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ACCELERATING BREAKTHROUGHS: HOW THE SPECIAL DIABETES PROGRAM IS CREATING HOPE 

FOR THOSE LIVING WITH TYPE 1 DIABETES 

HEARING 

BEFORE THE

COMMITTEE ON APPROPRIATIONS 

UNITED STATES SENATE 

ONE HUNDRED EIGHTEENTH CONGRESS 

FIRST SESSION 

SPECIAL HEARING 

JULY 11, 2023—WASHINGTON, DC 

Printed for the use of the Committee on Appropriations 

( 

Available via the World Wide Web: http://www.govinfo.gov 
(II) 

COMMITTEE ON APPROPRIATIONS 

PATTY MURRAY, Washington, Chair 

DIANNE FEINSTEIN, California 

RICHARD J. DURBIN, Illinois 

JACK REED, Rhode Island 

JON TESTER, Montana 

JEANNE SHAHEEN, New Hampshire 

JEFF MERKLEY, Oregon 

CHRISTOPHER A. COONS, Delaware 

BRIAN SCHATZ, Hawaii 

TAMMY BALDWIN, Wisconsin 

CHRISTOPHER MURPHY, Connecticut 

JOE MANCHIN, III, West Virginia 

CHRIS VAN HOLLEN, Maryland 

MARTIN HEINRICH, New Mexico 

GARY PETERS, Michigan 

SUSAN M. COLLINS, Maine, Vice Chair 

MITCH McCONNELL, Kentucky 

LISA MURKOWSKI, Alaska 

LINDSEY GRAHAM, South Carolina 

JERRY MORAN, Kansas 

JOHN HOEVEN, North Dakota 

JOHN BOOZMAN, Arkansas 

SHELLEY MOORE CAPITO, West Virginia 

JOHN KENNEDY, Louisiana 

CINDY HYDE-SMITH, Mississippi 

BILL HAGERTY, Tennessee 

KATIE BRITT, Alabama 

MARCO RUBIO, Florida 

DEB FISCHER, Nebraska 

EVAN D. SCHATZ, Staff Director 

ELIZABETH MCDONNELL, Minority Staff Director 
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C O N T E N T S 

Page 

Opening Statement of Chair Patty Murray ........................................................... 1 

Statement of Vice Chair Susan M. Collins ............................................................ 2 

Statement of Griffin P. Rodgers, MD, M.A.C.P., Director, National Institute 

of Diabetes and Digestive and Kidney Diseases, National Institutes of 

Health ................................................................................................................... 5 

Prepared Statement ......................................................................................... 7 

Statement of Aaron J. Kowalski, Ph.D., Chief Executive Officer, JDRF ............ 13 

Prepared Statement ......................................................................................... 14 

Statement of James ‘‘Jimmy Jam’’ Harris, Award-Winning Music Producer 

and Philanthropist ............................................................................................... 18 

Prepared Statement ......................................................................................... 19 

Statement of Maria Muayad, JDRF 2023 Children’s Congress Delegate ........... 20 

Prepared Statement ......................................................................................... 21 

Statement of Elise Cataldo, JDRF 2023 Children’s Congress Delegate ............. 22 

Prepared Statement ......................................................................................... 23 

Conclusion of Hearing ............................................................................................. 40 

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ACCELERATING BREAKTHROUGHS: HOW THE 

SPECIAL DIABETES PROGRAM IS CREATING 

HOPE FOR THOSE LIVING WITH TYPE 1 DIABETES 

TUESDAY, JULY 11, 2023 

U.S. SENATE, COMMITTEE ON APPROPRIATIONS, Washington, DC. 

The committee met at 10:07 a.m. in room SD–106, Dirksen Senate Office Building, Hon. Patty Murray (chair) presiding. 

Present: Senators Murray, Tester, Baldwin, Murphy, Manchin, 

Peters, Collins, Murkowski, Moran, Boozman, Capito, Kennedy, 

Hyde-Smith, Britt, and Fischer. 

OPENING STATEMENT OF CHAIR PATTY MURRAY

Chair MURRAY. Good morning. This hearing of the Senate Appropriations will please come to order. 

We are here for a very important reason, and the first is to 

thank all of the young people who are here today for your commitment to coming and fighting for yourself and for many others to 

talk about the Special Diabetes Program (SDP) and its critical 

work that supports life-saving research for millions of kids and people across our country and the world who are living with type 1 diabetes (T1D). And in particular, we are here today to hear from 

kids living with type 1 diabetes about why this program matters. 

So before I get started, I want to welcome all of you to Washington, DC, and to Congress. I know many of you have traveled 

from all over the country to be here today. And I want you to know 

that your voices make a huge difference in making sure that Congress takes action to treat and eventually cure type 1 diabetes. And 

the Special Diabetes Program plays a crucial role in fighting this 

disease because it supports NIH (National Institutes of Health) research into type 1 diabetes that has led to breakthroughs in diabetes prevention and treatment. 

Given this program does so much good for so many families back 

home, it should be no surprise that it has strong bipartisan support 

here in Congress. I was pleased to work with Senator Alexander 

to reauthorize this program back in 2020 when we led the HELP 

(Health, Education, Labor and Pensions) Committee together. 

And Vice Chair Collins is such a tremendous leader in that effort 

and is a tireless champion on this issue as Co-Chair of the Diabetes 

Caucus, along with Senator Shaheen. So I am very glad to have 

Vice Chair Collins who will lead this hearing today. I have heard 
2 

from so many patients fighting this disease. It can be really hard. 

Here in Congress, we need to make things easier and give people 

hope and show we are serious about breakthroughs to prevent, 

treat, and cure diabetes. That includes continuing to authorize this 

crucial program and to support it and, hopefully, reauthorize it 

again this year. 

And we also need to make life-saving insulin affordable for everyone, something Senator Collins and Senator Shaheen are working 

tirelessly on. 

I am going to keep pushing to grow the bipartisan momentum 

that we have for fighting this disease with everything we’ve got. 

And I know with the incredible advocates from this year’s Children’s Congress, we are going to keep making progress. We are 

going to keep investing in life-changing research and, eventually, 

cure type 1 diabetes. 

And on that note, I am very proud to turn it over—the gavel— 

to Vice Chair Collins who will lead this hearing. 

Senator Collins. 

STATEMENT OF VICE CHAIR SUSAN M. COLLINS

Vice Chair COLLINS. Well, before Senator Murray has to leave, 

I want to first thank you for your leadership on this issue and for 

allowing me to share the honor of chairing this important hearing. 

Good morning, everyone. And welcome to our Nation’s Capitol. 

This is our 12th Children’s Congress and the first since the pandemic. It is wonderful to host you and your families at the Senate 

Appropriations Committee. And again, I want to especially thank 

our Chair for sharing the honor of chairing this Children’s Congress. 

As the founding Co-Chair of the Senate Diabetes Caucus, I have 

long promoted diabetes research as one of my top priorities. Your 

advocacy for the life-changing research to prevent, treat, and one 

day cure diabetes—type 1 diabetes—motivates me. 

I think of all the terrific children with type 1, whom I have met 

over the years. Many I have watched grow up. Children like Aidan 

Sweeney, whom I first met at age 4, and he turned 21 this year; 

Ruby Whitmore, a young teen who is my summer neighbor; Nicole 

Wiesendanger is a Maine teacher who has lived with diabetes for 

more than 35 years, and she is married to my nephew; and so 

many more including our Maine delegate who will be testifying 

shortly. You inspire me. You inspire all of us. 

More than 160 delegates have traveled to Washington from every 

State in the Union and five foreign countries. In fact, this morning, 

I met someone from the United Kingdom who is here as well. You 

are all here to share your personal stories with Members of Congress. You will tell us what it is like to live with type 1 diabetes, 

and why it is critical for Congress to fund the research necessary 

to discover better treatments, more effective technology, and one 

day, a cure. Your personal stories really matter. They motivate 

Senators and Representatives to get involved in the cause. 

And I want to tell you my personal story of how I got involved. 

One of the very first meetings I had as a brand-new Senator in 

1997 was with families who had children with type 1. I will never 

forget this 10-year-old boy looking up at me and saying, ‘‘Senator 
3 

Collins, I wish I could just take one day off from having diabetes— 

Christmas or my birthday.’’ And of course, he never can. And that 

is why I started the Bipartisan Senate Diabetes Caucus that very 

year. 

Since then, Federal funding for diabetes research has almost 

quadrupled. The Federal Government now invests more than $1.2 

billion for diabetes research each year. Funding, as the Chair mentioned, for the Special Diabetes Program in particular, has contributed to phenomenal discoveries, including several advances since 

we last convened. For example, research conducted by the SDPfunded TrialNet Program demonstrated for the first time that early 

preventive treatment with a drug targeting the immune system can 

delay the onset of clinical T1D for some at-risk individuals. The 

FDA (U.S. Food and Drug Administration) also approved the first 

cell therapy to treat individuals with type 1. SDP supported clinical 

trial data that contributed to that advancement. 

Technology has also advanced. I remember the very first Children’s Congress that I chaired. We did not have continuous glucose 

monitors back then, or artificial pancreas systems. People had big 

bulky pumps with them; they were checking their blood sugar; they 

were taking injections. We have come a long ways. 

Another important component of the Special Diabetes Program 

supports prevention and treatment services for American Indians 

and Alaska Natives who experience type 2 diabetes at nearly three 

times the national average. Without an extension, both programs 

are at risk of expiring at the end of this fiscal year. That is September 30th. 

So, we simply must pass legislation to reauthorize the SDP. It 

has strong bipartisan support. Sixty Senators signed a letter, that 

Senator Shaheen and I authored, to Senate leaders advocating for 

this program. So, please ask your Senators and your Representatives to support the extension of this vital program. 

And there is encouraging news. Just last month, the Senate 

Health Education Labor and Pensions Committee, on which the 

Chair and I both serve, overwhelmingly approved the SDP Reauthorization Act that I introduced with Senator Shaheen. Our bill 

would fund both components of the Special Diabetes Program 

through December 2025. And here is the good news. Our bill contains a $20 million annual increase per program, and that would 

be the first increase in 20 years. So let us get that done. 

Finally, let me touch on another pressing issue which the Chair 

mentioned. And that is insulin affordability. And I know that many 

of you will be educating Members about this today. 

As some of you have experienced firsthand, the cost of insulin 

has soared in recent years, and this life-saving treatment has become unaffordable for far too many individuals with diabetes. So, 

we need comprehensive legislation to reform the whole insulin market, and we need to put a monthly cap on the cost. And that is 

what legislation Senator Shaheen and I have introduced would do. 

Let me just close by saying, it is so inspiring to look out and see 

that wave of blue in town today. When I was coming in to work 

this morning, I met a whole group of you and it lifted my spirits 

immediately. It is inspiring. Your passion and advocacy, your hope 
4 

for a cure are contagious. Together, I am confident that we will 

continue our progress and achieve that goal. Thank you. 

And I now have a brief statement from the Co-Chair of the Diabetes Caucus, Jean Shaheen of New Hampshire. She has a constituent who is going to be testifying before us today. 

Here is what Senator Shaheen said. 

[The following statement was read by Vice Chair Collins for Senator Shaheen:] 

I welcome all the witnesses, and the more than 160 

advocates that have traveled to Washington, DC, to participate in today’s 12th Annual Children’s Congress. Your 

relentless efforts to find a cure for type 1, and for all those 

living with the disease including my granddaughter, are 

an inspiration. 

In particular, I want to welcome Elise Cataldo and her 

family, from New Hampshire, whom I had the pleasure of 

meeting in our state. Elise is among the very best. There 

is no better advocate for those living with type 1. 

I urge my colleagues to listen to each witness closely, 

truly hear their stories, and finally act on legislation to improve the lives of those living with type 1. That means increasing investments and research to find a cure, such as 

the Special Diabetes Program Reauthorization Act authored by Senator Collins and myself, but it also means 

passing legislation to comprehensively and permanently 

solve insulin affordability, namely our Bipartisan Insulin 

Act which Senator Collins and I authored. 

Vice Chair COLLINS. It is kind of weird to refer to myself in third 

person, but I am reading Senator Shaheen’s statement. 

[Laughter.] 

[The statement continues:] 

Until the day comes when we finally have a cure, no 

patient should be forced to risk their lives rationing their 

daily insulin. Thank you again for coming today to share 

your stories. I wish you a productive and memorable Children’s Congress, and hope to see you again in DC very 

soon. 

Vice Chair COLLINS. Thank you, Senator Shaheen, for that statement. 

Well, thank you all for being here. And if there are any of our 

Members who want to make a very brief statement before we 

turn—are we all set? All right, we will introduce our witnesses. 

Our first witness today is Dr. Griffin Rodgers, the Director of the 

National Institute of Diabetes and Digestive Kidney Diseases 

(NIDDK) at the National Institutes of Health. He is no stranger to 

our Committee. He is a familiar face to the Children’s Congress. He 

assumed his current position in 2007. He has testified before us at 

each and every Children’s Congress. And I admire him so much, 

and I am delighted to welcome him back. 

