II 

111TH CONGRESS 

1ST SESSION S. 1473 

To catalyze change in the care and treatment of diabetes in the United 

States. 

IN THE SENATE OF THE UNITED STATES 

JULY 20, 2009 

Mrs. HAGAN (for herself and Mr. CORNYN) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To catalyze change in the care and treatment of diabetes 

in the United States. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Catalyst to Better Diabetes Care Act of 2009’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents; findings. 

Sec. 2. Diabetes screening collaboration and outreach program. 

Sec. 3. Advisory group regarding employee wellness and disease management 

best practices. 

Sec. 4. National Diabetes Report Card. 


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Sec. 5. Improvement of vital statistics collection. 

Sec. 6. Study on appropriate level of diabetes medical education. 

1 (c) FINDINGS.—The Congress finds as follows: 

2 (1) Diabetes is a chronic public health problem 

3 in the United States that is getting worse. 

4 (2) According to the Centers for Disease Con5 trol and Prevention: 

6 (A) One in 3 Americans born in 2000 will 

7 get diabetes. 

8 (B) One in 2 Hispanic females born in 

9 2000 will get diabetes. 

10 (C) 1,500,000 new cases of diabetes were 

11 diagnosed in adults in 2005. 

12 (D) In 2007, 23,600,000 Americans had 

13 diabetes, which is 7.8 percent of the population 

14 of the United States. 

15 (E) 5,700,000 Americans are currently 

16 undiagnosed. 

17 (F) African-Americans are nearly twice as 

18 likely as whites to have diabetes. 

19 (G) Nearly 13 percent of American Indians 

20 and Alaska Natives over 20 years old have diag21 nosed diabetes. 

22 (H) In States with significant Asian popu23 lations, Asians were 1.5 to 2 times as likely as 

24 whites to have diagnosed diabetes. 


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1 (3) Diabetes carries staggering costs: 

2 (A) In 2007, the total amount of the direct 

3 and indirect costs of diabetes was estimated at 

4 $174,000,000,000. 

5 (B) 18 percent of the Medicare population 

6 has diabetes but spending on this group con7 sumes 32 percent of the Medicare budget. 

8 (4) Diabetes is deadly. According to the Centers 

9 for Disease Control and Prevention: 

10 (A) In 2007, according to death certificate 

11 numbers, diabetes contributed to 284,000 

12 deaths. 

13 (B) Diabetes is likely to be seriously 

14 underreported as studies have found that only 

15 35 percent to 40 percent of decedents with dia16 betes had it listed anywhere on the death cer17 tificate and only about 10 percent to 15 percent 

18 had it listed as the underlying cause of death. 

19 (5) Diabetes complications carry staggering eco20 nomic and human costs for our country and health 

21 system: 

22 (A) Diabetes contributes to over 224,000 

23 deaths a year. 

24 (B) The risk for stroke is 2 to 4 times 

25 higher among people with diabetes. 


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1 (C) Diabetes is the leading cause of new 

2 blindness in America, causing approximately 

3 12,000 to 24,000 new cases of blindness each 

4 year. 

5 (D) Diabetes is the leading cause of kidney 

6 failure in America, accounting for 44 percent of 

7 new cases in 2005. 

8 (E) In 2002, 44,400 Americans with dia9 betes began treatment for end-stage kidney dis10 ease and a total of 153,730 were living on 

11 chronic dialysis or with a kidney transplant as 

12 a result of their diabetes. 

13 (F) In 2004, approximately 71,000 ampu14 tations were performed on Americans with dia15 betes. 

16 (G) Poorly controlled diabetes in women 

17 before conceiving and during the first trimester 

18 of pregnancy can cause major birth defects in 

19 5 percent to 10 percent of pregnancies and 

20 spontaneous abortions in 15 percent to 20 per21 cent of pregnancies. 

