U.S. GOVERNMENT PUBLISHING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Publishing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

91–169 PDF 2016

S. HRG. 113–807 

DIABETES RESEARCH: REDUCING THE BURDEN 

OF DIABETES AT ALL AGES AND STAGES 

HEARING 

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

WASHINGTON, DC 

WEDNESDAY, JULY 10, 2013 

Serial No. 113–8 

Printed for the use of the Special Committee on Aging 

( 

Available via the World Wide Web: http://www.fdsys.gov 

DeShaun on LAP51NQ082 with DISTILLER

(II) 

SPECIAL COMMITTEE ON AGING 

BILL NELSON, Florida, Chairman 

RON WYDEN, Oregon 

ROBERT P. CASEY JR, Pennsylvania 

CLAIRE MCCASKILL, Missouri 

SHELDON WHITEHOUSE, Rhode Island 

KIRSTEN E. GILLIBRAND, New York 

JOE MANCHIN III, West Virginia 

RICHARD BLUMENTHAL, Connecticut 

TAMMY BALDWIN, Wisconsin 

JOE DONNELLY Indiana 

ELIZABETH WARREN, Massachusetts 

SUSAN M. COLLINS, Maine 

BOB CORKER, Tennessee 

ORRIN HATCH, Utah 

MARK KIRK, Illinois 

DEAN HELLER, Nevada 

JEFF FLAKE, Arizona 

KELLY AYOTTE, New Hampshire 

TIM SCOTT, South Carolina 

TED CRUZ, Texas 

KIM LIPSKY, Majority Staff Director 

PRISCILLA HANLEY, Minority Staff Director 

DeShaun on LAP51NQ082 with DISTILLER

(III) 

CONTENTS 

Page 

Opening Statement of Chairman Bill Nelson ........................................................ 1 

Prepared Statement ......................................................................................... 68 

Statement of Ranking Member Susan M. Collins ................................................. 1 

Prepared Statement ......................................................................................... 69 

PANEL OF WITNESSES 

Jean Smart, Actress ................................................................................................ 4 

Ray Allen, Miami Heat Player and Father of JDRF Children’s Congress 

Delegate, Walker Allen ........................................................................................ 12 

Quinn Ferguson, Juvenile Diabetes Research Foundation, Children’s Congress 

Delegate ................................................................................................................ 19 

Griffin Rodgers, MD, Director, National Institute of Diabetes and Digestive 

and Kidney Disorders, National Institutes of Health ....................................... 24 

Jeffrey Brewer, President and CEO, Juvenile Diabetes Research Foundation .. 46 

APPENDIX 

PREPARED WITNESS STATEMENTS

Jean Smart, Actress ................................................................................................ 7 

Ray Allen, Miami Heat Player and Father of JDRF Children’s Congress 

Delegate, Walker Allen ........................................................................................ 15 

Quinn Ferguson, Juvenile Diabetes Research Foundation, Children’s Congress 

Delegate ................................................................................................................ 21 

Griffin Rodgers, MD, Director, National Institute of Diabetes and Digestive 

and Kidney Disorders, National Institutes of Health ....................................... 27 

Jeffrey Brewer, President and CEO, Juvenile Diabetes Research Foundation .. 48 

ADDITIONAL STATEMENTS FOR THE RECORD 

Juvenile Diabetes Research Foundation ................................................................ 71 

Robert J. Shapiro and Nam D. Pham, Sonecon .................................................... 73 

DeShaun on LAP51NQ082 with DISTILLER

DeShaun on LAP51NQ082 with DISTILLER

(1) 

DIABETES RESEARCH: REDUCING THE 

BURDEN OF DIABETES AT ALL AGES 

AND STAGES 

WEDNESDAY, JULY 10, 2013 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:10 p.m., in Room G– 

50, Dirksen Senate Office Building, Hon. Bill Nelson, Chairman of 

the Committee, presiding. 

Present: Senators Nelson, Blumenthal, Donnelly, Warren, Collins, and Ayotte. 

Also Present: Senator Shaheen. 

OPENING STATEMENT OF SENATOR BILL NELSON, CHAIRMAN 

The CHAIRMAN. The meeting will come to order. 

For all of you, this is a Congressional hearing in the Senate. We 

have these kinds of meetings, and as you can see, this is a meeting 

room that is one of the large ones, and, of course, we needed a 

large room today because of our special guests, all in the blue 

shirts, and your parents, and this very fine panel of witnesses that 

we are going to have. 

I am Bill Nelson. I am from Florida. Susan Collins is from 

Maine. We are in opposite parties, but that makes no difference. 

We work together, and that is the way it ought to be, and that is 

in a lot of contrast to what you see going on around here with regard to a lot of other stuff. 

I am very pleased that I have a colleague who works together, 

and when we have differences, then what we do is we respect each 

other’s opinion and then we work out the differences and we build 

consensus. And that is the essence of trying to govern in a democracy that represents a big, large, beautiful, diverse, and complicated country such as ours. 

So, we want to welcome all of you, and this is a very special topic 

today of which you are intimately familiar. 

[The prepared statement of Chairman Nelson appears in the Appendix on p. 68.] 

The CHAIRMAN. And so I want to turn to our Ranking Member, 

Senator Collins, for her statement. 

OPENING STATEMENT OF SENATOR SUSAN M. COLLINS 

Senator COLLINS. Thank you very much, Mr. Chairman. You put 

it so well. 

DeShaun on LAP51NQ082 with DISTILLER

2 

And when it comes to the issue of diabetes, it does not matter 

whether you are a Democrat or a Republican or an Independent or 

a Green Party member. What matters is that we all work together 

to focus on the estimated three million Americans with Type 1 diabetes and their families. 

This is my seventh consecutive Children’s Congress hearing, and 

I am very grateful to Chairman Nelson for allowing me to continue 

this tradition. I want to join him in welcoming our distinguished 

witnesses and the more than 160 delegates to the Children’s Congress who have traveled to Washington to tell us what it is like to 

have diabetes, just how serious it is, and why it is so important 

that we fund the research that is necessary to find a cure. 

I particularly want to give a special welcome to the delegate from 

Maine, 14-year-old Quinn Ferguson of Poland Spring, who will be 

speaking on our panel. 

As the founder and Co-Chair with Senator Jeanne Shaheen of 

New Hampshire of the Senate Diabetes Caucus, I have learned a 

lot about this disease and the heartbreak that it causes for so 

many American families as they await a cure. 

Diabetes is a lifelong condition that does not discriminate. It affects people of every age, race, and nationality. It is an extremely 

serious disease and it costs the United States an estimated $245 

billion a year and accounts for one out of every three Medicare dollars. Because of the serious complications associated with diabetes, 

medical costs for Americans with the disease are 2.3 times higher 

than those incurred by individuals without diabetes. 

Those statistics alone are overwhelming, but what motivates me 

to devote so much energy to this cause is meeting the children, the 

family, whose lives have been forever changed by diabetes. That is 

why it is so important that you have traveled here to Washington 

to tell your stories. You put a human face on the statistics. 

When I was meeting with Quinn and he showed me his scrapbook, he said that he felt that the day he was diagnosed at age 

eight with diabetes was his last full day of freedom, and that really 

touched me. So you help us focus on what Congress can do to understand and ultimately conquer this disease. 

While often associated with children, the fact is that 85 percent 

of those living with Type 1 diabetes are adults and many of them 

are seniors. An average individual with Type 1 will have to take 

more than 50,000 insulin shots or infusions over his or her lifetime. 

The discovery of insulin was a landmark breakthrough. However, 

it is not a cure for diabetes, as you well know. 

Thankfully, there is some good news. Since I founded the Senate 

Diabetes Caucus, we have been successful in working together in 

a bipartisan manner to triple the funding for diabetes research. As 

a consequence, we have seen some encouraging breakthroughs and 

we are on the threshold of a number of exciting discoveries. Advances in technology, like continuous glucose monitors, are helping 

patients control their blood glucose levels, which is key to preventing the complications from diabetes. 

We are also moving closer and closer to the goal of an artificial 

pancreas, which would revolutionize diabetes care. Recent advances 

also include the development of new treatments that can stop or 

DeShaun on LAP51NQ082 with DISTILLER

3 

even reverse certain complications, such as some nerve damage and 

diabetic eye disease. 

I am pleased to tell you that there is strong support in Congress 

for diabetes research funding, thanks in no small measure to the 

grassroots support provided by the JDRF volunteers. Earlier this 

year, we passed legislation to extend the Special Diabetes Program 

which provides $150 million a year above and over the regular appropriations for Type 1 diabetes research. This important program 

represents more than a third of our Federal commitment to diabetes research. As such, it is critical to our efforts to find better treatments, a means of prevention, and ultimately what we are all seeking, and that is a cure for this devastating disease. 

Again, I thank the Chairman for holding this important hearing 

and it is wonderful to see you all here. You really inspire us to 

work even harder. Thank you. 

[The prepared statement of Senator Collins appears in the Appendix on p. 69.] 

The CHAIRMAN. As a courtesy to all of you, overflow crowd, 

standing, we will suspend any of our opening statements, including 

the Chairman’s. We will insert our opening statements as a part 

of the official Congressional record. 

And as a courtesy to you all standing, I want to invite you to 

come up and have a seat here at the dais and at the staff chairs, 

where available. I would not like any lady standing in the audience. So, gentlemen—— 

[Laughter and applause.] 