Next, we will hear from Dr. Aaron Kowalski, the President and 

CEO (Chief Executive Officer) of JDRF. He is the first person with 

type 1 diabetes to lead JDRF. We had the pleasure of having Dr. 
5 

Kowalski testify as part of the 2019 Children’s Congress, that was 

the last one we had before the pandemic, and I am delighted to 

welcome him back. Prior to his appointment as President, he 

served as JDRF’s Chief Mission Officer. That means he oversaw 

significant advances in diabetes research. 

Now, our next witness comes to us from a very different background, R&B (rhythm and blues) songwriting and music productions. I am pleased to welcome ‘‘Jimmy Jam’’ Harris to testify before our Committee. Jimmy Jam is an award-winning music producer who has been inducted into the Rock and Roll Hall of Fame. 

His son, Max, was diagnosed with type 1 diabetes at 2 years old. 

Jimmy Jam is here to advocate on behalf of Max, who is now a 

thriving young adult and is sitting right over there, and to inspire 

other kids and teens living with diabetes. 

And with due respect to those three wonderful witnesses, we are 

then going to hear from the stars of the show. We are going to hear 

from two delegates. First, Maria Muayad—I practiced all this. 

[Laughter.] 

Vice Chair COLLINS. Maria Muayad—there I did it—from Yarmouth, Maine. Maria is 10 years old and was diagnosed with type 

1 diabetes when she was 7. She is proud to be a type 1 diabetes 

advocate and has helped to increase awareness at her school. 

We will also then hear from Elise Cataldo from New Hampshire. 

Elise does not remember life without diabetes since she was diagnosed at just over a year old. But she has not let type 1 diabetes 

hold her back. She is an extremely active teenager. She is an extraordinary athlete playing soccer, basketball, and lacrosse. Outside of school and sports, Elise is passionate about educating those 

around her about life with T1D. 

Thank you all for joining us. And we will start with Dr. Rodgers. 

Thank you Dr. Rodgers. 

STATEMENT OF GRIFFIN P. RODGERS, MD, M.A.C.P., DIRECTOR, NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY 

DISEASES, NATIONAL INSTITUTES OF HEALTH 

Dr. RODGERS. Thank you so much. Chair Murray, Vice Chair Collins, Senator Shaheen, Members of the Committee, thank you for 

this invitation to testify, and for your support of type 1 diabetes research. Research supported through the Special Diabetes Program, 

or SDP, has ushered in a new era of type 1 diabetes management 

and continues to improve the lives of people living with this disease. 

I would like to recognize my fellow witnesses. All of you, everyone here today are true champions in advancing diabetes research. 

NIH’s clinical research studies would not be possible without the 

participation and support of people like you, and those you represent across this country. Thank you. 

This year we celebrate the SDP’s silver anniversary. For 25 

years, SDP-supported research has sought ways to prevent, treat, 

and cure type 1 diabetes and its complications. This enduring investment has enabled us to take on challenges beyond what we 

could support with NIH’s regular appropriations and to perform 

critical trials unlikely to be done by the private sector. 

There is much progress to report since I last testified here in person 4 years ago. In November of 2022, the FDA approved the first 
6 

early preventive treatment that can delay clinical diagnosis of type 

1 diabetes for at least 3 years. That is 3 years without having to 

take insulin or you check your blood glucose, 3 years toward preventing or delaying diabetes complications. 

Key research underlying this landmark approval stem from clinical trials conducted by SDP-supported type 1 diabetes TrialNet. 

That trial was made possible by decades of NIH- and SDP-supported research by TrialNet and others that built a paradigm shift 

in understanding of how type 1 diabetes progresses from normal 

glucose levels to clinical disease. 

That knowledge also helped identify potential therapies and 

made prevention trials possible. TrialNet continues to test new prevention approaches with trials ongoing and others ready to launch. 

There has also been significant progress on ways to ease the burden of daily glucose management. 

When I first testified about type 1 diabetes 16 years ago, the goal 

was clear: Get an artificial pancreas device into the hands of those 

who need it. Now, we have six artificial pancreas devices on the 

market. Five of these had SDP support, and two of those devices 

the SDP supported both the development and clinical trials underscoring the value of long-term research support. Importantly, some 

of these devices are approved for children as young as 2, which can 

be life-changing for them and for their families. Looking into the 

future, NIDDK is supporting the development of the next generation of artificial pancreas devices, including fully automated systems. Toward this goal of a bionic pancreas which requires minimal 

user input and can automate insulin doses, one was just approved 

just this May. Another research focus is ensuring that new devices 

benefit all including groups that are understudied by industry. 

Finally, we continue to search for a biological cure for type 1 diabetes, a high priority for people with the disease and their families. 

This includes research to understanding how insulin producing 

beta cells are lost, and how they can be protected and replaced. Scientists are gaining new insights into how beta cell develop, finding 

ways to make replacements in the lab. And they are also devising 

ways to protect lab-grown cells from the body’s immune attack. 

You might be interested to know that SDP-funded research also 

provides benefits beyond type 1 diabetes. Blood glucose management technologies benefit those with type 2 diabetes, as does research on complications that affects organs, like the heart and the 

eyes. These broad benefits will expand as cutting-edge technology< 

such as artificial intelligence and machine learning, are applied to 

the big data that is being generated by SDP-supported studies. 

On the silver anniversary of the SDP, we celebrate the incredible 

progress made possible by this program and recognize the SDP 

value as a long-term investment in health. But we must continue 

to build on our remarkable progress. We look forward to achieving 

our ultimate goal: Preventing and curing type 1 diabetes. 

Thank you. And I will be pleased to answer questions when time 

is available. Thank you. 

[Applause.] 

[The statement follows:] 
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1https://pubmed.ncbi.nlm.nih.gov/36868256 

PREPARED STATEMENT OF GRIFFIN P. RODGERS, M.D., M.A.C.P. 

Chair Murray, Vice Chair Collins, and Members of the Committee, as Director of 

the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), I 

thank you for your invitation to testify at this hearing on type 1 diabetes. On behalf 

of NIDDK and the other Institutes and Centers of the National Institutes of Health 

(NIH) within the U.S. Department of Health and Human Services (HHS), I am honored to be here today to update you on recent scientific advances and future research opportunities in type 1 diabetes and its complications, including research 

supported by the Special Statutory Funding Program for Type 1 Diabetes Research 

(Special Diabetes Program). 

Diabetes takes an enormous personal and economic toll on our country, but we 

are making great strides in reducing that burden through the support of biomedical 

research. NIH invests over $1 billion a year in diabetes research, and NIDDK supports the majority of that research, including studies on both prevention and treatment of type 1 diabetes, type 2 diabetes, gestational diabetes, and diabetes complications. This NIH investment includes funding from the Special Diabetes Program, which has enabled the agency to expand type 1 diabetes research beyond 

what is possible with our regular appropriations and to conduct clinical trials that 

were unlikely to have been performed in the private sector. NIH’s efforts also have 

been complemented by our research partners—academic institutions; the U.S. Food 

and Drug Administration (FDA); the Centers for Disease Control and Prevention 

(CDC); and charitable, professional, and patient advocacy groups such as JDRF, the 

Endocrine Society, the American Diabetes Association (ADA), and the Leona M. and 

Harry B. Helmsley Charitable Trust. 

The important progress I will discuss today has only been possible through the 

invaluable support of Congress, the hard work of our researchers, and the dedication of our clinical study participants. Together, we are all working toward the goal 

of helping those with type 1 diabetes live longer, healthier lives. 

IMPROVING THE LIVES OF PEOPLE WITH TYPE 1 DIABETES

Type 1 diabetes can arise at any age, but it often begins in childhood or adolescence. It is an autoimmune disease, where the immune system attacks and destroys 

the insulin-producing beta cells in clusters called islets in the pancreas. Since their 

pancreas cannot make enough insulin, people with type 1 diabetes (or their caregivers) must monitor their blood glucose (sugar) levels, administering insulin as 

needed depending on their food intake, physical activity levels, and other factors. 

This is an enormous and relentless burden, and despite constant vigilance, keeping 

blood glucose levels in a healthy range day in and day out is a challenge. NIDDKsupported studies have shown that early, intensive management of blood glucose 

levels can prevent or delay the development of devastating complications such as 

eye, kidney, nerve, and heart disease. Therefore, it is imperative that we continue 

to develop effective ways to prevent and treat type 1 diabetes, and that we search 

for a cure. 

Furthermore, the SEARCH for Diabetes in Youth study, supported by CDC and 

NIDDK, has reported that type 1 diabetes incidence is increasing in youth under 

age 20 in the United States. Also, the rates of increase were higher among racial 

and ethnic minority groups, such as non-Hispanic Black and Hispanic youth.1 These 

findings underscore a major goal in NIDDK’s management of the Special Diabetes 

Program: to identify ways to overcome barriers to using new treatments and technologies. New research advances should benefit all people with type 1 diabetes, regardless of where they live, their socioeconomic status, their age, their race or ethnicity, or their medical status. Yet individuals from backgrounds traditionally 

underrepresented in research can also have more difficulty managing blood glucose 

levels and can have worse health outcomes and more complications. People with a 

history of high blood glucose levels or with frequent episodes of hypoglycemia (low 

blood glucose) also can be ineligible to participate in some clinical research studies, 

leaving open questions about whether a new approach will work for people with 

complex, ‘‘real-world’’ experiences and needs. 

NIH is pursuing a multi-pronged approach to type 1 diabetes research, focusing 

on key questions such as: how can we prevent this disease, how can we improve 

treatment, and how can we develop a cure? As the Special Diabetes Program celebrates its 25th anniversary this year, I am happy to report that Congress’ investment in the Program has led to life-changing improvements for people with the disease. When I testified at the 2015 Children’s Congress, there were no artificial pan-
8 

2https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-can-delayonset-type-1-diabetes 3https://pubmed.ncbi.nlm.nih.gov/31180194, https://pubmed.ncbi.nlm.nih.gov/33658358 

4https://pubmed.ncbi.nlm.nih.gov/35241690 

creas devices on the market. Today, there are six, with still more under FDA review. 

Some of these devices are now available to children as young as 2 years old, which 

is a tremendous advance given that it can be difficult to manage blood glucose levels 

in young children. As of the last Children’s Congress in 2019, there were no therapies on the market to slow type 1 diabetes progression. Now, we have an FDA-approved medication that delays clinical diagnosis of type 1 diabetes. These are only 

two examples of how the Special Diabetes Program has helped improve the lives of 

those with type 1 diabetes. There is much more progress to report, and a lot of work 

still to be done. 

PREVENTING TYPE 1 DIABETES INITIATION AND PROGRESSION

Preventing type 1 diabetes has been a long-standing goal of NIH-funded research. 

I am pleased to report that long-term research supported by the NIH and the Special Diabetes Program recently culminated in the FDA approval of the first early, 

preventive treatment that can delay clinical diagnosis of type 1 diabetes. In November 2022, FDA approved the use of the immune-modulating drug teplizumab to 

delay progression of type 1 diabetes in those 8 years and older who are at high risk 

of developing the disease.2

Key research underlying this FDA approval stemmed from a clinical trial conducted by the NIDDK—and Special Diabetes Program—supported Type 1 Diabetes 

TrialNet, which is a large, collaborative, international consortium designed to perform clinical trials of therapies to delay or prevent type 1 diabetes progression. The 

clinical trial found that teplizumab delayed type 1 diabetes onset by over 32 

months.3 This important finding has ushered in a new era of type 1 diabetes clinical 

management, allowing nearly 3 years without having to take insulin and nearly 3 

years toward preventing or delaying complications. The landmark FDA approval of 

teplizumab based on these clinical trial results underscores the importance of 

TrialNet, which continues to be a unique and critical network for testing novel type 

1 diabetes preventive therapies. 

This clinical trial was made possible by decades of NIH—and Special Diabetes 

Program—supported research on teplizumab, and by other research to understand 

how type 1 diabetes progresses and to identify potential therapeutic targets and 

agents. For example, it built on research conducted by the Immune Tolerance Network, led by the National Institute of Allergy and Infectious Diseases (NIAID) with 

Special Diabetes Program support, showing that teplizumab delayed the loss of insulin production in people with newly diagnosed type 1 diabetes. Additionally, for 

many years, NIDDK has invested in research looking for ways to reliably identify 

those at risk for type 1 diabetes. Data from TrialNet and a long-term clinical research study called The Environmental Determinants of Diabetes in the Young 

(TEDDY) have been critical to understanding and identifying markers of the early 

stages of type 1 diabetes. Thanks to these studies and others, we now know that 

there are distinct stages of type 1 diabetes, several of which happen before symptoms appear. Being able to identify those in these early stages of type 1 diabetes 

before their disease progresses to clinical diagnosis has enabled testing of type 1 diabetes prevention therapies, such as teplizumab. To this end, TrialNet has screened 

over 200,000 people, identifying those at risk of type 1 diabetes who are eligible to 

enroll in clinical trials testing ways to prevent disease onset or slow its progression. 

TrialNet is now testing multiple agents, as well as combination therapies, in those 

at high risk of type 1 diabetes and in the newly diagnosed, with new trials ready 

to launch. Researchers outside TrialNet are also testing another promising treatment: the blood pressure medication verapamil. A small clinical trial supported by 

the Special Diabetes Program has found that in people newly diagnosed with type 

1 diabetes, taking oral verapamil can delay disease progression and lower insulin 

requirements for at least 2 years.4 Due to these and other advances, I am happy 

to report that the long-term goal of preventing type 1 diabetes is now closer than 

ever, thanks to decades of dedicated work from scientists and clinical trial participants. 