22 (6) Diabetes is unique because many of its com23 plications and tremendous costs are largely prevent24 able through early detection, better education on diVerDate Nov 24 2008 00:57 Jul 21, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1473.IS S1473

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1 abetes self-management, and improved delivery of 

2 available medical treatment: 

3 (A) According to the Agency for 

4 Healthcare Research and Quality, appropriate 

5 primary care for diabetes complications could 

6 have saved the Medicare and Medicaid pro7 grams $2,500,000,000 in hospital costs in 2001 

8 alone. 

9 (B) According to the Diabetes Prevention 

10 Project sponsored by the National Institutes of 

11 Health, lifestyle interventions such as diet and 

12 moderate physical activity for those with 

13 prediabetes reduced the development of diabetes 

14 by 58 percent; among Americans aged 60 and 

15 over, lifestyle interventions reduced diabetes by 

16 71 percent. 

17 (C) Research shows detecting and treating 

18 diabetic eye disease can reduce the development 

19 of severe vision loss by 50 percent to 60 per20 cent. 

21 (D) Research shows comprehensive foot 

22 care programs can reduce amputation rates by 

23 45 percent to 85 percent. 

24 (E) Detecting and treating early diabetic 

25 kidney disease by lowering blood pressure can 


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1 reduce the decline in kidney function by 30 per2 cent. 

3 (7) Research shows that diabetes self-manage4 ment training programs, involving a health team 

5 that includes certified diabetes educators, not only 

6 significantly reduce overall health costs but also im7 prove health outcomes. 

8 SEC. 2. DIABETES SCREENING COLLABORATION AND OUT9 REACH PROGRAM. 

10 (a) ESTABLISHMENT.—With respect to diabetes 

11 screening tests and for the purposes of reducing the num12 ber of undiagnosed seniors with diabetes or prediabetes, 

13 the Secretary of Health and Human Services (referred to 

14 in this Act as the ‘‘Secretary’’), in collaboration with the 

15 Director of the Centers for Disease Control and Preven16 tion (referred to in this section as the ‘‘Director’’), shall— 

17 (1) review uptake and utilization of diabetes 

18 screening benefits to identify and address any exist19 ing problems with regard to utilization and data col20 lection mechanisms; 

21 (2) establish an outreach program to identify 

22 existing efforts by agencies and by the private and 

23 nonprofit sectors to increase awareness among sen24 iors and providers of diabetes screening benefits; and 


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1 (3) maximize cost effectiveness in increasing 

2 utilization of diabetes screening benefits. 

3 (b) CONSULTATION.—In carrying out this section, 

4 the Secretary and the Director shall consult with— 

5 (1) various units of the Federal Government, 

6 including the Centers for Medicare & Medicaid Serv7 ices, the Surgeon General of the Public Health Serv8 ice, the Agency for Healthcare Research and Qual9 ity, the Health Resources and Services Administra10 tion, and the National Institutes of Health; and 

11 (2) entities with an interest in diabetes, includ12 ing industry, voluntary health organizations, trade 

13 associations, and professional societies. 

14 SEC. 3. ADVISORY GROUP REGARDING EMPLOYEE 

15 WELLNESS AND DISEASE MANAGEMENT BEST 

16 PRACTICES. 

17 (a) ESTABLISHMENT.—The Secretary shall establish 

18 an advisory group consisting of representatives of the pub19 lic and private sector. The advisory group shall include— 

20 (1) representatives of the Department of Health 

21 and Human Services; 

22 (2) representatives of the Department of Com23 merce; and 

24 (3) members of the public, representatives of 

25 the private sector, and representatives of the small 


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1 business community, who have experience with dia2 betes or in administering and operating employee 

3 wellness and disease management programs. 

4 (b) DUTIES.—The advisory group established under 

5 subsection (a) shall examine and make recommendations 

6 of best practices of employee wellness and disease manage7 ment programs in order to— 

8 (1) provide public and private sector entities 

9 with improved information in assessing the role of 

10 employee wellness and disease management pro11 grams in saving money and improving quality of life 

12 for patients with chronic illnesses; and 

13 (2) encourage the adoption of effective employee 

14 wellness and disease management programs. 