The CHAIRMAN. As Senator Donnelly says, if there is any guy sitting down with a lady standing, the guy is going to get some dirty 

looks. 

[Laughter.] 

Okay. First, we are going to hear from Jean Smart. Ms. Smart 

is an Emmy winning television, film, stage actress who was diagnosed with Type 1 diabetes at the age of 13. 

And then we are going to hear from Ray Allen. He is a ten-year 

NBA All-Star who currently plays, by the way—— 

[Laughter.] 

And made the critical shot in Game Six—— 

[Applause.] 

For the NBA Champions, the Miami Heat. He and his wife, 

Shannon—— 

Senator DONNELLY. Being from Indiana, can I object to that 

shot? 

[Laughter.] 

The CHAIRMAN. Well, Indiana suffered, but the ones who really 

suffered was San Antonio. 

Ray’s wife, Shannon, who serves on the JDRF’s International 

Board, they are parents to Walker, who was diagnosed with Type 

1 diabetes at 17 months, and Walker is right there with us. They 

will share the difficulties in managing Type 1 diabetes in very 

young children. 

And then we will hear from Quinn Ferguson, a JDRF Children’s 

Congress Delegate from Senator Collins’s State of Maine. 

And then we are going to hear from Griffin Rodgers, the Director 

of the National Institute of Diabetes and Digestive and Kidney DisDeShaun on LAP51NQ082 with DISTILLER

4 

orders at NIH, the National Institutes of Health, which is one of 

the most fantastic research centers, all trying to do good in finding 

cures for the diseases that afflict us. 

And then we will hear from Jeffrey Brewer. Mr. Brewer is President and CEO of JDRF. 

And so let us start with you, Ms. Smart. 

STATEMENT OF JEAN SMART, ACTRESS 

Ms. SMART. Senator Nelson, Senator Collins, and members of the 

committee, thank you so much for allowing me the opportunity to 

appear here today and talk about an issue that is important to all 

these great kids and their families and their guardians and I, myself, and that is the issue of living life with Type 1 diabetes. 

I was actually here in Washington, D.C. in 1965. I was 13 years 

old. Go ahead, do the math. 

[Laughter.] 

And I was waiting with my family to see the Tomb of the Unknown Soldier and I was showing all the telltale signs of Type 1 

diabetes. I was so tired. I was so parched. I could not drink enough 

liquid to slake my thirst. It was over 100 degrees on that hot day 

in August, so my parents put it down to the heat. But later, after 

stopping, I think, at almost every gas station restroom on the drive 

home from D.C. to Seattle, Washington—a long drive—and after 

losing almost 20 pounds in a matter of weeks, my parents knew 

there was something seriously wrong. 

So shortly after returning home, I went to the doctor and I was 

told I had Type 1 diabetes and I cried. I started to cry. I remember 

the nurse—well, it was very shocking for my parents, too, as you 

can imagine. I remember the nurse very quietly offering smelling 

salts to my poor Daddy. He did not look too good. Nobody in our 

family had diabetes. No one can remember of anybody in the family 

ever having diabetes. And all I knew about it was, at that age, that 

you had to take injections and you could not eat sugar, which is 

quite a sentence to give to a scared child. 

But by the end of that day, I was actually giving myself injections, and five days later, I was released from the hospital, put on 

a very strict no-sugar diet. I was also told that I should not consider having children, ever, and that was a statement that would 

come back years later to haunt me. 

But 48 years ago, there were no blood glucose meters. There 

were no continuous glucose monitors. If you had diabetes, you had 

to assess your blood sugar level by doing a urine test, which was 

pretty inaccurate, but it was the best we had for home testing at 

the time. The syringes were large. The needles were big and heavy 

and they had to be reused, which made for some pretty painful injections in my skinny little 13-year-old thighs. Also, you had to boil 

them in a pot of water before every use. Now, luckily, of course, 

the needles are much smaller and finer. 

But even with the advent of devices like the insulin pump, it 

really is far from where we hope to be. My friend, Beverly, has realized much more stable blood sugars on the pump, but she still 

has some really frightening highs and lows if she is not ever, ever 

vigilant. 

DeShaun on LAP51NQ082 with DISTILLER

5 

I have never let diabetes define me. I never really thought of myself as a sick person. But, ironically, probably one of the main reasons I am a working actress today is because of diabetes. I actually 

had wanted to go to college on the other side of the State, to a college that did not offer a degree in drama, but my mother had other 

thoughts. She really wanted me to go to the University of Washington because it was very close to home. And so I went to UW for 

five years. I got my BFA in acting, which kind of launched my career. 

So, I was busy working as an actress and in 1989, I discovered 

I was pregnant. And my husband and I were quite devastated 

when we were advised to terminate the pregnancy because my 

blood sugars were not in good control, and we were reminded of the 

harm that Type 1 diabetes could do to myself and my baby. But 

I found a specialist who took me by the hand and guided me 

through the next eight months. I tested my blood sugar 12 times 

a day, with a meter at that point, fortunately. I was on the phone 

daily with the specialist to adjust my insulin dosages. And I was 

lucky enough, also, to have a husband who was very supportive 

and turned himself into a pregnancy diabetic specialist. And it was 

very, very hard work, but thankfully for myself and my strong, 

healthy son, Connor, it paid off. 

I am sorry. I did not want to forget anything here. 

But, unfortunately for a lot of people in my generation who were 

diagnosed as kids with diabetes, they have had a high rate of complications—heart disease, heart attacks, strokes, blindness, kidney 

failure, nerve damage, very complicated pregnancies. 

I have had some very scary low blood sugars, and I am sure the 

kids will identify what I am talking about. If you have never had 

one, it is hard to describe. It feels to me a little bit like drowning, 

actually. One close call I had, I was actually on stage in front of 

about 900 people on Broadway, opposite Mr. Nathan Lane—name 

dropping—and I knew I was in trouble. It was very scary. And my 

mouth somehow kept saying the words, but my brain was screaming, you are in big trouble, and fortunately, that scene ended just 

in time. And ever since then, I have stashed jelly beans all over 

every set I have ever worked on. Years from now, they will find 

petrified jelly beans in anyplace that I have ever worked. 

[Laughter.] 

You know, it is hard for me to remember what life was like before I had diabetes, and sometimes, selfishly, of course, I wish that 

I could just remember what that was like, to feel what that was 

like, to not be diabetic, to go maybe a day without being diabetic, 

to go more than just a couple of hours without having to think 

about my blood sugar. But what I really pray for is that the next 

generation of beautiful children like these do not ever have to go 

through the uncertainty and the fears of being diabetic, or the 

physical tolls that it can take on their bodies. 

You know, I never made it to the Tomb of the Unknown Soldier 

that day. I did not have the strength. But because I was lucky 

enough to be born in the second half of the 20th century, and because of the advances in diabetes care, and because Kay Smart was 

afraid to let me go away to college, I am able to appear here before 

you and to thank you and to thank Congress and to thank the 

DeShaun on LAP51NQ082 with DISTILLER

6 

JDRF for all you have done to promote Type 1 diabetes research, 

and I ask that you please, please continue your efforts so that one 

day, we can actually all say—everybody in this room can say, remember that day that we cured diabetes? 

Thank you. 

[Applause.] 

[The prepared statement of Ms. Smart follows:] 

DeShaun on LAP51NQ082 with DISTILLER

7 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 4 here 91169.004
8 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 5 here 91169.005
9 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 6 here 91169.006
10 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 7 here 91169.007
11 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 8 here 91169.008
12 

The CHAIRMAN. By the way, you all may be wondering, why is 

the Aging Committee having a hearing with so many young people 

here? 

Ms. SMART. It is because of me. 

[Laughter.] 

The CHAIRMAN. It is simply because the physical, the economic, 

and the emotional toll of diabetes lasts throughout a lifetime, and 

when one becomes a senior citizen, you really start to see a lot of 

the impacts on the individual and society. 

Thank you, Ms. Smart. 

Next, Mr. Allen. 

STATEMENT OF RAY ALLEN, PLAYER, MIAMI HEAT, NATIONAL 

BASKETBALL ASSOCIATION, AND FATHER OF WALKER 

ALLEN, JDRF CHILDREN’S CONGRESS DELEGATE FROM 

FLORIDA 

Mr. ALLEN. Thank you. Good afternoon, everybody. It is an honor 

to be invited to appear before you here today to give you an understanding of what it is like for a family to live with Type 1 diabetes. 

As you listen to our story, please know there is nothing special 

about our family, my wife, Shannon, our son, Walker, or me. Hundreds of thousands of other families across the United States and 

the world could tell you a story similar to ours. So, here is our 

story. 

In 2008, I was a member of the Boston Celtics and we had a 

great run that year and we found ourselves in the middle of playing in the NBA Finals against the L.A. Lakers, the moment I had 

dreamed of since I was a little boy. There I was, competing for an 

NBA Championship. It was everything that I could ever ask for. 

There were a lot of special things about that series. It was the first 

time since 1986 that the Celtics won the NBA Title. It was the 

most watched NBA telecast in NBA history. And, personally, it was 

my first NBA Championship. 

All of those things are very memorable, but what I remember it 

for is for another reason. While our family was in L.A. for Game 

5, our son, Walker, who was 17 months old at the time, became 

very ill. My wife, Shannon, rushed him to the hospital where he 

was diagnosed with Type 1 diabetes. It was as if a rug was pulled 

from underneath us. Life as we knew it was over. You see, even 

though just a few days later we finished our journey, winning 

Game 6 and being crowned an NBA Champion, another journey 

began that we are still on today. 