UNDERSTANDING THE CAUSES OF TYPE 1 DIABETES

Understanding the causes of type 1 diabetes could also help identify and advance 

new prevention strategies. We know that a person’s risk for developing type 1 diabetes is dependent on both genetic and environmental factors. We now know over 90 
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5https://pubmed.ncbi.nlm.nih.gov/34127860 

6https://pubmed.ncbi.nlm.nih.gov/30356183, https://pubmed.ncbi.nlm.nih.gov/30356187 

7https://pubmed.ncbi.nlm.nih.gov/34291312 

8https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-interoperableautomated-insulin-dosing-controller-designed-allow-more-choices 9https://pubmed.ncbi.nlm.nih.gov/36920756 

percent of the genetic contributions to type 1 diabetes risk in those of European ancestry, who have the highest prevalence of the disease. We also continue to expand 

our knowledge of type 1 diabetes in those with other backgrounds, and a recent 

large, ancestrally diverse study identified 36 new gene regions associated with type 

1 diabetes, offering potential new drug targets to treat or prevent disease.5

But genetics is only part of the story, and a person’s environment and environmental exposures also play a role in their risk of developing type 1 diabetes. Identifying these environmental influences will give us a better understanding of the disease and may point to new prevention strategies. 

To identify these environmental components of type 1 diabetes risk, NIDDK, 

through the Special Diabetes Program, supports an ambitious, long-term clinical research study called TEDDY. TEDDY has screened over 425,000 newborns, enrolling 

8,000 who were at high genetic risk of type 1 diabetes. These children are being 

followed until they are 15 years old, and they and their families have donated over 

4 million biological study samples to date. The youngest TEDDY participant will 

turn 15 in 2025, at which point final data analyses can begin. In the meantime, the 

TEDDY study is generating insights made possible by analysis of the ‘‘big data’’ collected by such a large study. TEDDY researchers are looking at genes, proteins, and 

metabolites and are also studying the children’s microbiomes, viromes, and environmental exposures to understand how these evolve during childhood and how they 

might influence disease. Analyses of these factors have yielded new insights into 

how the microbes in a child’s gut change as they age, and how those changes are 

affected by breastfeeding.6 Various TEDDY findings have also allowed researchers 

to construct a risk score tool that uses both genetic and immune factors to predict 

an individual’s risk of type 1 diabetes. Finally, new research is also illustrating how 

type 1 diabetes is not a single disease but a ‘‘heterogeneous’’ one that does not 

progress the same for every person. For example, type 1 diabetes diagnosed before 

6 years of age is more aggressive than that diagnosed in older children, and these 

two different courses of disease are associated with specific autoimmune reactions.7

These important findings could lead to more personalized preventive strategies in 

the future as we move toward the goal of precision medicine. 

DEVELOPING APPROACHES TO IMPROVE GLUCOSE MANAGEMENT AND QUALITY OF LIFE

For people already diagnosed with type 1 diabetes, keeping blood glucose levels 

within a healthy range is a key step to maintaining good health. NIDDK-supported 

research has demonstrated that intensely managing blood glucose levels, beginning 

as soon as possible after a type 1 diabetes diagnosis, can prevent or delay the development of long-term complications of the eyes, kidneys, nerves, heart, and other organs. However, intensive management also brings with it the risk of potentially 

dangerous and distressing episodes of hypoglycemia. New tools and approaches to 

glucose management—and ways to ensure that these new technologies meet peoples’ 

real-world requirements—are critically needed. 

The Special Diabetes Program has supported pivotal research in this area by contributing to the development of glucose management technologies, including artificial pancreas systems that automate insulin delivery in response to blood glucose 

levels. This support has successfully moved devices out of the lab and into peoples’ 

daily lives. In the last 8 years, the number of commercially available, FDA-approved 

artificial pancreas devices has increased from zero to six, offering people with type 

1 diabetes more tools to manage their health. 

I am pleased to report that NIDDK and Special Diabetes Program-supported research contributed to the development or testing of five of the six commercial devices, demonstrating the impact that research has had on improving the health and 

quality of life of people with type 1 diabetes. For example, the Special Diabetes Program supported development of the technology underlying the Control-IQ hybrid artificial pancreas system, and then later supported clinical trials demonstrating the 

system’s effectiveness at managing blood glucose levels in both children and adults. 

This research helped support FDA approval of Control-IQ technology for people with 

type 1 diabetes who are 6 years old and older.8 Further Special Diabetes Programsupported research has since tested the safety and efficacy of this device in children 

as young as 2 years old.9
10 

10https://pubmed.ncbi.nlm.nih.gov/36170500 11https://pubmed.ncbi.nlm.nih.gov/37000680 12https://xerispharma.gcs-web.com/news-releases/news-release-details/xeris-pharmaceuticalsreceives-us-fda-approval-gvoketm-glucagon 

We are also looking ahead to developing the next generation of artificial pancreas 

systems. As mentioned earlier, the Special Diabetes Program plays a unique role in 

expanding our knowledge of how new glucose management technologies can benefit 

all with type 1 diabetes, with the goal of having multiple artificial pancreas technologies available to fit people’s individual needs. An example of this is studying the 

use of these devices during pregnancy or in populations where managing blood glucose levels is particularly challenging, such as very young children and people with 

high hemoglobin A1c (HbA1c) levels (a measure of average blood glucose levels). 

A recent Special Diabetes Program-supported clinical trial is a successful example 

of the benefits of studying advanced artificial pancreas devices in groups that are 

representative of the type 1 diabetes community. This trial demonstrated that the 

iLet bionic pancreas device—which requires minimal user input and handles dosing 

decisions autonomously—improved blood glucose management for a diverse group of 

children and adults, keeping their blood glucose levels in a healthy range better 

than standard care.10 This trial specifically sought to recruit volunteers from a variety of backgrounds, including people with lower income and education levels, those 

from previously underrepresented racial and ethnic groups, and people with high 

HbA1c levels that put them at increased risk for developing long-term complications. As a result, this trial found that people from all backgrounds benefitted from 

use of the bionic pancreas, including those who had never used an artificial pancreas device previously. Additionally, those who had more difficulty managing blood 

glucose levels at the study’s start appeared to benefit most from using the bionic 

pancreas, reducing racial and ethnic disparities in average HbA1c levels.11

Of note, the artificial pancreas research community is a prime example of the 

power of teamwork, and we look forward to continued collaboration with our partners who have advanced this field. Just this past May, NIH hosted the 5th Artificial 

Pancreas Workshop organized collaboratively with the Diabetes Technology Society, 

the Helmsley Charitable Trust, JDRF, and FDA to discuss the current and potential 

future challenges in this field. 

NIDDK also continues to support academic and small business investigators at all 

stages to build upon past successes and advance research into innovative blood glucose management tools, including artificial pancreas systems. This includes supporting development of new technologies such as sensors, pumps, and algorithms; 

clinical trials to test safety and efficacy; and research into behavioral, psychosocial, 

and other ‘‘human’’ factors that affect peoples’ ability to use these new technologies. 

One example of the positive impact this support has had on people’s lives is the Special Diabetes Program-supported development of an improved glucagon formulation 

that does not require refrigeration. This research resulted in a ready-to-use rescue 

pen that is now commercially available to treat low blood glucose, a daily concern 

for people with type 1 diabetes.12

RESTORING BETA CELL FUNCTION

Technologies for managing type 1 diabetes are important tools for alleviating the 

burden of this disease, but they are not a cure. Finding a biological cure for type 

1 diabetes—a way to restore the body’s ability to produce insulin and regulate blood 

glucose levels—is another major, long-term goal of NIDDK- and Special Diabetes 

Program-funded research. One approach to a cure is the development of islet transplantation strategies. The Clinical Islet Transplantation Consortium—co-led by 

NIDDK and NIAID—demonstrated that transplantation of islets into a person with 

type 1 diabetes can eliminate severe hypoglycemic events, with some participants 

achieving near-normal average blood sugar levels and an improved quality of life. 

Though we are excited about this progress, we also recognize that, because of current limitations, including the need for lifelong immunosuppressive drugs and the 

low availability of donated islets, islet transplantation would only be suitable for a 

small number of people with type 1 diabetes. Therefore, it remains critically important to pursue research toward developing cell replacement strategies that could 

benefit more people. 

Advances in islet transplantation have also informed other studies of beta cell 

function. NIDDK’s Human Islet Research Network (HIRN) is a large, multidisciplinary group of consortia with the goal of understanding how beta cells are lost in 

type 1 diabetes and how they can be protected or replaced in people. HIRN investigations into how beta cells develop and mature are expanding our understanding 
11 

13https://pubmed.ncbi.nlm.nih.gov/37106062 14https://pubmed.ncbi.nlm.nih.gov/36749332 

of how to make new beta cells. For example, HIRN researchers recently found that 

cells from a person’s stomach can be coaxed in the lab to form pancreatic islet-like 

mini-organs or ‘‘organoids’’ that secrete insulin and can manage blood glucose levels 

in mice.13

Information on beta cell biology is also fueling the study of beta cell replacement 

strategies. Special Diabetes Program-supported researchers are working on approaches to develop bioartificial cell replacement technologies such as building 

multicomponent ‘‘designer islets’’ in the lab. Other researchers are developing improved techniques and technologies needed to place and maintain these beta cell replacements in the body. For example, Special Diabetes Program funding has supported work on improved islet transplantation procedures and has provided key support for developing the specialized encapsulation technologies needed to protect the 

transplanted cells from immune attack. Early investment in the development of 

these technologies through grants to academic labs and small businesses is providing the technical know-how required for future advances. 

PREVENTING AND TREATING DIABETIC COMPLICATIONS

People with type 1 diabetes are living longer than ever thanks to new therapies, 

devices, and other improvements in treatment. Therefore, it is critically important 

to find ways to prevent and treat the diabetes complications that can arise throughout the lifespan. To this end, NIDDK is collaborating with other NIH Institutes to 

study these potentially life-threatening complications, including through research 

supported by the Special Diabetes Program. 

Cardiovascular disease (CVD) is a leading cause of death for people with type 1 

diabetes, and CVD risk remains increased even with standard-of-care measures to 

treat underlying risk factors. However, many questions remain about how CVD may 

be different (or may be prevented) in people with type 1 diabetes compared to those 

without diabetes or with type 2 diabetes. NIDDK and the National Heart, Lung, and 

Blood Institute (NHLBI) have teamed up to investigate these questions by forming 

the Cardiovascular Biorepository for Type 1 Diabetes (CaRe-T1D). The CaRe-T1D 

biorepository is collecting donated tissues from human donors with and without type 

1 or type 2 diabetes. This repository of biological samples will be a critical resource 

for future research into how type 1 diabetes and CVD interact, and how type 1 and 

type 2 diabetes affect the heart differently. Such studies could lead to potential insights into new therapeutic targets and care strategies. 

Another major research opportunity is to investigate drugs already protecting the 

cardiovascular health of people with type 2 diabetes. For example, sodium-glucose 

cotransporter-2 (SGLT2) inhibitor medications, which are approved to help manage 

blood glucose levels in type 2 diabetes, have heart-protective effects and may also 

protect against kidney disease. Determining if these treatments are safe and effective for people with type 1 diabetes could provide a much-needed tool for preventing 

multiple important complications. 

Another debilitating and often-feared diabetes complication is blindness. For two 

decades, research from the National Eye Institute’s DRCR Retina Network, with 

Special Diabetes Program support, has been changing how diabetic eye disease is 

treated. Network studies—including studies comparing different drugs, which were 

unlikely to be performed by industry—have transformed clinical practice guidelines 

for diabetic eye care. Recently, DRCR Retina Network investigators continued to 

help guide management of diabetic eye disease by showing that early treatment of 

diabetic-related eye disease slowed progression to more serious disease but did not 

improve visual acuity compared with treating more severe disease once it developed.14 This result indicates that monitoring patients with diabetic retinopathy and 

treating eyes only as needed is the best approach. 

We are also supporting research to study a potentially serious complication called 

impaired awareness of hypoglycemia. Repeated episodes of severe hypoglycemia can 

diminish a person’s ability to recognize these episodes, leaving them unaware that 

they need assistance and increasing the risk of injury or even death. Impaired 

awareness of hypoglycemia also can make someone ineligible to participate in a type 

1 diabetes clinical trial, leaving this serious condition understudied. A new international research consortium is seeking to shed light on this condition, with the 

goals of identifying the factors that can lead to life-threatening hypoglycemic events 

and developing strategies to mitigate these factors and improve quality of life. 

Additionally, NIDDK is supporting important efforts to improve care for another 

serious and understudied complication of type 1 diabetes: diabetic foot ulcers. Foot 
12 

15https://pubmed.ncbi.nlm.nih.gov/32938916 

ulcers that become infected or do not heal can lead to amputations, but little is 

known about why some ulcers heal while others do not, and few treatments are 

available. NIDDK’s Diabetic Foot Consortium is the first consortium of its kind and 

is laying the foundation for a clinical trials network to test new strategies to improve diabetic wound healing and prevent amputations. Among other successes, 

Consortium scientists have gained new insights into factors that impair wound healing by comparing wound healing response in diabetes foot ulcers and normal skin.15

This Consortium, with Special Diabetes Program support, plans to accelerate advances in foot ulcer clinical care, including using machine learning techniques on 

the Consortium’s gathered data to identify wound characteristics that predict successful healing. 

