, SDPI. SDPI supports 
type 2 diabetes treatment and prevention strategies for Native American 
and Alaska Native populations who are disproportionately burdened with 
type 2 diabetes at a rate of nearly three times the national average. 
In Maine this program benefits five Tribal communities across the 
state, providing approximately 5 million dollars in support for 
diabetes prevention activities in those Tribal populations. This 
Federal support is critical to reducing disparities. As Chief William 
Nicholas of the Passamaquoddy Tribe in Maine recently explained, 
``Special Diabetes Program funding is instrumental and necessary to 
educate and address high rates of diabetes in Indian Country. Native 
Americans are high risk for diabetes, and the funding will continue the 
much-needed support, education, and treatment in our communities.''
  Tremendous improvements are occurring in diabetes outcomes for Alaska 
Natives and Native Americans, and the SDPI has played a key role, just 
as Congress envisioned when the program was created. Although diabetes 
rates among the IHS service population remain high, with the help of 
this program, diabetes rates in youth in these communities have not 
increased in more than 10 years, and diabetes rates in Alaska Native 
and Native American adults have not increased since 2011. Communities 
with SDPI-funded programs have actually seen the diabetes incidence 
rate decrease consistently since 2013.
  The program is effective by other measures as well. Since SDPI began, 
there has been a 50-percent reduction in diabetic eye disease rates 
among Alaska Natives and Native Americans; hospitalizations for 
uncontrolled diabetes among Alaska Native and Native American adults 
have dropped by 84 percent; and the rate of end-stage renal disease has 
fallen by more than 50 percent. These positive clinical outcomes have 
reduced the risk for blindness, amputations, and kidney failure, in 
addition to preventing the onset of type 2 diabetes.
  The Special Diabetes Program is funding research that is leading 
directly to the development of new insights and therapies that are 
improving the lives of those with diabetes and accelerating progress 
toward curing and preventing the disease. Ruby Anderson, a young Mainer 
with type I diabetes who testified before the 2019 JDRF Children's 
Congress, put an even finer point on the need to reauthorize the SDP. 
Ruby she said she doesn't want her brother or sister to have to go 
through what she has experienced. As she told Senators, ``We need more 
research to find a cure. We need even better devices. And we need to 
figure out what causes TID so we can stop it.''
  I couldn't agree more with Ruby, and I am confident the Special 
Diabetes Program will make these objectives possible. I urge my 
colleagues to support a multi-year extension of this important program 
so that one day we will find a cure to this debilitating disease.

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