As you can see, Walker, he is six now, but he is still too young 

to manage diabetes on his own. No disease is easy, but managing 

Type 1 diabetes may be one of the most complicated and complex 

responsibilities facing any caregiver or person living with diabetes, 

or any disease, for that matter. 

From the moment Walker wakes up in the morning until the moment he goes to sleep, we have to monitor everything he drinks. 

We have to test his blood sugar with finger pricks ten times a day. 

And we have to count the amount of carbohydrates he consumes. 

Then, do the mathematical equation required to decide how much 

insulin to inject. This can be as many as seven shots a day just so 

DeShaun on LAP51NQ082 with DISTILLER

13 

the blood glucose levels remain in the safe range. Any miscalculation on our part could be life-threatening for Walker. 

You might think we finally can catch our breath when Walker 

goes to bed. Not so. Type 1 diabetes can be at its most dangerous 

at night, as you all know. Blood sugars that seem fine at bedtime 

could suddenly come crashing down in the middle of the night. 

Without juice or food to restore the balance, Walker could drift into 

a coma and we would never know it until we tried to wake him 

in the morning, and that might just be too late. So we wake up 

every two hours throughout the night, on the clock, to check Walker’s blood sugars. Shannon and I often joke that we are vampires. 

Neither one of us has slept through the night in five years since 

his diagnosis. That is a reality for all families and not just ours. 

The Miami Heat, we played 106 games this past season. We had 

game days, practice days, travel days, even a few off days, days to 

rest, days to heal, days to rejuvenate, recharge. But for Walker, 

here, and I know a lot of the kids here in this room and a lot of 

the people that live with diabetes, there are no off days. 

As he gets older, Walker will gradually take more charge of his 

Type 1 diabetes, but it will not get any easier because more and 

more factors will impact the blood sugar levels—exercise, stress, 

even normal changes in adolescent hormonal activity, changes utterly beyond Walker’s control. They will all cause his blood sugars 

to gyrate wildly. 

Shannon and I know from talking to other parents that children 

and young adults with Type 1 diabetes show tremendous courage, 

resolve, and steadfast determination not to let this disease define 

them. But we also know that no matter how old Walker is, no matter where he is or what he is doing every day, he has to live a new 

day with Type 1 diabetes, and what works one day may not work 

the next day, and the risks are always ever present. I doubt Shannon and I will ever go a day without just a little bit of fear and 

worry in the back of our minds, fear for our son’s safety and his 

overall health that reaches his potential and is able to live his 

dreams. 

It is not his fault that he has diabetes. There is nothing he or 

we did to cause it. It is not diet or lifestyle related, as is the case 

with Type 2 diabetes. Genetics is a part of it, but there is no history of Type 1 diabetes in our family. We do know this. Type 1 diabetes and autoimmune disease, the body launches an attack on the 

cells that produce insulin, eventually destroying them and leaving 

people with Type 1 diabetes dependent on synthetic insulin to survive. But insulin is not a cure. It is a lifeline, and there is a big 

difference. 

That is why Shannon and I got involved with the JDRF. Shannon now serves on the Board of Directors, and we know that JDRF 

is working on therapies that may reduce the tremendous daily burden of living with Type 1 diabetes and that is working towards a 

cure. As we know, JDRF is working with Congress to make sure 

the government does its share and funds important programs like 

the Special Diabetes Program. 

On the basketball court, a lot of your success comes from experience, hard work, repetition, practice, instinct, and, of course, a little luck. A rebound careens off the rim, a teammate grabs it and 

DeShaun on LAP51NQ082 with DISTILLER

14 

passes you the ball in the corner. Without thinking, you catch it, 

step back, and you hit a ‘‘three.’’ Sometimes it happens that way. 

[Laughter.] 

It keeps your championship hopes alive. We will need more than 

hard work, repetition, instinct, luck, practice, and experience, 

though, to beat Type 1 diabetes. 

I know Type 1 diabetes will never hold Walker back, but we 

dream of a day when Walker can leave this disease behind with the 

continued support of Congress for the Special Diabetes Program, 

with the investment of JDRF and the private sector, and the dedication and commitment all the families in this room and all around 

America, all around the world, today, and hundreds of thousands 

of other people in other countries, that we will create a world without Type 1 diabetes. We have to, because together, we are a winning team. 

Thank you. 

[Applause.] 

[The prepared statement of Mr. Allen follows:] 

DeShaun on LAP51NQ082 with DISTILLER

15 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 9 here 91169.009
16 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 10 here 91169.010
17 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 11 here 91169.011
18 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 12 here 91169.012
19 

The CHAIRMAN. And, Walker, we are glad that you are here, too. 

Thank you for bringing your Dad here today. 

Mr. ALLEN. I am glad to be here. 

The CHAIRMAN. Okay. Quinn Ferguson. Now, you are a representative of all of these blue shirts out here, so tell us your story. 

STATEMENT OF QUINN FERGUSON, JDRF CHILDREN’S 

CONGRESS DELEGATE FROM POLAND SPRINGS, ME 

Mr. FERGUSON. Thank you, Senator Collins, Senator Nelson, and 

members of the Aging Committee, for inviting me to testify. My 

name is Quinn Ferguson. I am 14 years old and I am from historic 

Poland Spring, Maine. I have been living with Type 1 diabetes 

since I was diagnosed a week before my ninth birthday. 

I will never forget the day I was diagnosed. Actually, I was 

misdiagnosed. I was at my grandparent’s house when I passed out 

and had fallen on the ground, so my Mom drove me immediately 

to the hospital. On the way, I started throwing up, but my doctor 

said it was a concussion and sent me home. 

A week later, I was still not feeling better. After looking online 

to find out what was causing my symptoms, my Nana brought over 

my Grandpa’s diabetes test kit. He has Type 2 diabetes. My blood 

sugar was over 600, more than four times the normal range. After 

that, I was diagnosed with Type 1 diabetes, or T1D. 

Voices have been silenced and lives have been cut short because 

of this disease. I am here today to speak for them as well as myself, and I am not alone in my story. People are misdiagnosed every 

day or not diagnosed at all, suffering the consequences and sometimes paying the ultimate price. I am here today because they cannot be and because we need to do more about this disease. 

Every day since I was diagnosed, I have had to check my blood 

sugar at least ten times a day, even in the middle of the night. I 

measure everything I eat and drink and I think about my blood 

sugars constantly, when I am in school, on the football field, or in 

a chess match. If I do not, I could experience a seizure or a coma 

or suffer from long-term complications like eye disease, kidney failure, and heart problems. 

I am fully responsible for my diabetes, from caring for myself to 

taking charge of my attitude on T1D. While there are times I get 

down, I am not out. I am a strong person for living with this disease, but every day is a trial by fire. I will never have a day off, 

and even as a teenager, I will never outgrow T1D. 

Thanks to medical research, life will get better. It has to. I am 

not giving up on a cure and hope Congress will not, either, and will 

continue to support the Special Diabetes Program, my hope for a 

cure. While we wait for a cure, I am doing my part by educating 

others about T1D and enrolled in a TrialNet study that tests the 

drug Abatacept to stop or slow down destruction of insulin-producing beta cells. Those newly diagnosed with T1D who got the 

drug produced insulin longer than people who did not for almost 

one year. The study is now testing the drug in people at risk, but 

not yet diagnosed, to see if it can help delay or prevent T1D. Having a relative greatly increases the chance of being diagnosed. 

Without the SDP, TrialNet studies of almost 20,000 patients will 

not see results. 

DeShaun on LAP51NQ082 with DISTILLER

20 

The SDP led us to the artificial pancreas technology now being 

used in—tested in T1D patients. These patients are living my 

dream. They do not have to worry constantly about blood sugars 

and can sleep through the night. The artificial pancreas is taking 

the guess work out of managing the disease by automatically testing blood sugars and giving insulin as needed. It will help keep 

people with T1D safe and healthy until a cure is found. 

My Great-Grandfather Alfred Clark Ferguson came to the New 

World on an orphan ship when he was five years old. At that age, 

he could only dream of a future where the sugars would never take 

parents away from their children again. He lived to see science find 

a treatment for diabetes. Whether my generation lives to see a cure 

depends on research and funding. We need your help. 

Today, I am surrounded by 160 delegates and their parents who 

represent the millions of people doing everything possible for a 

cure. I am grateful that Senator Collins and so many in Congress 

have been so supportive and I urge you to keep it up. Our hope for 

a full life depends on it. While the worry never goes away, we know 

better days are ahead. That is why we need your support for the 

Special Diabetes Program, so that maybe one day we can say that 

the world is free from T1D. 

Thank you. 

[Applause.] 

[The prepared statement of Mr. Ferguson follows:] 

DeShaun on LAP51NQ082 with DISTILLER

21 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 13 here 91169.013
22 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 14 here 91169.014
23 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 15 here 91169.015
24 

The CHAIRMAN. Thank you, Quinn. 

I still see some ladies standing back there, one there, one there, 

and I see one over here, and we have plenty of seats here, so please 

avail yourselves of the opportunity. 

Okay, Dr. Rodgers. Tell us what is happening at NIH. 