EMERGING OPPORTUNITIES IN TYPE 1 DIABETES RESEARCH

The scientific achievements that I described today are just a few examples of recent progress in understanding and combatting type 1 diabetes and its complications. The investments we have made in infrastructure, technology, bold ideas, research talent, and enduring collaborations are bearing fruit, improving the lives of 

people with type 1 diabetes and others. Blood glucose monitoring and management 

technologies are also benefitting those with type 2 diabetes, and insights into the 

immune system’s role in type 1 diabetes can shed light on other autoimmune diseases. Likewise, the study of type 1 diabetes complications can also inform research 

into other diseases and conditions of the heart, eyes, kidneys, skin, and other organs. In these ways, type 1 diabetes research, including that supported by the Special Diabetes Program, continues to reap broad benefits. 

As we celebrate our successes, we recognize that there is still much critical work 

to be done. Our efforts were significantly strengthened by the renewal of the Special 

Diabetes Program through the end of Fiscal Year 2023, which enabled NIH to continue many of these successful, long-running programs. Sustained long-term funding 

of the Program has allowed NIH to launch new clinical trials and support novel research areas, capitalizing on emerging opportunities in type 1 diabetes. Maximizing 

the value of the Special Diabetes Program and responsibly administering its funds 

is one of NIDDK’s highest priorities. 

As mentioned throughout this testimony, further research will help us maintain 

the momentum we have built. Tomorrow’s research advances are already on the horizon as we continue to build upon past successes and advance into emerging areas 

of interest. ‘‘Big data’’ analysis of large datasets such as those amassed by TEDDY 

and the DRCR Retina Network are unlocking even more insights from these longstanding efforts, and cutting-edge machine learning, artificial intelligence, ‘‘omics’’ 

technologies, and other emerging methods offer new opportunities to inform clinical 

care approaches. These technologies also underscore the importance of NIDDK’s 

long-standing commitment to making biosamples and data from completed studies 

available to the broad scientific community. Data sharing is critically important for 

maximizing the return on our research investments, and the NIDDK Central Repository continues to share resources from completed studies with the scientific research community. 

Significant opportunities also exist to identify existing barriers to good health and 

ways to overcome them. The Special Diabetes Program is supporting multiple approaches toward this end. One such effort is searching for ways to improve technology adoption, for instance by identifying behavioral factors that contribute to successful artificial pancreas usage. Other researchers are investigating the use of social and medical care interventions to improve diabetes outcomes by addressing social barriers to good diabetes management. People with type 1 diabetes are also disproportionately affected by mental health issues, which can affect their diabetes outcomes. To help understand this possible barrier to diabetes care, research is ongoing 

on how to treat the ‘‘diabetes distress’’ that can result from the demands of living 

with type 1 diabetes. There is also growing evidence of neurocognitive complications 

of type 1 diabetes, and NIDDK-supported studies are seeking to better understand 

the neurocognitive impact of type 1 diabetes in children and adults. 

It is imperative that we foster a talented, diverse biomedical workforce to conduct 

tomorrow’s cutting-edge research into type 1 diabetes and its complications. The 

NIDDK Diabetes-Docs program strives to bolster the pipeline of pediatric 

endocrinologists and other physicians committed to careers in diabetes research. Additionally, the New Investigator Gateway Awards in Type 1 Diabetes Research will 

support innovative projects by promising new investigators by embedding them in 

the rich intellectual environment of existing large NIDDK collaborative research 
13 

programs. These and other training and career development efforts—as well as consistent funding for type 1 diabetes research—will help recruit and support the next 

generation of type 1 diabetes researchers. 

Looking forward, NIDDK solicited input from scientific and lay experts about future research directions in type 1 diabetes and its complications at a workshop held 

in March 2022 under the auspices of the statutorily required Diabetes Mellitus 

Interagency Coordinating Committee. Numerous opportunities were identified at 

that meeting to build upon the significant progress to date. NIDDK’s support of type 

1 diabetes research will also continue to be guided by strategic planning efforts and 

input from scientific conferences and workshops. These varied streams of input will 

continue to ensure that NIDDK-supported type 1 diabetes research benefits people 

of all ages and backgrounds who are living with or at risk for type 1 diabetes. 

CONCLUDING REMARKS

I appreciate this opportunity to share these exciting scientific advances, ongoing 

efforts, and emerging opportunities in type 1 diabetes research. We are extremely 

grateful for the continued support of Congress that has allowed NIH to vigorously 

support research to combat type 1 diabetes and its complications. We are also grateful for the extension and increase in Special Diabetes Program funding requested 

in the Fiscal Year 2024 President’s Budget, which would extend the Program 

through Fiscal Year 2026. We look forward to continuing our strong partnerships 

with patient advocacy groups, professional organizations, research institutions, and 

our sister Federal agencies. We also thank our dedicated clinical study participants, 

without whom the clinical research I described today would not be possible. The 

Special Diabetes Program has catalyzed remarkable progress in type 1 diabetes research and has ushered in a new era where individuals with type 1 diabetes have 

significantly improved health, longevity, and, importantly, quality of life. We have 

shown for the first time that type 1 diabetes can be delayed, and NIH remains 

steadfast in our goals of preventing, treating, and ultimately curing type 1 diabetes. 

With continued research, we hope to move even closer to the day that all people can 

be free from the burden of type 1 diabetes and its complications. 

Thank you, Chair Murray, Vice Chair Collins, and Members of the Committee. 

I will be pleased to answer any questions you have. 

Vice Chair COLLINS. Thank you very much. 

Dr. Kowalski. 

STATEMENT OF AARON J. KOWALSKI, Ph.D., CHIEF EXECUTIVE OFFICER, JDRF 

Dr. KOWALSKI. Chair Murray, Vice Chair Collins, Senator Shaheen, and Members of the Committee, thank you for welcoming all 

of our amazing 2023 Children’s Congress delegates, their guardians, and our special guests. Also, thank you for allowing me to testify before you today. I am honored to be here and be joined by Dr. 

Rodgers, and three of our incredible JDRF Advocates, to highlight 

the important progress advanced by the Special Diabetes Program, 

or SDP, and our hopes for the future. 

I am Dr. Aaron Kowalski, chief executive officer for JDRF. I am 

a trained scientist, and I have been fortunate to work for JDRF for 

the past 19 years, 4 of which in my current role. 

Like every delegate here and far too many people across the 

world, my family and I are impacted by type 1. My family’s experience dates to 1977 when my brother, Steve, out of the blue, was 

diagnosed at just the age of 3. And then I was diagnosed a few 

years later when I was 13. 

Grappling day to day with T1D was difficult—very, very difficult 

then—and still impacts every aspect of our lives today. But we 

have good news to share. Because of your steadfast leadership, 

Senators Collins and Shaheen, and the strong bipartisan support 

in Congress, the Special Diabetes Program has fundamentally 

changed what it means to live with type 1 diabetes. It has put new 
14 

life-changing therapies in our hands and brought us closer to cures. 

The SDP sister program, the Special Diabetes Program for Indians, 

is yielding similar significant results. We must keep this momentum going so we can capitalize on the progress to date and ultimately realize cures. 

Since our last Children’s Congress in 2019, we now have on the 

market a therapy, as Dr. Rodgers pointed out, that can delay the 

onset of type 1 for up to 3 years. 

In June, the FDA approved the first cell therapy for adults with 

T1D, who are unable to maintain their blood glucose levels due to 

severe hypoglycemia problems. This therapy allows some patients 

to live without external insulin for several years. The SDP-supported Clinical Islet Transplantation Consortium played a major 

role in this pivotal step forward to identifying cures. 

Now, most delegates as you see here in the pit, are wearing AP 

(artificial pancreas) systems now, which is an amazing thing for me 

to see. And the SDP funded the trials that led to the approvals of 

the systems that I use, many of the kids here use, and people 

around the country are using, making diabetes much more manageable, and I cannot wait to see what is coming next. Continued 

SDP support would enable several long-term T1D-oriented research 

programs and clinical trial networks to continue their important 

work. Plus, it will enable researchers to explore new opportunities. 

For example, SGLT2 (sodium-glucose co-transporter-2) inhibitors 

are not yet approved for people with type 1. We need to develop 

strategies to ensure these drugs can be safely used by people with 

type 1 which could reduce the costly and devastating impacts of 

heart and kidney disease. 

The SDP is, indeed, improving and saving lives and creating 

hope for those living with this disease. Our future is bright. 

Senators Collins and Shaheen, we are tremendously grateful for 

your leadership. And Committee Members, we are greatly appreciative of your support. I know many of you are among the 60 Senators who signed a letter, led by Senator Shaheen and Collins, recognizing the importance of the SDP and its renewal. Thank you. 

I urge you also to all vote in favor of S. 1855 which would extend 

SDP funding through December 2025. The program expires this 

September, so please act swiftly. JDRF is doing its part having invested over $2.5 billion in research to date. 

I must also mention, until we have cures, people with diabetes 

need access to affordable insulin. We are making progress but we 

must do more. JDRF urges Congress to pass the Bipartisan Insulin 

Act of 2023 which will establish a $35-per-month cap, copay cap, 

for people with commercial insurance, and includes other provisions that would make insulin more affordable for everyone irregardless of their insurance status. We need your continued support. 

Thank you, again, for allowing me to testify. And I am happy to 

answer any questions. 

[Applause.] 

[The statement follows:] 

PREPARED STATEMENT OF AARON J. KOWALSKI, PH.D. 

Chair Murray, Vice Chair Collins, Senator Shaheen, and Members of the Committee, thank you for welcoming all our amazing JDRF 2023 Children’s Congress 
15 

1 Centers for Disease Control and Prevention. National Diabetes Statistics Report website. 

https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed July 6, 2023. 2 American Diabetes Association. Economic costs of diabetes in the US in 2017. Diabetes Care. 

2018 May;41(5):917–928. 3 American Diabetes Association. Economic costs of diabetes in the US in 2017. Diabetes Care. 

2018 May;41(5):917–928. 

Delegates, their guardians, and our special guests. Also, thank you for allowing me 

to testify before you today. I am honored to be here and to be joined by Dr. Rodgers 

and three of our amazing JDRF advocates to highlight the important progress advanced by the Special Diabetes Program and our hope for the future. 

I am Dr. Aaron J. Kowalski, Chief Executive Officer for JDRF, the leading global 

organization harnessing the power of research, advocacy, and community engagement to advance life-changing breakthroughs for type 1 diabetes, or T1D. A scientist 

by training, I have been fortunate to work for JDRF and on behalf of countless individuals and families impacted by T1D for the past 19 years, four of which in my 

current role. 

Like every delegate in this room and far too many people across the world, my 

family and I are impacted by T1D. My family’s experience dates to 1977 when, out 

of the blue, my younger brother, Stephen, was diagnosed at the age of 3. My own 

T1D diagnosis followed when I was 13. 

Grappling day-to-day with T1D was difficult then and it still impacts every aspect 

of life today. But we have good news to share. 

Because of your steadfast leadership, Senators Collins and Shaheen, and the 

strong bipartisan support in Congress, the Special Diabetes Program, or SDP, has 

fundamentally changed what it means to live with diabetes, put new life-changing 

therapies in our hands, and brought us closer to cures. The SDP’s sister program, 

the Special Diabetes Program for Indians (SDPI), is yielding similar significant and 

impactful results. We must keep this momentum going so we can capitalize on the 

progress to date and realize cures. 

DIABETES—A COSTLY AND BURDENSOME DISEASE

First, let me start by sharing a bit about type 1 diabetes. T1D is an autoimmune 

disease in which a person’s pancreas stops producing insulin, a hormone that enables a person to utilize energy from food. T1D lasts a lifetime, and people with T1D 

must take insulin to live. Type 2 diabetes, also known as T2D, is a metabolic disease. With T2D, the body still produces insulin but cannot use it effectively. While 

T1D and T2D are different, the costly and burdensome complications are the same. 

Today, more than 37 million Americans have diabetes and 96 million have 

prediabetes 1. The disease affects people of all ages and races across the country. 

The complications that result from diabetes are significant—ranging from heart disease and strokes to lower-limb amputations. 

Due to the disease’s breadth and impact, about one in four healthcare dollars and 

one in three Medicare dollars are spent treating people with diabetes. The total cost 

of diagnosed diabetes in the United States in 2017 was a staggering $327 billion, 

with $237 billion spent on direct medical costs and another $90 billion on reduced 

productivity 2. Another astounding fact is that the economic costs of diabetes, adjusted for inflation, increased by 26 percent from 2012 to 2017 3. As more people develop diabetes, these costs will be even more significant. 

Fortunately, Congress had the foresight to address the growing magnitude of the 

challenge years ago. With bipartisan support, the SDP and SDPI were created as 

part of the Balanced Budget Act of 1997 and have been strongly supported by both 

chambers of Congress and both parties ever since. 