15 (c) REPORT.—Not later than 1 year after the date 

16 of the enactment of this Act, the advisory group estab17 lished under subsection (a) shall submit to the Secretary 

18 the results of the examination under subsection (b)(1). 

19 SEC. 4. NATIONAL DIABETES REPORT CARD. 

20 (a) IN GENERAL.—The Secretary, in collaboration 

21 with the Director of the Centers for Disease Control and 

22 Prevention (referred to in this section as the ‘‘Director’’), 

23 shall prepare on a biennial basis a national diabetes report 

24 card (referred to in this section as a ‘‘Report Card’’) and, 

25 to the extent possible, for each State. 


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1 (b) CONTENTS.— 

2 (1) IN GENERAL.—Each Report Card shall in3 clude aggregate health outcomes related to individ4 uals diagnosed with diabetes and prediabetes includ5 ing— 

6 (A) preventative care practices and quality 

7 of care; 

8 (B) risk factors; and 

9 (C) outcomes. 

10 (2) UPDATED REPORTS.—Each Report Card 

11 that is prepared after the initial Report Card shall 

12 include trend analysis for the Nation and, to the ex13 tent possible, for each State, for the purpose of— 

14 (A) tracking progress in meeting estab15 lished national goals and objectives for improv16 ing diabetes care, costs, and prevalence (includ17 ing Healthy People 2010); and 

18 (B) informing policy and program develop19 ment. 

20 (c) AVAILABILITY.—The Secretary, in collaboration 

21 with the Director, shall make each Report Card publicly 

22 available, including by posting the Report Card on the 

23 Internet. 


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1 SEC. 5. IMPROVEMENT OF VITAL STATISTICS COLLECTION. 

2 (a) IN GENERAL.—The Secretary, acting through the 

3 Director of the Centers for Disease Control and Preven4 tion and in collaboration with appropriate agencies and 

5 States, shall— 

6 (1) promote the education and training of phy7 sicians on the importance of birth and death certifi8 cate data and how to properly complete these docu9 ments, including the collection of such data for dia10 betes and other chronic diseases; 

11 (2) encourage State adoption of the latest 

12 standard revisions of birth and death certificates; 

13 and 

14 (3) work with States to re-engineer their vital 

15 statistics systems in order to provide cost-effective, 

16 timely, and accurate vital systems data. 

17 (b) DEATH CERTIFICATE ADDITIONAL LANGUAGE.— 

18 In carrying out this section, the Secretary may promote 

19 improvements to the collection of diabetes mortality data, 

20 including the addition of a question for the individual cer21 tifying the cause of death regarding whether the deceased 

22 had diabetes. 

23 SEC. 6. STUDY ON APPROPRIATE LEVEL OF DIABETES MED24 ICAL EDUCATION. 

25 (a) IN GENERAL.—The Secretary shall, in collabora26 tion with the Institute of Medicine and appropriate assoVerDate Nov 24 2008 00:57 Jul 21, 2009 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1473.IS S1473

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1 ciations and councils, conduct a study of the impact of 

2 diabetes on the practice of medicine in the United States 

3 and the appropriateness of the level of diabetes medical 

4 education that should be required prior to licensure, board 

5 certification, and board recertification. 

6 (b) REPORT.—Not later than 2 years after the date 

7 of the enactment of this Act, the Secretary shall submit 

8 a report on the study under subsection (a) to the Commit9 tees on Ways and Means and Energy and Commerce of 

10 the House of Representatives and the Committees on Fi11 nance and Health, Education, Labor, and Pensions of the 

12 Senate. 

13 SEC. 7. AUTHORIZATION OF APPROPRIATIONS. 

14 There are authorized to be appropriated to carry out 

15 this Act such sums as may be necessary. 

Æ 


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