STATEMENT OF GRIFFIN P. RODGERS, M.D., DIRECTOR, NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISORDERS, NATIONAL INSTITUTES OF HEALTH, U.S. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Dr. RODGERS. Thank you. Chairman Nelson, Senator Collins, 

members of the committee, thank you for giving me the opportunity to testify today. 

On behalf of the National Institutes of Health, I am pleased to 

report that our investment in Type 1 diabetes research continues 

to improve lives around the country and around the world. 

Through coordinated efforts with research partners such as the 

JDRF and the ADA, as well as continuous support from the special 

statutory funding program for Type 1 diabetes research, we are 

helping people with Type 1 diabetes, such as the children sitting 

here today, live longer and healthier lives. 

First, I would like to acknowledge the important contribution of 

my fellow witnesses. Ray Allen, you are a champion in basketball, 

but you and your family—your entire family—are truly champions 

in promoting efforts toward curing this disease. 

I am also pleased to share the table with Jeffrey Brewer and 

Jean Smart, who I know share our goals of preventing, treating, 

and ultimately curing Type 1 diabetes. 

I would also like to thank those here today representing Americans of all ages with Type 1 diabetes. Quinn, the clinical trial that 

you and other young people here today have participated in could 

not occur without your support. Our research is your research and 

we thank you for making it possible. 

The future for those with Type 1 diabetes is brighter than ever. 

NIDDK-supported research has found that life expectancy for people with diabetes has increased by 15 years, and this increase is 

largely due to advances in technology and understanding that early 

glucose control is critical to reducing risk of long-term complications. This key insight was provided by the NIDDK’s landmark Diabetes Control and Complication Trial, or DCCT, and its follow-up 

study called EDIC, E–D-I–C. Everything in government has an acronym. 

[Laughter.] 

This year, DCCT/EDIC celebrated its 30th anniversary, and we 

celebrate the great contributions to health of those with Type 1 diabetes. 

Controlling blood glucose, as you all know, is very challenging, 

so it is critical that we continue the search for ways to prevent, 

treat, and cure diabetes. And we are, thus, focusing research on 

every stage of Type 1 diabetes development. 

The first stage is the onset of auto-immunity, a stage where no 

symptoms are apparent, but where insulin-producing beta cells are 

being slowly destroyed. We have long sought to better understand 

what causes auto-immunity and now know that both genetic and 

DeShaun on LAP51NQ082 with DISTILLER

25 

environmental factors play a role. We support various efforts, including a major international study involving thousands of children, to better understand these factors and we look forward to 

translating our discoveries into new treatments to prevent not only 

Type 1 diabetes, but other auto-immune diseases. 

Stopping the auto-immune attack once it has begun is another 

focus of NIH research. The NIDDK’s Type 1 Diabetes TrialNet and 

the NIAID’s Immune Tolerance Network have identified several 

treatments to protect the beta cells, and studies to extend the effects of those promising results are ongoing. 

Replacing or restoring the function of beta cells is another area 

of great interest, and one strategy is to replace the beta cells via 

islet transplantation, and recent progress in this area was largely 

made possible by NIDDK and the NIAID co-led Clinical Islet 

Transplantation Consortium. Today, islet transplant recipients are 

more likely to not need insulin at some point after their transplant. 

Their insulin independence lasts much longer. And they are less 

likely to have severe side effects than their peers receiving islet 

transplants just a decade ago. 

We also plan to build upon the success of the NIDDK’s Beta Cell 

Biology Consortium by creating the Human Islet Research Network, which will focus on improving methods to create beta cells 

and to extend their survival. 

Now, we know that self-managing one’s blood glucose levels is 

critical to long-term health, but it is also a huge burden, as you 

have heard from the witnesses already. A promising approach to 

ease this burden is an artificial pancreas, a device that can automatically sense blood glucose levels and administer insulin accordingly, and there has been tremendous progress in this area in recent years. 

Preliminary studies indicate that these devices can keep blood 

glucose levels within an optimal range and allow the blood glucose 

to stay in control, much better than self-managed insulin pumps. 

Ongoing trials, such as devices in the real world setting, are also 

yielding extremely promising results. With continued research, artificial pancreas technology has tremendous potential to allow people with Type 1 diabetes to live, eat, and exercise freely without 

the fear of hypoglycemia. 

The NIH also vigorously supports research to prevent and treat 

diabetes complications. For example, progress has been made by 

the Diabetic Retinopathy Clinical Research Network led by the NEI 

with support from the Special Diabetes Program. Research conducted through this network contributed to the recent FDA approval of a treatment for a serious diabetic eye complication, 

progress that has been hailed as the most important advanced 

treatment for diabetes retinopathy in the last 25 years. 

Chairman Nelson, Senator Collins, members of the committee, 

thank you for this opportunity to speak today, and we are grateful 

for the continued support of Congress and for our public and private research partners and for the inspiring efforts of our clinical 

trial volunteers. Together, we strive to allow those of all ages with 

Type 1 diabetes to live longer, healthier lives, free of the burden 

of this disease. 

DeShaun on LAP51NQ082 with DISTILLER

26 

Thank you for your attention. I will be pleased to answer any 

questions that you might have. 

[The prepared statement of Dr. Rodgers follows:] 

DeShaun on LAP51NQ082 with DISTILLER

27 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 16 here 91169.016
28 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 17 here 91169.017
29 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 18 here 91169.018
30 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 19 here 91169.019
31 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 20 here 91169.020
32 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 21 here 91169.021
33 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 22 here 91169.022
34 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 23 here 91169.023
35 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 24 here 91169.024
36 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 25 here 91169.025
37 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 26 here 91169.026
38 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 27 here 91169.027
39 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 28 here 91169.028
40 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 29 here 91169.029
41 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 30 here 91169.030
42 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 31 here 91169.031
43 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 32 here 91169.032
44 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 33 here 91169.033
45 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 34 here 91169.034
46 

The CHAIRMAN. Thank you, Dr. Rodgers. 

[Applause.] 

Okay, Mr. Brewer. You brought along a lot of your colleagues 

today. 

Mr. BREWER. I sure did. 

The CHAIRMAN. Share with us, please. 

STATEMENT OF JEFFREY BREWER, PRESIDENT AND CHIEF 

EXECUTIVE OFFICER, JDRF 

Mr. BREWER. Chairman Nelson, Senator Collins, members of the 

committee, I greatly appreciate the opportunity to be here today. 

My name is Jeffrey Brewer and I am the President and CEO of 

JDRF. As an entrepreneur and the father of a son with Type 1 diabetes, it is my great honor to lead the world’s largest charitable 

funder of Type 1 diabetes research and to partner with the public 

and private sectors to drive progress toward our goal of a world 

without Type 1 diabetes. 

I want to begin by thanking all the Senators who are here today 

for your great leadership in diabetes research. All of us at JDRF 

were extremely grateful in January when the Congress included a 

one-year, $150 million extension of the Special Diabetes Program. 

The SDP funds critical research upon which the private sector relies to identify in advance new therapies for Type 1 diabetes. 

Thanks to the SDP, scientists have identified more than 50 genes 

that influence a person’s risk of developing Type 1 diabetes, and researchers are halfway through a 15-year study to identify what factors trigger its onset in the first place. At the same time, the SDP 

has helped advance important new therapies, including one that is 

available to patients today, one that can help reverse vision loss related to diabetes. 

Last year, 72 Senators signed a letter in support of the Special 

Diabetes Program, and I would like to say a special thanks to Senate Diabetes Caucus Co-Chairs Collins and Shaheen, who are here 

today. Thank you very much for leading this effort. 

As many of you know, Type 1 diabetes, also known increasingly 

as T1D, is a life-threatening disease that creates constant challenges for Americans of all ages. At every meal and many other 

times throughout the day and night, people with T1D must test 

their blood sugar and try to give the right amount of insulin, always at the right time. Too little insulin and high blood sugar will 

cause devastating complications. Too much insulin and low blood 

sugar will cause seizures, coma, and sometimes death, unfortunately. 

In my family, my wife had to watch in horror as paramedics 

rushed into our home to rescue our son, who had lapsed into a 

coma as a result of too much insulin. Firefighters had to break 

down his door with an axe and rush him to the hospital, where he 

spent 48 hours in the ICU before recovering full consciousness. Living with T1D is a daily high-stakes challenge. 

Diabetes has taken a toll on my family, the Children’s Congress 

families here today, and many others around the world. It has also 

taken a toll on our nation, costing $245 billion in medical and economic expenses last year. Diabetes costs are rising rapidly, and according to a new study released today, the costs of diabetes are exDeShaun on LAP51NQ082 with DISTILLER

47 

pected to more than double in the next eight years. The overall 

costs are expected to rise from $245 billion in 2012 to $512 billion 

in 2020. Costs to Medicare due to diabetes will also double, rising 

from $104 billion to $226 billion in 2020. As our population ages 

in the coming years, what is currently a significant problem is 

going to become a fiscal crisis. 

Diabetes is a health crisis for patients and their families and a 

financial crisis for every American. Therefore, all of us, especially 

older Americans, have a serious stake in diabetes research. Research investments offer the only real hope for reversing these 

troubling trends. 

Today, due to public and private research partnerships, there are 

new therapies in the pipeline that show great promise in improving 

the health of people with diabetes and reducing the costs to our nation. For example, in the last year, for the first time, people with 

T1D in the United States have worn artificial pancreas systems 

outside of the hospital as a part of groundbreaking research studies. In these studies, people with T1D have gone about daily life, 

going for walks, out to eat to restaurants, and to work with experimental technologies that automatically controlled their blood sugar. 