JDRF PARTNERING WITH THE FEDERAL GOVERNMENT

Before I share some of the exciting breakthroughs resulting from the SDP, I want 

Congress to know that JDRF’s private funding works hand in hand with SDP funding to ensure that the most important and promising research projects have the 

support they need. JDRF accelerates the path to cures by raising funds and allocating them to T1D research and therapy development, as well as by leveraging our 

expertise and leadership to bring in additional funding and supporters. 

I am proud to say that JDRF has invested more than $2.5 billion in research 

funding since our founding in 1970. And through direct research investments and 

partnerships within the public and private sectors, including through the SDP, we 

helped raise $483 million for T1D research and therapy development in FY21. This 

partnership between the public and private sectors is what it takes to deliver major 

advances for T1D research. 
16 

4Winn, A, Skandari, R, O’Grady, M, and Huang, E. ‘‘Potential Medicare Savings of Delaying 

Type 1 Diabetes Onset,’’ May 2023. Unpublished white paper. 

SPECIAL DIABETES PROGRAM ACCELERATING BREAKTHROUGHS

Since we held our last Children’s Congress in 2019, there has been remarkable 

progress that gives us even more hope for a brighter future. These are just a few 

of the many advancements that are exciting to the T1D community where the SDP 

played a role. 

First Disease-Modifying Therapy Brought to Market 

The SDP enabled the creation of TrialNet, the largest clinical network for T1D. 

TrialNet conducted the clinical trials that led to the November 22 U.S. Food and 

Drug Administration (FDA) approval of Tzield, the first disease-modifying therapy 

for T1D. This therapy can delay onset for nearly 3 years; others to delay and ultimately prevent onset are in the research pipeline. 

A recent study examined how Medicare spending would be impacted by delaying 

the development of T1D by 3, 5, and 10 years. For the current and future population 

living with diabetes, different amounts of time delaying diagnosis are expected to 

generate a range of Medicare savings that build over time. Cumulative savings accrued to Medicare range from $1.6—$3.0 billion within 10 years. By the 25-year 

mark, the Medicare savings reaches $5.9–$16.6 billion 4. These analyses do not account for the costs associated with delaying diabetes development. 

Advances in Cell Therapies 

A recent exciting development in diabetes research is the June 2023 FDA approval of the first cell therapy for adults with T1D. The approval is specifically for 

adults unable to maintain average blood glucose levels due to repeated severe episodes of low blood glucose levels or hypoglycemia. This therapy, with the use of 

immunosuppression, takes deceased donor islets and places them into people with 

T1D. This is an important first for the diabetes community, as it is a therapy that 

allows some patients to go without any injected or infused insulin for several years. 

Clinical trial data resulting from the SDP-supported Clinical Islet Transplantation 

Consortium contributed to this pivotal step toward identifying cures. 

Artificial Pancreas Systems 

Another area of progress that is a real game changer for people with T1D is in 

the field of technologies to better manage blood glucose levels. An artificial pancreas 

(AP) system consists of an insulin pump, a continuous glucose monitor (CGM), and 

a computer program called an algorithm that allows the pump and CGM to talk to 

each other to give the right amount of insulin at the right time—much like the pancreas does in people without T1D. AP systems are not perfect, but they allow people 

to think about their diabetes less and have better blood glucose control, which improves the quality of life of those impacted by T1D and helps to mitigate costly and 

burdensome long-term diabetes-related complications. 

SDP-funded research laid the early groundwork for developing AP systems. In 

fact, SDP funds contributed to the first fully automated insulin-dosing system being 

made available to patients in 2017, some five to 7 years earlier than expected. Positive results from SDP-supported clinical trials since then have led to other FDA-approved systems and next-generation AP devices that have outperformed first-generation devices in adolescents and young adults. 

The majority of the delegates with us here today have AP systems. The SDP funded the clinical trial that led to the FDA approval of the system I use, and my blood 

glucose control is much more manageable because of it. I am excited to see what 

comes next for AP systems, which will keep us healthier until we have cures. 

OPPORTUNITIES FOR FUTURE FUNDING

In the early years of SDP funding, we were excited to discover a few new genes 

that might unlock clues to understand the origin of this disease better, and now we 

have transformational therapies and management tools that are improving lives and 

bringing us closer to our ultimate goal of cures for this disease. While the opportunities before us are abundant, these are just a few examples in need of funding with 

the next SDP renewal. 

Fund Long-Term Research Programs and Clinical Trials 

Continued support of the SDP would keep several long-term T1D-oriented research programs and clinical trial networks running strong, enabling them to continue their work which has yielded so many exciting and promising discoveries. For 

example, The Environmental Determinants of Diabetes in the Young (TEDDY) 
17 

5Winn, A, Skandari, R, O’Grady, M, and Huang, E. ‘‘Potential Medicare Savings of Reduced 

End Stage Renal Disease in Patients with Diabetes,’’ May 2023. Unpublished white paper. 6 Centers for Disease Control and Prevention. National Diabetes Statistics Report website. 

https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed July 6, 2023. 

study of 8,600 children, enrolled at birth and being followed until they are 15 years 

old, seeks to understand which environmental factors trigger or protect against T1D 

onset. Information on diet, infections, and other exposures is being analyzed from 

children who are progressing toward—or now have—full T1D onset. Results to date 

indicate that there are multiple pathways leading to full T1D onset. Further investigation is needed to develop strategies to prevent the onset of the disease, ranging 

from a vaccine to specific dietary changes. The data collected from this study could 

also benefit other autoimmune diseases, such as celiac disease. 

Protect Heart and Kidney Health for Those with T1D 

SGLT2 inhibitors protect heart and kidney health for people with type 2 diabetes 

but are not yet approved for people with T1D. There is an immediate need to develop evidence-based strategies to ensure these drugs can safely be used by people 

with T1D, which could reduce costly and devastating impacts of heart and kidney 

disease. 

A recent study shows that for the current population living with T1D, lowering 

End Stage Renal Disease rates by 50 percent is expected to generate Medicare savings that build over time. At the ten-year mark, the cumulative savings to Medicare 

are $5.1 billion. By the 25-year mark, Medicare savings reach $13.6 billion 5. These 

savings estimates do not incorporate individuals who will be diagnosed in the future 

and therefore are conservative. 

Investigate Cardiovascular Disease in People with T1D 

Cardiovascular disease (CVD) in people with T1D is not nearly as well studied 

as in people with T2D despite the fact that it is a major cause of death in people 

with T1D. There is a major unmet need to identify the mechanisms that promote 

earlier development of CVD in people with T1D, to learn and develop new interventions to prevent and treat it. 

LONG-TERM, UNINTERRUPTED SDP SUPPORT NEEDED

The critical research supported by the SDP requires long timeframes to achieve 

optimal results. A long-term reauthorization would allow the National Institute of 

Diabetes and Digestive and Kidney Diseases to carefully plan the use of funds, 

which are directed toward new and ongoing clinical trials that take multiple years 

to complete. 

Technology development also takes time. The noteworthy progress in developing 

artificial pancreas and other glucose management technologies has been spurred by 

long-term SDP support, as I noted earlier. A short-term reauthorization would make 

it much more difficult to undertake long-term planning in these areas. 

For the scientists who conduct the research, long-term, sustained funding is incredibly important. With the uncertainty of sustained funding, they may pursue 

other research opportunities elsewhere. The assurance of long-term funding is also 

important to attract new talent to this field and to maintain a pipeline of future 

generations of scientists to conduct T1D research. 

FEDERAL FUNDING FOR NIH, FDA, AND ARPA–H

While the SDP is a key component in our collective efforts to accelerate T1D research breakthroughs, three key agencies—the National Institutes of Health, the recently formed Advanced Research Projects Agency for Health and the Food and 

Drug Administration—are also vital to speed the advancement of research and access of new therapies for people with T1D. We ask that this committee support 

these agencies with the highest funding levels possible. 

INSULIN AFFORDABILITY

While the focus of this hearing is on the Special Diabetes Program, research 

progress, and hopes for the future, it is important to note that people with diabetes 

need access to affordable insulin until we have cures. As you have heard from your 

constituents and our many advocates, the current drug pricing system in the United 

States does not work for countless people who need insulin to survive. 

Over a 10-year period, the cost of insulin increased threefold 6. Currently, insulin 

can cost between $175 and $300 per vial and up to $1,000 per month. Studies have 
18 

7 Centers for Disease Control and Prevention. National Diabetes Statistics Report website. 

https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed July 6, 2023. 

shown that these inflated costs can cause up to one-quarter of people with diabetes 

to skip or ration their insulin 7, potentially leading to costly medical emergencies, 

severe complications, or death. 

We are seeing real progress in addressing this critical issue through actions taken 

by governments, health plans, and insulin manufacturers. Medicare now caps the 

cost of insulin at $35 per month due to the Inflation Reduction Act. Earlier this 

year, Lilly, Novo Nordisk, and Sanofi announced reductions in the cost of their insulin. And the Civica Insulin Project, of which JDRF is a funder, is on track to 

produce the first of three biosimilar insulins for $30 per vial and $55 for a box of 

five pens. They intend to submit to the FDA next year. 

However, we must do more. We need Congress to take the next step this year. 

JDRF urges Congress to pass the bipartisan INSULIN Act of 2023, led by Senators 

Collins and Shaheen, which establishes a $35 per month insulin copay cap for people with commercial insurance and includes other provisions that would make insulin more affordable for everyone, regardless of insurance status. 

CONCLUSION

As you can see, the Special Diabetes Program is indeed improving and saving 

lives and creating hope for those with type 1 diabetes. We have come so far since 

I was diagnosed as a teen and even since our last Children’s Congress in 2019. The 

future is bright for all these delegates with us today and the countless others across 

the country who are impacted by T1D, with continued support for the SDP and your 

help. 

Senators Collins and Shaheen, we are tremendously grateful for your leadership. 

And members of this committee, we so greatly appreciate your support. I know 

many of you are among the 60 Senators who signed the letter, led by Senators Collins and Shaheen, supporting the SDP and its renewal. Thank you! 

I urge you all to vote in favor of S. 1855, led by Senators Collins and Shaheen, 

which was approved by the Senate Health, Education, Labor, and Pensions Committee. The bill would increase the current funding of the SDP from $150 million 

to $170 million for 2 years and include nearly $43 million more to extend the program through December 2025. The current funding expires at the end of this September, so I urge you to act quickly. And please support next steps on insulin affordability and do that promptly as well. We are counting on you. 

Thank you again for the opportunity to testify. I am happy to answer any questions. 

Vice Chair COLLINS. Thank you very much, Doctor. 

Mr. Harris, welcome. 

STATEMENT OF JAMES ‘‘JIMMY JAM’’ HARRIS, AWARD-WINNING 

MUSIC PRODUCER AND PHILANTHROPIST 

Mr. HARRIS. Talk, how about that. Okay. 

Thank you, Chair Murray, Vice Chair Collins, Senator Shaheen, 

and Members of the Committee. My name is Jimmy Jam. I am a 

songwriter, producer, musician, and recording artist. Today, I am 

honored to be testifying, not as a member of the music community, 

but as a parent whose family has been impacted by type 1 diabetes 

for the past 2 decades. 

My son, Max, was just 2 years old when he was first diagnosed 

with type 1 diabetes. At the time I thought I knew what T1D was, 

but I did not really understand what it meant. Type 1 diabetes is 

something you—it does not affect you until it really affects you, 

and once it does you are completely immersed in it. 

Our lives quickly revolved around Max’s diabetes. Late nights 

working on music for me quickly became working on waking my 

son up to test and manage his blood sugar levels. 

Now, Max is now in his 20s, and we are glad that instead of 

those constant finger pokes to test him, he now uses a continuous 
19 

glucose monitor, or CGM. Those life-changing devices never would 

have come to market as quickly as they did, or perhaps even at all, 

without research funded by the Special Diabetes Program and 

JDRF’s funding and extensive involvement. 

But even with the great new technologies to help control T1D, we 

can never take Max’s levels for granted. That is the thing with diabetes: The second that you think you have it down, something else 

changes, and now the number is too high or too low. Congress 

needs to renew the SDP so that researchers can discover new 

breakthroughs to help families with type 1 diabetes. 

Through Max’s eyes I have also seen the crisis facing millions of 

Americans, insulin affordability. I remember when Max was young, 

we went on a family trip to New York, and in the chaos of packing, 

we forgot to pack his insulin. Now, I did not think it would be a 

big deal because we had insurance. But then our insurance would 

not cover it. We had already used our refill. So we ended up having 

to pay at that point in time, probably a couple hundred dollars out 

of pocket just to get his life-saving insulin. 

Now, we were fortunate that we could afford the cost, but even 

as a child, Max realized the problem. I will never forget how he 

asked me that day, ‘‘What about the people that cannot afford 

that?’’ There are so many people across the country who cannot afford their insulin, and over the years the cost has only gotten higher. People like Max need insulin to survive. I have heard heartbreaking stories of families forced to ration insulin because it is too 

expensive. Congress should make sure no family has to make these 

impossible choices to keep their child alive. 

Aside from my roles as father and musician, I am also Chairman 

Emeritus of the Recording Academy; that is the organization behind the Grammy Awards. Like the Members of this Committee I 

know what it is like to sit in a contentious meeting and worry that 

no one will ever agree because our differences are too great. But 

I have also learned, if I start playing music, I can look around and 

I can see the commonalities of everyone’s head moving at the same 

time in the same way. We all may have our differences, but there 

are things we can all agree upon: Music is one of those things. But 

type 1 diabetes should be one of those things we can all agree upon 

too. 

