The National Clinical Care Commission (NCCC) reset diabetes as more than a medical issue in its January 2022 report to Congress. A series of 39 recommendations calls for a concerted national effort across multiple agencies, departments, and levels of government to address the social determinants that play key roles in the pathogenesis and progression of diabetes.
The Saturday, June 4, session, A Transformative Approach to the Prevention and Control of Diabetes in the U.S.—The National Clinical Care Commission Report to Congress, explored these recommendations. The session was livestreamed and can be viewed on-demand by registered meeting participants at ADA2022.org. If you haven’t registered for the 82nd Scientific Sessions, register today to access the valuable meeting content.
“The NCCC determined that diabetes cannot simply be viewed as a medical problem, but must be addressed as a societal problem,” said NCCC Chair William H. Herman, MD, MPH, the Stefan S. Fajans/GlaxoSmithKline Professor of Diabetes, Professor of Metabolism, Endocrinology & Diabetes and of Epidemiology, and Director, Michigan Center for Diabetes Translational Research, University of Michigan.
“Federal policies and programs should ensure that people at risk for or with diabetes have access to comprehensive, high-quality, and affordable health care,” he continued. “Health equity should be considered in every new or existing federal policy and program that impacts people at risk for or with diabetes to eliminate any unintended, adverse impacts those policies and programs may have on health disparities.”
The NCCC is a direct result of the 1974 National Commission on Diabetes, which led to the Diabetes Control and Complications Trial, the Diabetic Retinopathy Study, and diabetes control programs under the Centers for Disease Control and Prevention (CDC), the Veterans Administration, and the Indian Health Service, among other groundbreaking diabetes efforts.
An all-of-government approach is essential to changing the trajectory of diabetes, said Dean Schillinger, MD, Professor of Medicine and Director of the Health Communications Research Program, University of California, San Francisco.
“The U.S. lacks adequate structures, policies, and practices to coordinate strategic planning across health and non-health agencies,” Dr. Schillinger said. “We have untapped opportunities to leverage efforts of federal agencies and increase coordination.”
The U.S. Department of Agriculture, for example, could dramatically reduce food insecurity and nutritional patterns that contribute to type 2 diabetes by altering the Supplemental Nutrition Assistance Program. Recommendations include incentives for the purchase of fruits and vegetables, elimination of sugar-sweetened beverages (SSBs) as allowed purchases and expanding enrollment. The Commission also called for a Surgeon General’s report on the scientific evidence linking SSBs and type 2 diabetes.
“Diabetes is the most costly chronic condition in the United States,” said Howard Tracer, MD, Medical Officer, Agency for Healthcare Research and Quality. “Diabetes is more common and more consequential among communities of color, those who live in rural areas, and those with less education, lower incomes, and lower health literacy. We must ensure that all persons with prediabetes have equal access to preventive intervention.”
The NCCC recommends increasing support to the CDC for its highly successful National Diabetes Prevention Program (NDPP) lifestyle change program. The Commission also suggests the Centers for Medicare & Medicaid Services should cover A1C testing to screen for prediabetes and harmonize its own Medicare Diabetes Prevention Program with the NDPP. The recommendations seek clarification and simplification of requirements from both programs, as well as increased reimbursement, to ensure the prevention programs are financially viable services.
The NCCC also calls for the National Institutes of Health to fund a third party to collect, analyze, and summarize data from the Diabetes Prevention Program study and encourage a U.S. Food and Drug Administration submission to consider an indication for the use of metformin in high-risk patients with prediabetes.
The Commission had similar recommendations for treatment: expanding access to effective treatments, including diabetes self-management, and federal action to ensure affordable access to insulin.
“Diabetes care is preventive care,” said endocrinologist M. Carol Greenlee, MD, FACE, MACP, Western Slope Endocrinology, Grand Junction, CO. “We have the resources to prevent complications, yet only about a third of people with diabetes actually receive standard of care treatment today.”
The NCCC would like to see a national diabetes strategy in the United States. Paul R. Conlin, MD, Professor of Medicine, Harvard Medical School, the Maurice Strauss Chair, Boston University School of Medicine, and Chief of Medicine, VA Boston Healthcare System, said an Office of National Diabetes Policy should be created in the Executive Branch.
“We need a health-in-all policies agenda. All of this requires action by Congress and by the Secretary of Health and Human Services,” Dr. Conlin said before calling on 82nd Scientific Sessions participants to help make this and other NCCC recommendations a reality.
“Each of you, as diabetes specialists, has a singular and important role in communicating, supporting, advocating for, and implementing these recommendations,” he said. “It is going to take everyone here to implement our recommendations.”
The NCCC Report to Congress on Leveraging Federal Programs to Prevent and Control Diabetes and Its Complications is available online.