Less burden, better glucose control—it is not a cure, but it is great 

progress, progress made possible by JDRF, the National Institutes 

of Health, the Food and Drug Administration, various private sector companies, other research foundations, and all of you here 

today. 

And with great progress, there is great potential for fiscal savings. For example, researchers have found that intensive glucose 

control over six-and-a-half years can cut in half the onset of kidney 

disease, and a 50 percent reduction in end-stage renal disease 

could save Medicare $126 billion over a term of 25 years. 

With your leadership and the public-private partnership for diabetes research, potential therapies could transform millions of lives 

and improve the fiscal health of our nation. But we must move forward with urgency and with a long-term commitment to the investments and research that are needed to finish the job. 

JDRF is funding ourselves more than $100 million in research 

this year and we currently have more than $500 million deployed 

in research programs at work today around the world. JDRF and 

our many volunteers will keep doing our part. But if we are to continue to make progress to advance towards desperately needed new 

therapies to cure, treat, and prevent T1D, we need the Federal 

Government to continue to do its part and that requires a longterm commitment to ensure that vital multi-year research proceeds 

without interruption. 

I urge the Congress to fund a three-year extension of the Special 

Diabetes Program this year at the current funding level. We must 

make the promise of life saving and cost saving diabetes therapies 

a reality. We can make this future happen. We need your help. 

Thank you, and I would be happy to answer any questions you 

may have. 

[Applause.] 

[The prepared statement of Mr. Brewer follows:] 

DeShaun on LAP51NQ082 with DISTILLER

48 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 35 here 91169.035
49 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 36 here 91169.036
50 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 37 here 91169.037
51 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 38 here 91169.038
52 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 39 here 91169.039
53 

The CHAIRMAN. Thank you, Mr. Brewer. 

Now, for our young friends, normally, what happens, we get into 

the questions. The Chairman will ask questions, the Ranking Member, and then according to the order in which the members appeared, then they are recognized. Because of my colleagues being 

so smart and so interested in all of this, I will defer my questions 

and I will do a wrap-up. So I want to call first on Senator Collins. 

Senator COLLINS. Thank you once again, Mr. Chairman. 

Dr. Rodgers, when Quinn was talking to me prior to the hearing, 

he mentioned that when he was diagnosed at age eight, he was the 

only person in his community with Type 1 diabetes. Now, he tells 

me, there are 12 or 13 children. I am very alarmed by a recent 

CDC study that shows that Type 1 diabetes among young people 

rose by a troubling 23 percent between 2001 and 2009. Do researchers have any idea why this increase? 

Dr. RODGERS. Thanks for that question, Senator Collins. First, I 

would point out that the reason that we know that it has increased 

over 20 percent in that period of time is directly due to the Special 

Diabetes Program. The Special Diabetes Program has enabled us 

through a program called SEARCH in which the NIH works in conjunction with the CDC in several cities around the United States 

to monitor the onset of diabetes in youth. And in that group, there 

has been not only an increase in Type 1 diabetes at a younger age, 

as you indicated, but also Type 2 diabetes among adolescents and 

youth. 

We know, as I indicated, that diabetes, especially Type 1 diabetes, is a result of a combination of genetic and environmental factors. It is quite likely that our genes have not changed over this 

short period of time, strongly indicating that it is quite likely some 

environmental factor that is increasing that is associated with that 

increased incidence of Type 1 diabetes. 

And this long-term investment made possible by the Special Diabetes Program, a study called TEDDY, The Environmental Determinants of Diabetes of the Youth, in which we screen over 425,000 

kids and we have enrolled 8,000 kids who are about halfway 

through the study. The hope there is to actually learn what are 

those environmental factors that trigger the autoimmune response 

to this disease. 

If it turns out that it is a virus or a collection of viruses, then 

we would be prepared to develop vaccines to prevent this in people 

at youth. If it turns out that it is a dietary factor, then, obviously, 

avoidance of that would be important. But it is with the funding 

of the Special Diabetes Program that we have been able to both 

monitor the numbers of kids as well as be in a position to now determine what those environmental factors are. 

Senator COLLINS. That is, indeed, absolutely critical research. 

I know that everyone in this room is very interested in development of an artificial pancreas and much progress has been made 

in moving the clinical trials from hospital settings to diabetes 

camps and real world settings. Could you give us some idea on 

when you think the artificial pancreas will be more generally available. 

Dr. RODGERS. Sure. Well, I would be pleased to comment on the 

research progress in this area. Obviously, I will have to defer to my 

DeShaun on LAP51NQ082 with DISTILLER

54 

colleagues at the FDA to provide information on the regulatory aspects of this. 

What I can say is that the FDA issued final guidance on the lowglucose suspend system, actually, in June of 2011, just a few weeks 

two years ago as a result of this meeting, as you remember, and 

for the development of an artificial pancreas system, they issued 

guidance in November of 2012. 

What I would say is that there has been really strong research 

findings recently in trials conducted in Europe, in Australia, as 

well as in the United States that were recently published in the 

last six to eight months in the prestigious New England Journal 

of Medicine. These trials showed that this system can reduce the 

episodes of hypoglycemia, especially at night, which is especially 

worrisome, as you have heard from Ray Allen and Jeff Brewer as 

well as from other parents in this room. 

This is an important finding, because we know that the threat 

of hypoglycemia is oftentimes what prevents people from very 

closely managing their blood sugar in tight control, which we now 

know definitely prevents long-term complications of the disease. 

From a research perspective, I can say that the NIDDK continues its vigorous support for this artificial pancreas, both with 

the funds that we have in fiscal year 2013 and because the committee allowed us to move forward in fiscal year 2014. We will continue the strong support for this artificial pancreas in those years, 

as well. 

Senator COLLINS. Thank you, Doctor, and I want to thank all of 

the witnesses. You are absolutely terrific. 

The CHAIRMAN. Thank you, Senator Collins. 

Senator Shaheen. 

Senator SHAHEEN. Thank you very much, Mr. Chairman and 

Ranking Member Collins and Senator Warren, for allowing me to 

go next. 

I very much appreciate the inspiring and compelling testimony 

from each of you on the panel, and I want to thank all of the delegates who are here with the Children’s Congress. Your effort here 

today really makes a difference in educating us in Congress about 

what it is like living with Type 1 diabetes and how important it 

is for us to look at the policy level on things that we can do to help 

address Type 1 diabetes. 

I have a personal window into what it is like to live with Type 

1 diabetes because my oldest granddaughter has Type 1. She was 

diagnosed a little after she turned eight. So I have watched very 

directly the challenges that you all face and so appreciate your 

being here. Thank you very much. 

Dr. Rodgers, you and Mr. Brewer and, really, everyone on the 

panel has talked about the importance of making investments that 

can help us find a cure for Type 1. Can you talk about what the 

impact of sequestration has been on the efforts currently underway 

at NIH with the Special Diabetes Fund and other efforts to try and 

look for therapies and a cure for diabetes. 

Dr. RODGERS. What I can say is that, obviously, the more funds 

that we have available, obviously, we can provide progress much 

more rapidly. We attempt in a strategic manner to bring together 

external experts to sort of tell us about what it is that is critically 

DeShaun on LAP51NQ082 with DISTILLER

55 

important to move forward with. With the possibility that funds 

will be limited, what would be the first studies that one might consider amplifying and what studies, of course, would either have to 

be scaled back or stopped completely? 

The efforts for clinical research, such as the ones involving the 

artificial pancreas, or in the use of trials of drugs that may either 

prevent or delay the destruction of the beta cells, are the types of 

studies that we would be, from an ethical standpoint, not good 

judgment to move forward with if you are uncertain about having 

future funds. And so in opportunities in which funds are cut back, 

one really has to think, despite the fact that these are high priority 

areas, think very strongly about committing families and patients 

to getting involved in clinical trials that you may or may not be 

able to complete. 

Senator SHAHEEN. Well, let me ask the question a little differently. 

Dr. RODGERS. Sure. 

Senator SHAHEEN. What would happen if we do not fund the Special Diabetes Program this year, if we do not fund it for another 

year, and if we do not fund it for the three years that you are suggesting we should do? 

Dr. RODGERS. Well, let me answer that question by telling you 

about the progress that has been made when the committee has 

been able to give us three years of funding. The TEDDY program, 

The Environmental Determinants of Diabetes in the Young, is a 

program that, because of the long-term nature of it, we were able 

to begin it, and now with the renewal, we have been able to continue it. And TEDDY has really put us in the position now to determine what are those risk factors and how we might intervene. 

TrialNet, the trial that Quinn is on, is another one of these longterm trials, and once we have an idea to move forward, TrialNet 

has allowed us the infrastructure to begin to address some of those 

questions about promising treatments. Those types of trials would 

be in jeopardy, those that are sort of next up, without a commitment for longer-term research funding. 

Senator SHAHEEN. Thank you. 

Dr. RODGERS. Thank you. 

Senator SHAHEEN. Mr. Allen and Mr. Brewer, too, as parents of 

children with Type 1 diabetes, what would you like us as policymakers to go away from this hearing understanding and what action would you like us to take? 

Mr. ALLEN. Well, first and foremost, we live with this disease 

every day. You know, when we look at Walker every day and he 

stands up and we have to give him a shot and every day he says 

he wants this disease to stop, he wants to not have to take a shot, 

and his brothers run outside and go play and he has to stay behind 

and he has to take a shot, he looks at us and he says, you know, 

‘‘When is this going to end? When can we stop doing this?’’ 