It is a non-partisan condition. Diabetes does not care if you are 

a Democrat or a Republican. And we can all agree there should be 

research to improve the lives of those with diabetes. And we can 

also all agree that insulin should be affordable to all that need it. 

Thank you for the opportunity to join you today. And I am happy 

to answer any of your questions. Thank you. 

[Applause.] 

[The statement follows:] 

PREPARED STATEMENT OF JAMES ‘‘JIMMY JAM’’ HARRIS

Thank you, Chair Murray, Vice Chair Collins, Senator Shaheen, and Members of 

the Committee. My name is Jimmy Jam. I am a songwriter, producer, musician and 

recording artist. Today, I am honored to be testifying not as a member of the music 

industry, but as a parent whose family has been impacted by type 1 diabetes every 

day for the past two decades. 
20 

My son Max was just two years old when he was first diagnosed with type 1 diabetes. At the time, though I knew what T1D was, I didn’t really understand what 

it meant. 

Type 1 diabetes is something that doesn’t affect you until it really affects you. 

Once it does, you are completely immersed in it. Our lives quickly revolved around 

Max’s diabetes. Late nights working on music became late nights working on music 

and waking up my son to test and manage his blood sugar levels. 

Max is now in his twenties, and we’re glad that instead of those constant finger 

pokes to test him, he now uses a continuous glucose monitor, or CGM. These lifechanging devices never would have come to market as quickly as they did—or perhaps even at all—without research funded by the Special Diabetes Program and 

JDRF’s funding and extensive involvement. 

But even with great new technologies to help control T1D, we can never take 

Max’s levels for granted. That’s the thing with diabetes: the second you think you 

have it down, something else changes and the number is too high or too low. Congress needs to renew the SDP so that researchers can discover new breakthroughs 

to help families with type 1 diabetes. 

Through Max’s eyes, I have also seen the crisis facing millions of Americans: insulin affordability. I remember when Max was young, we went on a family trip to New 

York, and in the chaos of packing we managed to forget his insulin. 

I didn’t think it would be a big deal. We had insurance. But then our insurance 

wouldn’t cover it. We had already used our refill, so we ended up having to pay a 

couple hundred dollars out of pocket just to get his life-saving insulin. We were fortunate we could afford the cost, but even as a child, Max realized the problem. I’ll 

never forget how he asked me that day: ‘‘What about the people who can’t afford 

that?’’ 

There are already so many people across the country who can’t afford their insulin, and over the years the cost has only gotten higher. People like Max need insulin 

to survive. I’ve heard heartbreaking stories of families forced to ration insulin because it is too expensive. Congress should make sure no family has to make these 

impossible choices to keep their child alive. 

Aside from my roles as a father and musician, I am also chairman emeritus of 

the Recording Academy—the organization behind the Grammy Awards. Like the 

members of this committee, I know what it’s like to sit in a contentious meeting 

and worry no one will ever agree because our differences are too great. 

But I’ve learned that if I start playing music, I can look around and see the commonalties of everyone’s head nodding the same way. We may all have our differences, but there are things we can all agree on. Music is one of those things. 

Type 1 diabetes should be one of those things we can all agree on too. It is a nonpartisan condition—diabetes doesn’t care if you’re a Democrat or a Republican. We 

can all agree that there should be research to improve the lives of those with diabetes. We can all agree that insulin should be affordable for all who need it. 

I thank you for the opportunity to join you today. And I’ll be happy to answer 

any of your questions. 

Vice Chair COLLINS. Thank you very much. Thank you so much 

for your testimony. 

Maria, welcome, from the great State of Maine to Washington, 

DC. 

STATEMENT OF MARIA MUAYAD, JDRF 2023 CHILDREN’S CONGRESS 

DELEGATE, YARMOUTH, MN 

Ms. MUAYAD. Chair Murray, Vice Chair Collins, Senator Shaheen 

and Members of the Committee. Thank you for inviting me to 

speak. I am honored to represent my fellow delegates at JDRF 

2023 Children’s Congress in this hearing. 

I am Maria Muayad from Yarmouth, Maine. I am 10 years old, 

and I have been living with type 1 diabetes for 3 years. 

As you can tell from looking at all the delegates in front of you, 

we are a diverse group of people. Some of us are in preschool and 

some are about to go to college. Some, like me, love math, and others, well, they prefer other classes at school. What brings us together is that we all live with type 1 diabetes. We know what it 

feels like to live with the highs and lows of diabetes, literally. 
21 

My family and I are a first-generation Americans and proud 

Mainers. We know that with hard work, we can do anything. Every 

delegate knows this, too. And that is why we are here. My dream, 

and my family’s big hope, is to cure type 1 diabetes. Together, with 

your help, we can do it. 

The Special Diabetes Program funds research that is leading us 

to cures. We do not have one today, but someday we will, and research from the SDP is important to make that happen. 

It is going to be amazing when we cure type 1 diabetes. There 

is so much I am looking forward to. When there is a cure, I will 

not have to wear my devices that itch and hurt and that brings me 

unwanted attention from my classmates when they make noises. 

When there is a cure, I will not have to eat food to treat a low after 

I brush my teeth which is just as annoying as any device I have 

to wear. 

[Laughter.] 

Ms. MUAYAD. When there is a cure, I will be able to spend more 

time doing the things that I love, like FaceTiming with my family 

and playing outside with my friends. 

Until we cure this disease, I would also like if everyone could afford the diabetes supplies they need to live. All the medicines and 

tools I need to stay alive are very expensive, but they are necessary, and they work. I hope that you can help find a way to— 

for that to happen. 

When I grow up, I want to become a pediatrician so I can help 

other people, including kids with diabetes. It would be even better 

if, by the time I am a pediatrician, kids do not get type 1 diabetes 

anymore. The only way that will happen is if you keep funding diabetes research. 

Thank you very much for letting me share my hopes for the future. And thank you, Senator Collins and all the Members of the 

Committee, for all you are doing to help us. 

[Applause.] 

[The statement follows:] 

PREPARED STATEMENT OF MARIA MUAYAD

Chair Murray, Vice Chair Collins, Senator Shaheen, and Members of the Committee—thank you for inviting me to speak. I am honored to represent my fellow 

delegates at JDRF 2023 Children’s Congress in this hearing. 

I am Maria Muayad from Yarmouth, Maine. I am ten years old, and I have been 

living with type 1 diabetes for three years. 

As you can tell from looking at all the delegates in front of you, we are a diverse 

group of people. Some of us are in preschool and some are about to go to college. 

Some, like me, love math and others, well, they prefer other classes at school. 

What brings us all together is that we all live with type 1 diabetes. We know 

what it feels like to live with the highs and lows of diabetes. Literally. 

My family and I are first generation Americans and proud Mainers. We know that 

with hard work, we can do anything. Every delegate knows this, too. And that’s why 

we’re here. 

My dream, and my family’s big hope, is to cure type 1 diabetes. Together, with 

your help, we can do it. 

The Special Diabetes Program funds research that is leading us to cures. We don’t 

have one today, but someday we will—and research from the SDP is important to 

making it happen. 

It’s going to be AMAZING when we cure type 1 diabetes. There is so much I’m 

looking forward to. 

Where there’s a cure, I won’t have to wear devices that itch and hurt—and that 

bring me unwanted attention from my classmates when they make noise. 
22 

When there’s a cure, I won’t have to eat food to treat a low right after I brush 

my teeth—which is just as annoying as any device I have to wear. 

When there’s a cure, I’ll be able to spend more time doing the things that I love, 

like FaceTiming with my extended family in Iraq, painting my mom’s nails, and 

playing outside with my friends. 

Until we cure this disease, I would also like it if everyone could afford the diabetes supplies they need to live. All the medicines and tools I need to stay alive are 

very expensive, but they are necessary, and they work. I hope that you can help 

find a way for that to happen. 

Next year I will start middle school. Later, I want to go to college and eventually 

become a pediatrician so I can help other people—including kids with diabetes. 

It would be even better if, by the time I am a pediatrician, kids don’t get type 

1 diabetes anymore. The only way that will happen is if you all keep funding diabetes research. 

Thank you very much for letting me share my hope for the future. And thank you, 

Senator Collins and members of the committee, for all you are doing to help us. 

Vice Chair COLLINS. Thank you, Maria. 

Elise, welcome. 

STATEMENT OF ELISE CATALDO, JDRF 2023 CHILDREN’S CONGRESS 

DELEGATE, HOOKSETT, NH 

Ms. CATALDO. Thank you. Chair Murray, Vice Chair Collins, Senator Shaheen, and Members of the Committee, thank you for inviting me to speak with you today about my life with type 1 diabetes. 

My name is Elise Cataldo. I am 15 years old, and I am from 

Hooksett, New Hampshire. I was diagnosed with type 1 diabetes 

when I was 18 months old. Many of my fellow delegates here can 

remember a time without diabetes. I cannot. Life with diabetes is 

the only life I have ever known. However, my life with diabetes 

today is drastically different than it was when I was diagnosed. 

Back then, we did not have the same tools we have today. Continuous glucose monitors, like the one I am wearing today, were not 

yet widely adopted by the type 1 diabetes community. Insulin 

pumps with artificial pancreas technology were not yet available. 

Thanks to brilliant researchers, clinical trial participants, advocates, JDRF, and the overwhelming support of Senators like you, 

the tools I have today are vastly superior. In fact, I currently use 

an insulin pump that has an algorithm called Control IQ that gives 

me more insulin when I need it, and it decreases the amount of insulin I get to help prevent dangerously low blood sugars. The Special Diabetes Program, or SDP, funded the final clinical trial for 

this algorithm. That clinical trial led to its FDA approval, and my 

life is so much better because of it. I can sleep better at night, and 

so can my parents, because of SDP-funded research. I am not 

alone. I can guarantee many of my fellow delegates here utilize this 

or other systems like it, and they are all helped in one way or another by the SDP. Thank you for your past support of this critical 

program. 

Today, I am incredibly proud to say that I live as close to a normal life as possible. I am active, as I play soccer and basketball. 

I am able to spend time with my family where I am the oldest of 

five, and for example, our most recent camping trip. In a few years, 

I hope to go to college, become a D1 athlete, and study psychology 

so that I can become a child life specialist. 

But as normal as I look on the outside, type 1 diabetes is always 

in the back of my mind. It affects every decision I make, every day. 

When I am playing soccer, I need to ensure my blood sugar is in 
23 

the right range. If it is too high, I can become fatigued. But if it 

is too low, I can become disoriented and even pass out. If this 

sounds like a lot for a 15-year-old to keep track of, you are right. 

It is. 

Many Americans with diabetes have one more thing to keep 

track of: Whether or not they can even afford their insulin. I am 

incredibly lucky to say that I am able to access the insulin I need. 

It makes me so disappointed that there are people just like me who 

have trouble affording their insulin, and have to make terrible decisions, like whether to buy groceries or insulin, which are both 

things that we cannot live without. I hope that the Members of the 

Senate and the rest of Congress can work together to solve this 

problem. The diabetes community needs your help. 

One day soon, I hope to live free from type 1 diabetes. You play 

a critical role in making that a reality. Please fund the SDP and 

continue to fight for me, the 163 kids here today, and the millions 

more in America affected by this disease. 

Thank you for listening to my story. And thank you for your support. I am happy to answer any questions. 

[Applause.] 

[The statement follows:] 

PREPARED STATEMENT OF ELISE CATALDO

Chair Murray, Vice Chair Collins, Senator Shaheen, and Members of the Committee—thank you for inviting me to speak with you today about my life with type 

1 diabetes. 

My name is Elise Cataldo. I am 15 years old, and I live in Hooksett, New Hampshire. 

I was diagnosed with type 1 diabetes when I was 18 months old. Many of my fellow delegates can remember a time without diabetes—I cannot. Life with diabetes 

is the only life I’ve ever known. 

However, my life with diabetes today is drastically different than it was when I 

was diagnosed. Back then, we didn’t have the same tools we have today. Continuous 

glucose monitors, like the one I am wearing today, were not yet widely adopted by 

the type 1 diabetes community. Insulin pumps with artificial pancreas technology 

were not yet available. 

Thanks to brilliant researchers, clinical trial participants, advocates, JDRF, and 

the overwhelming support of Senators like you, the tools I have today are vastly superior. In fact, I currently use an insulin pump that has an algorithm called control 

IQ that gives me more insulin when I need it, and it decreases the amount of insulin I get to help prevent dangerous low blood sugars. 

The Special Diabetes Program, or SDP funded the final clinical trial for this algorithm. That clinical trial led to its FDA approval—and my life is so much better 

because of it. I can sleep better at night—and so can my parents—because of SDP 

funded research. 

I am not alone—I can guarantee many of my fellow delegates utilize this or other 

systems like it—and they were all helped in one way or another by the SDP. 

Thank you for your past support of this critical program. 

Today, I am incredibly proud to say that I live as close to a normal life as possible. I play many sports, including soccer; I spend time with my family; I go camping. In a few years, I hope to go to college, be a D1 athlete, and study psychology 

so that I can become a child life specialist. 

But as normal as I look on the outside, type 1 diabetes is always in the back of 

my mind. It affects every decision I make, every day. When I’m playing soccer, I 

need to ensure my blood sugar is in the right range. If it’s too high, I can become 

fatigued. If it’s low, I can become disoriented and even pass out. 

If this sounds like a lot for a 15-year-old to keep track of, you’re right. It is! 

Many Americans with diabetes have one more thing to keep track of: whether or 

not they can afford their insulin. 
24 

I am incredibly lucky that I am able to access the insulin I need. It makes me 

so sad that there are people just like me who have trouble affording insulin and 

have to make terrible decisions, like whether to buy groceries or insulin. 

I hope that all the members of the Senate and the rest of Congress can work together to solve this problem. The diabetes community needs your help. 

One day soon, I hope to live free from type 1 diabetes. You play a critical role 

in making that a reality. Please fund the SDP and continue to fight for me, the 163 

kids here today, and the millions more in America affected by this disease. 

Thank you for listening to my story and thank you for your support. 

Vice Chair COLLINS. Thank you very much, Elise. 

We will now do a round of 5 minutes per Senator for questions, 

although I am sure that we could all go on way longer than that. 

Let me start with Maria. Maria, first of all, thank you for that 

inspiring testimony. I know that you and your family moved to 

Maine from Iraq, and that you were diagnosed here with—in 

Maine—with type 1 diabetes. I want to ask you whether you think 

that having type 1 led to your decision to become a pediatrician 

when you grow up? 

Ms. MUAYAD. Yes. It did lead to me wanting to become a pediatrician because I think—I know that only kids and adults with type 

1 diabetes will understand the pain and struggle that they go 

through. And I would like to help kids better understand that. 

Vice Chair COLLINS. Thank you. Dr. Rodgers, I appreciate your 

strong leadership and all that you have done for the community 

with type 1 diabetes and the Special Diabetes Program for Indians 

and the Native Alaskans as well. 

I want you to look ahead and answer two questions for me. One, 

what would happen to those research efforts if Congress failed to 

extend the Special Diabetes Program, if it just went away on September 30th? 

And second, since I do not think we are going to allow that to 

happen, I would like you to give us a sense of what exciting developments are on the horizon. 

Dr. RODGERS. Well, thank you for that question, Senator Collins. 

I think that if there were to be a circumstance in which the funds 

would lapse, of course our regular appropriations would continue to 

fund existing studies in type 1 diabetes and type 2 diabetes, but 

we certainly would not be able to do it at the pace that we are able 

to do it now. Clearly, in order to recruit people for clinical trials 

we really follow a philosophy that we do not want to subject individuals and their families of these trials if we are not sure we can 

conclude them. And that would be an important aspect of what 

would happen. 

Vice Chair COLLINS. So, you are saying that the Special Diabetes 

Program allows you to achieve breakthroughs much more quickly? 

Dr. RODGERS. Absolutely. Absolutely. In terms of your second 

question, looking towards a future, what would we like to see with 

these funds? You heard from Dr. Kowalski about the use of drugs 

that are currently approved for type 2 diabetes, including so-called 

SGLT2 drugs and GLP–1 receptor agonists. These drugs have not 

only the ability to lower blood sugar and actually reduce weight in 

many instances, but they also have a protective effect on the heart 

and the kidneys. These complications of the disease are really what 

is driving a lot of the cost associated with it. 
25 

And so we really look forward to those are continuing, and making sure that those drugs are safe and effective for individuals with 

type 1 diabetes as well. 

Vice Chair COLLINS. Thank you. I am going to do a second round 

later, so I am going to yield to Senator Tester. 

Senator TESTER. Well, thank you. Thank you, Ranking Member 

Collins. First of all, it is great to have everybody here in the blue 

shirts. The diabetes folks know how to lobby, I will tell you that. 

[Laughter.] 

Senator TESTER. Pretty impressive. Let me tell you a story about 

me. I came to school in seventh grade and my best buddy was not 

there. And I wondered why. And he came back to school, and he 

had been diagnosed with diabetes. I have watched—that was 1969, 

by the way—and Jimmy Jam, in 1969, do you know what he paid 

for a vial of insulin? $2.03. That $300 vial of insulin today was 

$2.03. That is, by the way, with a patent that was passed along to 

the pharmaceutical companies. Now, the delivery system has 

changed, and we talked about that. 

But I have watched him for the last 54 years go through life, and 

it has not been easy. And watching him and the challenges he has 

had to deal with every day because he has diabetes, has made me, 

personally, very angry because life is much more complicated for 

him than it is for me. 

My question is for you, Dr. Rodgers. Congratulations on 25 years. 

You have talked about some of the successes you have had in putting diabetes off for 3 years is no small—I mean that is 1,000 days 

that you get. Okay? The glucose monitoring, the artificial pancreas, 

the delivery system where you do not have to prick your finger, and 

take your pants down and give yourself a shot in the leg every 

day—I mean, all that stuff is admirable, and I will preface but my 

question by saying, you put the—if the R&D money that Senator 

Collins and Senator Shaheen put up, I am going to support it because it is really important. Research is really critical in this area. 

But my question is, as you talked about a biological cure, which 

I think is the goal here. The goal here is not to have to have an 

artificial pancreas. The goal here is not to have to have an early 

potential drug because we have a biological cure; whether it is 

through stem cell or some other method which is far beyond my 

ability to understand as a farmer, just having it so kids, and 

adults, can go through and live a normal life and not have to deal 

with some of the challenges that are out there that diabetes creates. 

So my question is, how close are we? We have been at this for 

25 years, $2.5 billion Dr. Kowalski said we put in. I mean it is real 

money; these folks are real people; these are real kids; they are the 

reason we are in this position. Tell me what we got to do to get 

a biological cure. 

Dr. RODGERS. Thank you for your question, Senator. The SDP is 

supporting and has supported a group of scientists called the 

Human Eyelet Research Network, or HERN. And HERN is trying 

to very much understand and move towards the goal that you set 

forward to try to take stem cells, either from a person’s skin or 

some other place, transform it into beta cells producing insulin, 

and get those cells back into the patient, which would be a true 
26 

biologic cure. The problem is, of course, that those same cells would 

be subjected to the immune response which caused the type 1 diabetes in the first place. 

An alternate way would be to develop these cells and somehow 

encapsulate it to override the immune effect. And that is being actively studied as well, but at the same time we have a group of investigators looking at prevention. It may be better to prevent the 

disease than to actually cure it. And what we know is that individuals that you see here, have a genetic predisposition towards diabetes, and for some reason there is a trigger that turns on their immune system against those cells producing in the pancreas. And if 

we were able to determine what that trigger is—be it a food, be it 

a virus, or a bacteria—we may be able to prevent that unwanted 

autoimmune disease. 

So we have a program called TEDDY (The Environmental Determinants of Diabetes in the Young), which is really actively studying that, and we hope to report to you the results of these studies. 

These are kids that we first brought into the study when they were 

born, and we studied them until they are 15 years of age. And that 

is about to come to a conclusion. And we have a lot of samples that 

have been collected. And this is the first instance in which we are 

going to be using artificial intelligence and machine learning to discern patterns of what it is likely to be the trigger, and it is quite 

likely to be more than one trigger that is turning that on. So that 

is sort of another—obviously it is prudent to explore multiple pathways as well, but that is, certainly, two of the things I can tell you, 

Senator. 

Senator TESTER. Thank you, Doctor. 

Thank you, Senator Collins. 

Vice Chair COLLINS. Thank you. 

Senator Kennedy. 

Senator KENNEDY. Thank you, Madam Chair, and thanks to all 

of our witnesses. 

Dr. Kowalski, thank you for giving so much. Have you ever heard 

the expression, ‘‘Yada, yada, yada’’? What does that mean? 

Dr. KOWALSKI. ‘‘Yada, yada, yada’’ mean? 

Senator KENNEDY. Yeah. 

Dr. KOWALSKI. On and on and on. 

Senator KENNEDY. We have had so much yada, yada, yada about 

affordable insulin. Not from people like you, but from us. We have 

been nibbling around the edges for years. 

Dr. Rodgers, thank you for giving so much. Let me ask you a 

question. Do you have health insurance? 

Dr. RODGERS. Fortunately, as a government employee, I do have 

health insurance. 

Senator KENNEDY. And it is pretty good, isn’t it? 

Dr. KOWALSKI. It is pretty good, Senator. 

Senator KENNEDY. Now, who do you think needs affordable insulin? Who do you think needs capping the price of insulin at 30 

bucks, or so, more; you or an uninsured person? 

Dr. RODGERS. Is that to me, Senator, or to Dr. Kowalski? 

Senator KENNEDY. You. 

Dr. RODGERS. Well, as you asked the question, I think the person 

who is less available to afford it would probably benefit more. 
27 

Senator KENNEDY. Yeah. We have got 30 million people who are 

uninsured in this country, and some of them are diabetic too. Now, 

Senator Shaheen and Senator Collins have a great bill. Senator 

Warnock and I have a bill, too. It is called the Affordable Insulin 

Now Act, and we are working closely with my—with Senator Collins and Senator Shaheen. Our bill would cover everybody, everybody, whether you have health insurance or you are uninsured because a lot of people become uninsured. 

Now, I know our health insurance companies—and God bless 

them—they are trying to work with us to lower the cost of insulin, 

and they have these programs. They call them Patient Assistance 

Program. So if you are uninsured and you cannot afford your insulin, they will work with you. But have you ever tried to apply for 

one of those programs; either of you; any of you? 

Oh, my, God. First, the application process: The fine print to 

apply is so much of it, you could hide a dead body in there. Nobody 

would ever find it. 

Number two, they send the medicine to your doctor, not to you. 

So if you got a job, or if you do not have a job, you got to go to 

the expense of driving all the way to your doctor’s office. You probably have to pay your doctor to get the medication. I mean that is 

a special kind of stupid. It only covers—these free programs only 

cover one or two forms of insulin. And get this, yeah, they will give 

you—they will give you cheap insulin, maybe free insulin for a 

month, or 3 months, or at best a year. And then after a year, you 

go in one day and instead of 30 bucks, it is $567.23, and you go, 

‘‘Oh, my, God, I have got to go sell blood plasma to be able to afford 

it.’’ 

We need to stop nibbling around the edges. We need to be smart 

enough to figure this out. And the cost? I think it could be done 

for $250 million a year. And I am not talking about taking out a 

reverse mortgage on Alaska and borrowing more money. I am talking about finding it in our budget. 

Elise, let me ask you a quick question. You probably do not know 

the answer; I had to look it up. But if I started counting to a billion 

right now, right this moment in 2023, and I counted—you all listen 

to this, you may know the answer. I counted one number a second—one, two, three, four, five—and I counted all day and all 

night, and I counted in the shower, and I counted between bites of 

a Pop-Tart at breakfast. I keep counting and counting. How long 

do you think it would take me to count to a billion? 

Ms. CATALDO. A very long time. 

[Laughter.] 

Senator KENNEDY. Do you know how long? You are right. I told 

you, you were smart. It would take me, it would take me 32 years 

for 1 billion. I would be 55—it would be 2055. I would not make 

it. Now, do you know how big the Federal budget is? That is just 

1 billion folks. The Federal budget is $6,000 billion, every year. 

And we cannot find $250 million to cap the price of insulin? 

Let us do it right. No more yada, yada, yada. 

[Applause.] 

Vice Chair COLLINS. Thank you. 

Senator Baldwin. 
28 

Senator BALDWIN. Thank you. I want to start by both congratulating and welcoming my constituents, Meredith, Mira, Sylvia, and 

Talon. Welcome to our Nation’s Capitol. And I want to thank you 

for your role in the JDRF 2023 Children’s Congress and for your 

continued advocacy on behalf of Wisconsinites with diabetes. Your 

advocacy really helps drive the work of Congress, and I want to 

thank you for using your voices for this important cause. 

This is for Dr. Rodgers. The Max McGee Diabetes Research Center in Milwaukee, Wisconsin, is focused on early identification and 

prevention of type 1 diabetes. Thanks to funding from the National 

Institute of Diabetes and Digestive and Kidney Diseases, the Center developed a [inaudible] cutting-edge blood test that can detect 

inflammation associated with type 1 diabetes up to 7 years before 

the disease’s onset. 

This test is already helping researchers better understand how 

patients are responding to new therapeutic interventions and 

strengthens our understanding of the development of type 1 diabetes. 

So Dr. Rodgers, can you describe how research that focuses on 

the development of type 1 diabetes leads to progress in preventing 

juvenile diabetes? 

Dr. RODGERS. Thank you, Senator. That is outstanding work that 

is being done by investigators in your State. You know, I have to 

say the Special Diabetes Program, as I mentioned in my introduction, over the years of this continuous funding, has really changed 

the way we think about diabetes in the various stages. 

It is not that you have it or you do not, we know that it progresses through several stages until one actually develops clinical 

disease associated with abnormal blood sugar levels, and it is getting the disease and people who are extremely high risk, after they 

have antibodies, but before their blood sugar gets out of whack. It 

is critically important because that leads to the development of 

studies such as was reported by Senator Collins, and has been 

mentioned, this drug, teplizumab, for example, which works in the 

immune system to actually stop the immune system from damaging those insulin producing cells. 