So we say we are going to do everything we can in our power to 

make this disease cease, so we are here today because we want you 

to understand that this is the face of our children, you know, all 

these kids in here, and they all feel the same way every single day, 

seven to ten times a day. So we are advocating for them so you understand. I am sure you have people living with diabetes every day. 

DeShaun on LAP51NQ082 with DISTILLER

56 

So when you walk away from this, you understand that these are 

innocent children who had nothing to do with getting diabetes, and 

we want you to understand that as you make your decisions, knowing that these are our children and they are the future of our universe and future of our world. 

Senator SHAHEEN. Thank you very much. 

Mr. BREWER. I have a unique perspective as a father of a child 

with the disease but also the CEO of this organization. So I have 

the sense of the opportunities that we have before us to solve this 

problem. There are concrete opportunities that can improve the 

lives of people in a very substantial way, to help them to live safer 

and easier lives and avoid some of the adverse events that you 

heard about today. And they are really lying right before us. They 

are lying right before us as a result of previous research funding, 

JDRF having funded $1.7 billion of research over the last 43 years 

and the NIH having funded untold billions dollars of research. 

We have been brought to a point where we can translate these 

scientific discoveries through to really meaningful impact on people 

living with this disease—children, adults, everybody living with the 

disease. It is going to take some more research funding, but it is 

also going to take some very close look at the regulatory challenges 

that are involved in translating therapies, testing therapies for 

safety and efficacy in order to deliver them through. 

We need to take a look at the reimbursement paradigm for how 

Type 1 technologies for treatment are paid for, because there is a 

tremendous cost savings to prevent some of these catastrophic 

events that we are talking about. Emergency room visits are very 

expensive. The complications of Type 1 diabetes later in life are 

very expensive and burdensome on the medical system. And yet, 

we have such promise and opportunity to really change those outcomes. 

So there is a fiscal imperative here. There is an imperative to 

look at how our system translates these scientific discoveries into 

technologies that can be used here and around the world where we 

have historically been a leader and where, frankly, we are now falling behind because of some structural challenges in this pipeline. 

Senator SHAHEEN. Thank you very much. Thank you, Mr. Chairman. 

The CHAIRMAN. Dr. Rodgers, directly to Senator Shaheen’s question, the continued existence of this program, is it not absolutely 

critical to continue your efforts to fight the disease? 

Dr. RODGERS. I could not say it better, Senator. Thanks for the 

question. It is. It is critically important. We have a range of areas 

not only in the course of the disease that I have tried to outline 

during my oral statement, but also a range from very basic research. We are learning quite a bit about how one could actually 

tease cells that are in the pancreas, that exist, and transfer them 

into beta-producing cells, and these discoveries which have now 

been found in animal models but also their equivalents exist in humans, would not have been possible. And we are on the precipice 

of beginning to translate these findings into clinical research, 

translational research as well as clinical research. All of this work 

over and above the regular appropriations that we get would not 

be possible without the Special Diabetes Program. 

DeShaun on LAP51NQ082 with DISTILLER

57 

The CHAIRMAN. Senator Warren. 

Senator WARREN. Thank you, Mr. Chairman, and I want to say 

to all of you at the Children’s Congress, thank you very much for 

being here. You know, this is what democracy is about. People here 

in Washington will decide how we spend money and how much 

money goes into research for diabetes and for other medical problems. And so your coming here and making the case for why it is 

important that we put money into research for diabetes is really 

important. I am really glad you are here. I think you make a real 

difference. 

I also want to say to Senator Collins and to Senator Shaheen, 

thank you very much for your leadership in creating a caucus that 

has made a real difference. I am a new Senator. I am just getting 

started, so I am learning about this. But they have shown great 

leadership in making sure that there is better funding, better support, better awareness here in Washington for the issues surrounding diabetes. 

So, thanks for being here today. I also want to say to our panel, 

a terrific panel. Thank you so much. I am grateful to all of you for 

being here. 

There are a couple of questions I want to follow up on. I want 

to start with you, Dr. Rodgers. This is not just about the level of 

funding, which I understand is critically important, but it is also 

the long-term commitment on funding. And what I have observed 

is that NIH funding, generally, and diabetes funding, has been getting shorter and shorter and shorter. That is, you cannot be sure 

the money is coming until just before you get it and it is for a short 

period of time. I suspect that has an impact on the research and 

on attracting more people to do more research in this field. Could 

you speak about that just a little bit, Dr. Rodgers. 

Dr. RODGERS. Thank you, Senator. You are absolutely right in 

your observations. I think when one—first of all, let me start off 

by saying that the investments are already paying off as clearly 

shown in these critical studies, the Diabetes Control and Complication Trial. People are living longer and healthier lives than even 

a decade ago. And so if future promise—anything about past successes really point out that we are really at that point in which we 

are about to make major milestones and landmarks. 

Now, specifically to your question about the duration of funding, 

as one is managing programs, one has to think about what are the 

feasible programs that one can begin. Clinical trials are such that 

without having an assurance for long-term funding, it would be, in 

a sense, unethical to put people into trials with all that is involved 

in the trials without knowing that the funding will continue 

through a period of time to see it successfully completed. And that 

is why the three-year funding that Mr. Brewer suggests, on the 

longer-term, makes both planning and management of clinical 

trials and clinical studies so vitally important. 

When we get one year of funding, of course, we appreciate it and 

we try to manage it in a way that we can achieve it. But having 

longer-term trials, or longer-term funding horizons allows us not 

only to complete ongoing trials or ancillary trials to those trials to 

get really the best return on the investment, but also to begin the 

DeShaun on LAP51NQ082 with DISTILLER

58 

planning of longer-term trials as our external experts help us with 

prioritizing them. 

Senator WARREN. Thank you. That is very helpful, Dr. Rodgers. 

You know, as much as we talk about our funding through NIH— 

and please count me as a supporter of substantially increasing our 

funding—it is also important, though, to talk about the investments that are made by the private sector in new technologies and 

making living with diabetes easier. And I am very proud, of course, 

to be from Massachusetts, where we are not only making great 

progress on the research, the front-end part with NIH and other 

support, but also that we have a medical device, pharmacology, biotechnology that we are working on in Massachusetts to try to help 

people who are currently living with diabetes. 

And you raised the question about the Special Diabetes Program. 

I understand there are clinical trials going on, and I understand, 

Mr. Ferguson, you have been a participant in the clinical trials, is 

that right? 

Mr. FERGUSON. Yeah. 

[Laughter.] 

Senator WARREN. Okay. He gets to the point. 

[Laughter.] 

So I have a question for you. Would you mind, just for a minute, 

talking a little bit about what it is like to participate in a clinical 

trial on diabetes? 

Mr. FERGUSON. Well, it is just a great experience. Even though 

you are going down for a trial, it is, like, I have got to go down 

every month to get the drug Abatacept tested, so they would—like, 

I get an IV and then they put in water first to make sure I was 

hydrated and then they would start putting Abatacept in. And I 

have got to go down to Boston every time with my father, so—and 

it is really cool. You get to see really smart people, minds like no 

others, and—yeah. 

Senator WARREN. All right. 

[Laughter.] 

Thanks, Quinn. But, you know, you are out there making a difference, and you are making a difference for everybody, everybody 

who has got diabetes now and people who develop it in the future. 

But the question, then, that I want to ask Dr. Rodgers and Mr. 

Brewer, is if you can just speak briefly to the issue about barriers 

that are in the way of getting people into clinical trials. Mr. Brewer, would you like to start. 

Mr. BREWER. Well, there are barriers in the way of information 

getting out to people about what clinical trials there are. We probably do not have enough clinical trial sites to be able to provide opportunities outside of concentrations like we have in Massachusetts 

of these kinds of resources. And, frankly, we just do not have 

enough things to test right now, and that is why we need the research funding, because the pipeline that is created by this research funding, the Special Diabetes Program, other NIH funding, 

and the funding that JDRF does, we are the feeder for those clinical trials. 

Senator WARREN. Dr. Rodgers, would you like to add anything to 

that? 

DeShaun on LAP51NQ082 with DISTILLER

59 

Dr. RODGERS. I would agree with that, and I would just emphasize that we—just because of the unawareness of the availability 

of participating in trial, we are trying to explore other avenues, 

such as using social media, for example, to have—instead of having 

doctors recommend patients, actually going directly to the patient 

communities, and we are working in conjunction with the JDRF to 

try to use social media to get patients to participate, perhaps who 

live in areas that are not heavily concentrated with researchers. 

Senator WARREN. Well, that is very valuable. I just want to say, 

it is so impressive to me when you meet young people who are 

managing diabetes. They are not letting diabetes manage them. 

They are managing it and taking responsibility. And then taking 

that extra step to join in in part of how you find the cure, being 

part of the research and the clinical trial for it, good for you, 

Quinn. So, thank you all very much. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Senator Donnelly. 

Senator DONNELLY. Thank you, Mr. Chairman. 

It is an honor to have all of you here. I not only have the opportunity to represent Indiana in the United States Senate, but am 

part of a family that has been touched by Type 1 diabetes, and so 

I know every day what you deal with, as well—not me personally, 

but a family member. My pledge to you, as I know everybody is up 

here, is that we will beat this. We will find a cure. We will take 

every step necessary along the way. And I want you to all know 

that you have an incredible amount of advocates here on this side 

who will fight for the funding that you need to make sure that you 

have that three-year window that you need and to—economically, 

it makes sense, as well, that when we cure this, we not only make 

everybody have a chance to be more productive, but we save so 

much funds, as well. 

But to all of you, what we want to do is make it so you never 

have to think about this, so that as you live your life, this is something that you can say we beat, we cured, and it is over with, and 

that is the goal of what we are trying to accomplish here. 

And I want to thank, also, our three participants from the Children’s Congress who are from Indiana, Rebecca Moody, Claire 

Dunagan, and Gwen Wahler [phonetic], and just for all of you to 

know, another Indiana resident who is here, my friend Charlie, is 

an Indy car driver, and—— 

[Applause.] 

Charlie actually almost won the Pocono Race this past weekend. 

Charlie has Type 1 diabetes and is an Indy car driver and almost 

won the Indianapolis 500. If it was for the amount of cheers given, 

he would have won the Indy 500. 

But what I want to also do is ask you, Dr. Rodgers, in terms of 

an artificial pancreas, how far are we from—and, obviously, not an 

exact date—but how far are we from a time when we will have this 

available to all? 

Dr. RODGERS. Again, as I—trying to answer this, I can tell you 

really more about the research and the great progress, and I would 

have to say that—again, I would leave it to my colleagues at the 

FDA to discuss the regulatory aspects of it, but there really have 

been great advances within the last—and published within the last 

DeShaun on LAP51NQ082 with DISTILLER

60 

few months and presented at the American Diabetes Meeting just 

last month—about these devices. 

They are much smaller. They allow for ways of actually suspending insulin injection when the glucose level reaches a critical 

point. Less frequent episodes of hypoglycemia at night, which is 

really the critical time that people worry about. There was concern, 

for example, from the FDA’s perspective not only that the threshold 

was not reached and people would get seriously hypoglycemic, 

which was not shown, but as you suspend the insulin, of course, 

the glucose will begin to rise. And what these studies and presentation clearly show, that those episodes of hyperglycemia and its 

associated ketone production did not occur. 

So from a safety perspective, trials here in the U.S. as well as 

in Europe and Australia are clearly pointing to a point where we 

are about to make major breakthroughs and allow this for more 

children to be able to utilize this—— 

The CHAIRMAN. If the Senator would yield, would you describe 

for the committee what the device looks like? 

Dr. RODGERS. Sure. An artificial pancreas puts together two 

pieces of instrumentation, one that can continuously measure blood 

glucose levels, so a continuous glucose monitor. That glucose monitor sends signals to an insulin pump, just as your pancreas would. 

Your pancreas senses when there is too much sugar. It puts out 

more insulin. When the sugar drops too low, it puts out less insulin, and in certain instances, glucagon. 

And the other aspect is the pump. These are now connected by 

a computerized system which now the technology is available that 

even on a smart phone, one can link these two together. 

So this particular aspect, this insulin suspend, is a situation in 

which a glucose monitor indicates that the glucose levels are 

trending too low and, therefore, the insulin infusion in the pump 

is suspended, and as I said, keeps you in that critical window so 

that the blood sugar does not drop too low or too high. 

There has been a recent report, actually, from—and that is done 

because it actually monitors what the glucose is. There is a second 

major advance in which one uses mathematical algorithms to actually predict, based upon the rate at which the glucose is falling, 

when it is likely to reach that critical threshold, and this is why 

you have to bring engineers and mathematicians into this, as well. 

And this has actually shown great promise, as well. 

So, to answer your question, I cannot predict precisely, but I 

think that we are really on the precipice of this. 

Senator DONNELLY. Just outside of—obviously, the FDA is critical and has an important role, but outside of their role, would you 

say the technology is basically just about there at this point? Obviously, we have safety tests to do, but the technology itself is there? 

Dr. RODGERS. I think the components for the technology are certainly there. We can always do better. For example, I mentioned 

that the current artificial pancreas is actually infusing insulin. 

Now, to completely replicate the pancreas, one might do better with 

both insulin and glucagon, which is what the pancreas does, so a 

so-called bi-hormonal pump. And, obviously, one would have to, in 

a clinical setting, do trials to indicate the superiority of that over 

others. 

DeShaun on LAP51NQ082 with DISTILLER

61 

There are certainly areas in which we can improve upon, but 

generally, the technologies have greatly advanced within the last 

few years, and so I think we are certainly close to being there. 

Senator DONNELLY. I just want to ask one other question, and 

that is in regards to islet, that you discussed. There are efforts on 

islet transplants that are being done. Have you looked at the area 

of epigenetics and their possible assistance in regards to making 

the islets work better? 

Dr. RODGERS. Epigenetics refers to changes in the DNA structure, either by the addition of methyl groups or others, that can 

critically influence the expression of genes leading to certain proteins, and that is certainly an area in which we are critically—we 

are actively involved in research findings. 

One example of the importance of epigenetics is actually potentially in the development of diabetes. We talk about this gene environment interaction, but what we know, for example, is that the 

first environment that a developing infant is exposed to is actually 

the interuterine environment, and it is quite likely, and we certainly now know through a number of studies, that a woman who 

has diabetes, who develops in this case Type 2 diabetes, the likelihood of that infant born from that pregnancy has a greater risk of 

developing diabetes sometimes later in life than a sibling born to 

that mother under the situation in which she did not have diabetes. And it is thought that epigenetics plays an important role. 

Epigenetics is a way in which the environment makes marks 

upon your existing genes that can change the development of cells. 

So that is an important area that we are looking at. 

Senator DONNELLY. I want to thank all of you for being here, and 

to all of you young people, we promise we will be never ending in 

our efforts to cure this and to solve this so you never have to worry 

about it. And when one of you is the future President of the United 

States, I want to come visit you in the White House. 

[Applause.] 

The CHAIRMAN. Thank you, Senator Donnelly. 

Senator Blumenthal. 

Senator BLUMENTHAL. Thank you, Chairman Nelson, and thank 

you for holding this hearing. I want to join in expressing my gratitude to you for giving us this wonderful opportunity to express our 

determination, as my colleague, Senator Donnelly, has so eloquently and powerfully, that we will conquer diabetes. No question. 

We will conquer diabetes, and it will be due to the courage and 

strength of a lot of folks who are here today, particularly young 

people who have joined us, and I cannot imagine a better use of 

this space than for their to be visiting and sitting here. And I want 

to join Senator Donnelly in expressing the view that some of you, 

I am willing to bet a lot of money, will be sitting up here one of 

these days in the not too distant future. 

Let me say, at the risk of offending the Chairman, that I know 

he has referred to Ray Allen’s distinguished career as an NBA star, 

but I just want to remind the Chairman that before he was a winner for the Miami Heat, he was a Husky, a UConn Husky and a 

champion there. 

Mr. ALLEN. I am always a Husky. 

[Laughter.] 

DeShaun on LAP51NQ082 with DISTILLER

62 

Senator BLUMENTHAL. And I was going to say—— 

Mr. ALLEN. Yes, always. 

[Applause.] 

Senator BLUMENTHAL. And we can applaud that, yes. 

[Laughter.] 

It is like being a Marine. You are always a UConn Husky. 

Mr. ALLEN. Always. 

Senator BLUMENTHAL. I just want to say, Couch Calhoun would 

be very proud of you today, and most especially proud of your son, 

Walker. Thank you for being here today, Walker. 

Mr. ALLEN. Thank you, Senator. 

[Applause.] 

Senator BLUMENTHAL. Let me also thank Ms. Smart. Your work 

personally on this has been so valuable, and your sharing with us 

your story of your battle with diabetes from the age of 13, your 

pregnancy in 1989, your nearly succumbing on the stage. All of it 

shows, really, the human consequences and how even the most illustrious struggle equally with this dreaded disease. 

I have been a longtime advocate of NIH funding. The costs of 

this disease in Connecticut and elsewhere are staggering. Two-hundred-and-sixteen thousand people in Connecticut alone have diabetes, which costs a total of $2.92 billion. That is billion with a ‘‘b.’’ 

Two-point-nine billion dollars, Connecticut alone. So if we are really mindful of the costs here, we will do more and do it more effectively. 

This diabetes has a face and a voice. You are here to tell us 

about it. I also want to thank, by the way, Sophie Brown, Harrison 

Zuckerberg, and Robert Miles [phonetic], who are from Connecticut. 

Thank you for being here. I visited with you earlier, very proud 

that you are here today. 

[Applause.] 

But I want to ask about the meaning of this NIH funding. Again, 

if you could explain to us—I know you have alluded to it before— 

the importance of sufficient funding to do the work and do it effectively and what this money actually goes to do. What is the use of 

this money that makes it so valuable? Perhaps you could talk 

about that, Dr. Rodgers. 

Dr. RODGERS. Sure. Let me mention that there are a range of not 

only studies in terms of their design, both basic studies to understand how the beta cell works, why you lose it over time, 

translational studies, now understanding, for example, that there 

are hormones that are produced as these cells start to die that 

could allow for them to what is called differentiate or de-differentiate into other cells, what can allow them to proliferate, research 

that is currently ongoing to try to develop therapies to reverse the 

autoimmune attack once it has actually begun in patients or in 

people who are at risk, actually preventing it from ever occurring, 

studies that will allow us to more closely treat patients who have 

the disease for some time in terms of their complications—heart 

disease, stroke, blindness, amputations, for example. 

We have made great progress, and, in fact, to a first approximation, critically, we know that just controlling the blood glucose 

makes major difference. But now we want to—I think everyone 

agrees that it is better to prevent a disease than to actually treat 

DeShaun on LAP51NQ082 with DISTILLER

63 

long-term complications, and obviously, we have to continue efforts 

in all of these areas. But preventing the disease or reversing it 

once it is established very early on, as well as ultimately curing 

disease, is really what the Special Diabetes Program funds allow 

us to do. 

Some of the studies, one can do in the short term in terms of 

basic studies. But the longer-term studies, the clinical studies and 

the clinical trials, really require long-term sustained funding in 

order to achieve successfully. 

Senator BLUMENTHAL. So we cannot do it just by one year, by 

one shot. It has got to be sustained and committed. 

Dr. RODGERS. Ultimately, optimally, that is the best way to approach this problem. 

Senator BLUMENTHAL. Thank you. My time has expired, regretfully, but again, my thanks to this very, very distinguished panel. 

My thanks to the Chairman. And, again, thank you to everyone for 

being here today. I know you are not going away. We are not going 

away. We are going to win this. Thank you. 

[Applause.] 

The CHAIRMAN. Thank you, Senator Blumenthal. Well said, Senator Blumenthal. 

Ms. Smart, tell us your lessons learned on how to stay healthy 

from your experiences over the years. 

Ms. SMART. Oh, gosh. I think, and I do not want to make too 

much of this, but I do think that there is a great value in not looking upon yourself as a sick person, not thinking about being sick 

as a part of your identity, because we—obviously, our brain sends 

messages to our body. So I think that that is really, really important and I hope—and it seems like most of the kids here are pretty—incredibly sharp and have that attitude. I was reading all of 

your stories last night and it is impressive, to say the least. I wish 

that I had had that kind of gumption when I was 13. 

And, again, it is just trying to do what you want to do. I mean, 

I never felt like there was anything I could not do. I was a cheerleader in high school and all that, and, of course, sometimes I 

would use my diabetes as an excuse if I did not want to do something sometimes. You know, if I wanted to take a break, I would 

say, oh, I need to go get a Coke. You guys go ahead without me. 

You know, things like that, which you have to not try to do. But, 

again, it is just—— 

[Laughter.] 

Do not copy what I did. Do as I say, not as I do. 

But, no, it is follow your dreams, whatever they are, but just be 

smart. Be wise. Do not ever feel self-conscious about letting people 

know what is going on with you, and never be afraid to ask for help 

if you need it, and just be smart. And I do not think I need to tell 

this group that, but maybe they can tell other kids they meet some 

of those messages. 

And I would just like to add one little thing, too, just from what 

I have heard here today and what little I know. I hope and pray 

that the insurance business and our government and everything 

will not be penny wise and pound foolish, because it is, for all diseases but certainly for this one, better to try to find a cure and a 

DeShaun on LAP51NQ082 with DISTILLER

64 

prevention than treat complications 50 years down the road. I hope 

that we can convince those in power that that is a huge thing. 

And I think the work on beta cells and also this issue of whatever environmental causes, to me, that has got to be huge, because 

once we figure that out, that is going to be, it seems like, half the 

battle. Thank you. 

The CHAIRMAN. Speaking of the cost, Mr. Brewer, Medicare in 

and of itself, the Medicare costs are going to double by 2020. We 

are estimating $226 billion. How much of that is due to Type 1? 

Mr. BREWER. I am not sure I have that specific estimate to give 

to you today, but I can tell you that Type 1 is a disproportionate 

cost of the expense of diabetes because the complications tend to 

occur at a higher rate than in Type 2. The costs of treating the disease over a lifetime are increasingly burdensome to the system, as 

well. So I have seen estimates that even though Type 1 may only 

account for five to ten percent of the population of people who have 

diabetes, upwards of 30 to 40 percent of the costs that actually are 

absorbed by the system are driven by Type 1, which, I think, 

makes the argument even greater that focus on this area is going 

to have a very significant implication for Medicare spending. 

The CHAIRMAN. Absolutely. 

Mr. Allen, tell us about the resources and services that were 

available to you and Shannon as parents when Walker was diagnosed and how you were able to use that resource and services to 

manage the physical and emotional aspects of the disease. 

Mr. ALLEN. Well, when Walker was diagnosed in 2008, just, I 

think, we talked about the environment. That was the one thing 

we wanted to figure out, because Walker was pre-screened when he 

was just one year old, or one day old. And we talked about so many 

things that we can do that can help him benefit, or help us help 

him benefit from this disease. 

I think being in Boston was probably one of the best places that 

we possibly could have been because of the care, the hospitals 

there. The Joslin Center took us in immediately. They had such 

great doctors there and we had a huge connection with the Celtic 

ownership. So the minute we flew back from L.A., we had doctors 

waiting for us that took care of us immediately. I do not think— 

I can honestly say that just because I was a Boston Celtic at the 

time, it was not because of that. You know, they take care of all 

people that way. The Joslin Center there in Boston has been incredible. They continue to be incredible. Dr. Lori Laffel, who was 

Walker’s doctor permanently, regardless of where we live, she always sees him and takes care of him and fields the phone calls 

from my wife. 

So we feel so fortunate that we continue to learn and stay on the 

cutting edge because the Joslin Center is right there in Boston, and 

we live in Connecticut, as well, so we are a very close distance, and 

we have people that continually stay in contact with myself and my 

wife to make sure that we see and know everything diabetes-related so we can help his care over a long period of time. 

The CHAIRMAN. Dr. Rodgers, how many types of diabetes are 

there? 

Dr. RODGERS. Largely, there are two types, but there are perhaps 

others. Type 1 diabetes, the reason we are having this Congress, 

DeShaun on LAP51NQ082 with DISTILLER

65 

as Mr. Brewer indicated, probably accounts for somewhere between 

five to ten percent of the diabetes. 

The overwhelming majority is Type 2 diabetes, what we used to 

call adult-onset, certainly when I was in medical school. But, as I 

said, as a result of this SEARCH program that we were able to set 

up, increasingly, we are seeing more of this in children and adolescents. And Type 2 diabetes in children is a much more complicated 

disease to treat than even Type 1 diabetes. And because of the long 

nature of having complications, this really could be a major challenge for this country, and those numbers that you quoted in terms 

of expenditures could really increase exponentially if we do not 

keep an eye on this, as well. 

There are rarer forms of diabetes which account for one or two 

percent, maturity-onset diabetes, certain genetic diseases in which 

insulin is not secreted well, et cetera. But the vast majority is Type 

1 and Type 2 diabetes. 

The CHAIRMAN. Colleagues, any further wrap-up, mindful that 

our young guests are still sitting horizontal? 

[Laughter.] 

I mean, still sitting vertical instead of horizontal. 

Senator COLLINS. Or both. 

[Laughter.] 

Mr. Chairman, I just want to thank you so much for holding this 

hearing. As I mentioned in my opening statement, this is my seventh hearing of the Children’s Congress and it is always so inspiring to see the young people here, to hear their stories, and to realize the progress that has been made, but also the work that must 

be done. 

So I particularly want to thank our delegates, my constituent 

Quinn, who did such a great job, Walker, who puts a human face 

on it, as well, and did a great job sitting next to Dad for a very 

long time, and all of the wonderful young people that we have here 

today. 

When I first met families whose children had Type 1, I knew 

that I had to get involved, and we are making a difference and I 

just wanted to pledge my continued support and leadership, and 

again, thank you, Mr. Chairman. 

The CHAIRMAN. Senator Warren. 

Senator WARREN. Thank you, Mr. Chairman, for doing this. 

Thank you. 

The CHAIRMAN. Senator Donnelly. 

Senator DONNELLY. It was a great honor to be part of this. 

Thank you, and we are going to win. 

The CHAIRMAN. Amen to that. 

[Applause.] 

And with that statement, the meeting is adjourned. 

[Applause.] 

[Whereupon, at 3:41 p.m., the committee was adjourned.] 

DeShaun on LAP51NQ082 with DISTILLER

DeShaun on LAP51NQ082 with DISTILLER

(67) 

APPENDIX 

DeShaun on LAP51NQ082 with DISTILLER

68 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 1 here 91169.001
69 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 2 here 91169.002
70 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 3 here 91169.003
71 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 40 here 91169.040
72 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 41 here 91169.041
73 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 42 here 91169.042
74 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 43 here 91169.043
75 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 44 here 91169.044
76 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 45 here 91169.045
77 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 46 here 91169.046
78 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 47 here 91169.047
79 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 48 here 91169.048
80 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 49 here 91169.049
81 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 50 here 91169.050
82 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 51 here 91169.051
83 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 52 here 91169.052
84 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 53 here 91169.053
85 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 54 here 91169.054
86 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 55 here 91169.055
87 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 56 here 91169.056
88 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 57 here 91169.057
89 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 58 here 91169.058
90 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 59 here 91169.059
91 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 60 here 91169.060
92 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 61 here 91169.061
93 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 62 here 91169.062
94 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 63 here 91169.063
95 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 64 here 91169.064
96 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 65 here 91169.065
97 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 66 here 91169.066
98 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 67 here 91169.067
99 

Æ 

DeShaun on LAP51NQ082 with DISTILLER


Insert offset folio 68 here 91169.068