So having ways of defining the disease much earlier is critically 

important for prevention. And we continue to work with investigators throughout the country to try to come up with a more precise, 

easy, and a more accurate way of detecting that just for that purpose. 

Senator BALDWIN. Great. Thank you. Also, Dr. Rodgers, thanks 

to the Special Diabetes Program people with type 1 diabetes are 

living longer than ever, but there is much more that we can do to 

improve the lives of those with type 1 and make sure that we are 

working to reduce complications. This is especially important for 

children living with type 1 diabetes, including the Wisconsinites 

who I welcomed earlier. 

Dr. Rodgers, what are some of the understudied complications of 

type 1 diabetes that you hope will be examined in the future? And 

you know, what are the gaps, or things that we have not studied 

enough? And how will this research improve the lives of many in 

this audience? 
29 

Dr. RODGERS. Two aspects of that. I will answer your question 

in two ways. Number one is there are understudied groups of individuals with type 1 diabetes that, unfortunately, industry is not 

studying that much, and this is where SDP fills in a gap. Those 

understudied individuals include those who are pregnant, those 

who have frequent episodes of low blood glucose, or this condition 

that Dr. Kowalski mentioned of impairment—impaired hypoglycemia when their blood sugar dips very low, older adults and 

younger—very young adults are understudied. Those with lower in 

education levels are also tend to be understudied by industry. 

And now, with respect to complications of the disease, something 

that we really need to focus on because this is where a lot of the 

funding for diabetes comes in. People with heart disease, and unfortunately, it looks like people that have type 1 diabetes may have 

a different form of heart disease in terms of its manifestations. 

Diabetic foot ulcers is something that I think is very much 

understudied. We have begun a consortium to study foot ulcers because once people get this, you may not be aware, but the mortality 

associated with having foot ulcers actually is very close to some 

people with certain types of cancers. 

And so those are two areas. We have learned a lot in terms of 

diabetic eye disease and other manifestations. But if I had to pick 

two complications that would be where we would want to focus, 

and we have studies already developed in those—in that regard. 

Senator BALDWIN. Thank you, Dr. Rodgers. 

Dr. RODGERS. Thank you. 

Vice Chair COLLINS. Thank you. 

Senator Hyde-Smith. 

Senator HYDE-SMITH. Thank you Senator Collins. And I want to 

thank everyone for being here today. This means so much. And I 

hope you always remember this day for your effort in trying to 

make your situation, make your lives better. You are playing a part 

today. And I appreciate all of you coming. 

Dr. Rodgers, my question is for you and it is more State-specific. 

Mississippi is the State I represent—a very large State with a pretty low population for such a large State, a lot of rural areas. And 

so many times we have so many patients who go undiagnosed and 

their chronic disease complications just skyrocket. Specialists are 

few and far between, and the patients usually have to travel a long 

way for their appointments. 

We have seen positive impacts of the Special Diabetes Programs 

and Research at the NIH. However, rural communities seem to face 

such a greater challenge. I have more family members who suffer 

from diabetes. I mean, everyone in Mississippi is very aware of 

what this is because we do have one of the highest rates. 

During your time as the Director of the National Institute of Diabetes and Digestive and Kidney Diseases, how have researchers focused on rural populations in their research and their studies because this is a great concern in my State? 

Dr. RODGERS. Thank you, Senator, for that question. There is a 

lot of activity in Mississippi. I have visited there multiple times to 

actually speak. And you are right, it is rural disease. We have been 

following and working with the Centers for Disease Control who, 

as you know, follow the incidence and prevalence of certain dis-
30 

eases like diabetes, not only at a state level, but even sort of at a 

county level, to try to understand what are some of the factors that 

are contributing to the prevalence and changing in the prevalence 

of the disease. 

We are also learning, for example, that in a study that we work 

with the CDC (Centers for Disease Control and Prevention), it is 

called SEARCH (SEARCH for Diabetes in Youth Study). And what 

SEARCH is now telling us—of course everything in Government 

has an acronym, so SEARCH is an acronym, which I will not go 

into at the moment, but we are really searching for diabetes in 

youth and adolescents. 

And we are finding that not only are we seeing an increase in 

the numbers of kids with type 1 diabetes in certain rural areas 

that was totally unexpected, but we are also seeing type 2 diabetes, 

for example, in kids as young as 10, 11, or 12. And what we know 

about type 2 diabetes in these kids is that: (a) It does not respond 

at the same way that drugs that are commonly available respond 

in adults with the disease. And secondly, it is a much more aggressive disease. This is type 2 diabetes, not type 1. It seems to be associated with the development of complications much, much earlier 

than what we see in adults which, typically, takes 10 or 15 years 

of the disease. 

And so these are studies that are really being actively pursued, 

both at the State and the county level, to try to understand this 

and using, you know, new, sophisticated GPS to actually target 

these. We have some young investigators who are coming up with 

some ideas that will be subject to testing. So we are very much focused on the disparities that exist in rural America. And that is 

something that, it really is something that is very important to me. 

Senator HYDE-SMITH. Can you tell me, Doctor, how we as Congress can help address some of those issues? Is there anything specific because of the lack of quality health care in so many rural 

areas? Is there anything specific we, as Congress, can do to improve that? 

Dr. RODGERS. Well, certainly your support for this program and 

other programs, I think, are certainly critically important. We want 

to make sure that we continue to have investigators in the pipeline 

to continue investigative inquiries to be, you know, right there to 

answer questions that they pose. And so making—ensuring that we 

can not only maintain pivotal clinical trials in diabetes and in 

other areas but obviously funding the next generation of investigators both to treat patients appropriately, but also to uncover ideas 

that we are not even aware of yet to make sure they are there to 

help us move forward. And your ongoing support for those efforts, 

I think, is totally—is very much valuable. 

Senator HYDE-SMITH. Well, I just thank all of you for being here. 

I thank you for your efforts. And I do have one young man, 17 

years old, in Hattiesburg, Mississippi, who has the CGM pump, 

and it has changed his life. I just want that opportunity for every 

child who suffers from this. I want them to have every opportunity 

that we can possibly provide. So thank you for doing the research. 

Thank you for your diligence. 

Dr. RODGERS. Thank you. 

[Applause.] 
31 

Vice Chair COLLINS. Thank you. 

Senator Manchin. 

Senator MANCHIN. Thank you, Madam Chairman. And thank all 

of you for being here. Thank our presenters. And to Maria and 

Elise, thank you all for sharing your stories with us. 

Maybe one question, real quick, for both of you, what would you 

think is something most people do not understand about diabetes, 

as far as childhood diabetes? Something that they just do not understand, unless your families and you all live with it no one else 

would understand that. Anything very quickly? 

Ms. CATALDO. Yeah. I think a lot of people do not understand 

that it is ongoing. You never get a break from it. You cannot ever 

just say I do not feel like doing this today. And a lot of people get 

it confused with type 2 diabetes—— 

Senator MANCHIN. Mm-hmm. 

Ms. CATALDO [continuing]. Which is really frustrating because it 

is not something we ever wanted to live with; we were given it. 

And I think that is just really frustrating, especially as children 

here, a lot of adults do not want to give time to listen to us all the 

time, and even though some of the times we know. 

Senator MANCHIN. Keep telling, you keep telling your story, 

okay? 

Ms. CATALDO. Yeah. 

Senator MANCHIN. Maria? 

Ms. MUAYAD. I think that, and I feel that that kids in my school, 

at least, they think that I do not need my CGM and my pump on 

all the time. And they just come and like poke at it and touch it. 

And when the nurse comes up to my classroom, they always crowd 

around me when my blood sugar is going up or down. 

Senator MANCHIN. And you just keep telling—keep explaining to 

them. Trust me, they want to know. And I am sure most people 

want to help. But understanding is the most important thing, and 

educating them is something you can do and nobody else can do. 

And I think, you never give up and never be ashamed. Make sure 

that you make people understand what we all can do, working together. 

I want to also recognize Mr. Chris Ward from Charleston, West 

Virginia. He is here today, and I want to thank him. 

Let me say this to all the family members, thank you all for the 

support you give your loved ones, and what you do every day because people do not understand. And there is not a family in America that has not been affected one way or another with diabetes, 

not one family, they have someone in their immediate family, extended family, or close relation. 

To all of you, let me just say, you are the hope of America. You 

are sitting here today, you are our hope. I think there is going to 

be many of you sitting where we are sitting right now, wondering 

how you can make life better, how you can improve the quality of 

life. And that is what we are trying to do. We want to make sure 

that you have the greatest opportunity that anybody and any generation has ever had. We can only do that if you are healthy. And 

we want to make sure you have that opportunity. But I want to 

make sure you understand you have to live and grow to be a living, 

a loving, caring adult and give something back. You have a lot to 
32 

share with a lot of people, and how they can live a better life. And 

as you grow and become responsible for that, you are going to be 

sharing the greatest gift that you have and that is the knowledge 

of knowing the challenges some people have that people do not understand. They just do not. And you being here today sharing that 

with us makes the difference of what we do and support. There is 

not a person here, Republican or Democrat, you hear a lot about 

politics, you have united Congress. You made us all understand it 

is not about politics, it is about each individual having the opportunity for quality of life. That is why you are here; that is what 

you are accomplishing today. And I hope that you understand making an effort to come here today makes a big difference in what we 

do, and how we do our job, and how important it is that we do it 

as quickly as humanly possible. 

We had a piece of legislation called the Inflation Reduction Act which put a cap at $35. We tried to cap all across the board, everybody, no one would ever pay more than $35. We are achieving it 

a little bit of the time. We got Medicare first. Now we got some 

companies that were shamed into knowing that they are making 

excessive profits to come down to $35, we want to make sure that 

we have a piece of legislation that does it. 

And I want to thank the Chairwoman, my good friend from 

Maine, and also my good friend from Washington, the State of 

Washington, for what they have done in leading this cause and the 

charge. 

And I would say one final thing. Dr. Rodgers, on the TEDDY 

Program, that is a very important program. My State of West Virginia has the largest percentage of adult diabetes in the country. 

We are over 16 percent of our population as adult, when the national average is about 10 percent. 

Can you tell me how that affects the families, and what we can 

do, and how TEDDY is working to also—I have always said this, 

you cannot teach an old dog new trick but you can teach a young 

pup tricks that can help the old dogs. And that is what we have 

got to do. And these kids can basically help educate a population 

that does not know how effective it is. 

Dr. RODGERS. Well, TEDDY is certainly one of these studies that 

I want to emphasize your points that this is something that families are very much involved. The study identifies kids from birth. 

They come in periodically—several times a year in the first few 

years, and then maybe three times a year, and then quarter— 

bringing all types of samples, urine, stools, saliva, with the, you 

know, very detailed record of when they had colds—— 

Senator MANCHIN. Sure. 

Dr. RODGERS [continuing]. And whether they received vaccines, 

and the like. So it really is quite labor intensive, but the product 

of that, that study, is really going to inform us greatly in terms of 

what some of those triggers are. 

So TEDDY, again an acronym, The Environmental Determinants 

of Diabetes of the Young, we are going to learn quite a bit from 

that, and I would say probably within the next few years. So really, 

stay tuned. And what we learn about that I think might give us 

clues for other autoimmune diseases. That is why I am saying this; 

SDP is really having benefits beyond its intended purpose, so really 
33 

stick with it. And again we really appreciate all of your support, 

as I am sure, the population in your State does your support. 

Senator MANCHIN. And let me say this to all of you. Thank you 

for being here today, you live in the greatest country in the world, 

the United States of America, and it is not the ‘‘divided’’ States, it 

is the ‘‘United’’ States. Today, you have helped unite us more than 

you know, making an effort to be here. I want God to bless each 

and every one of you. Thank you for being here. 

[Applause.] 

Vice Chair COLLINS. Senator Britt. 

Senator BRITT. Thank you so much, Ranking Member Collins. I 

want to tell you how much I appreciate your efforts on this important issue. I am proud to support the work that you and Senator 

Shaheen are doing, proud to work alongside Senator Kennedy and 

others. 

I want to tell you all how important it is you continue to tell your 

story. So Maria, Elise, the people from my home State, Tory and 

Violet, where are you? Are you out there? Oh, yes. This makes such 

a difference. You are changing hearts and minds. For me, it was 

one of my very dear friends, Elizabeth. She has two children diagnosed with type 1 diabetes. Her telling her story gave me a window 

into the struggles and sacrifices each and every one of you make. 

To all of the mamas out there: Wow, thank you for your vigilance—hey, and the dads, too. We appreciate what you are doing 

each and every day to make sure that every one of these kids can 

live a happy and healthy and fulfilled life. Please continue to do 

what you do so that we can make sure that we do our job. 

Dr. Rodgers, your research is needed. It is important so we can 

continue to make the right decisions here, in this body, in this 

chamber. Unfortunately, in Alabama, diabetes continues to grow, 

approximately 568,000 Alabamians suffer with diabetes. That is 12 

percent of the population in my home State. It is estimated that 

probably 35,000 of these diagnoses have just recently happened. 

So my question for you is, this continual increase must be 

stopped. What are we seeing in the research and the development 

that tells us where this is coming from? What are the triggers? 

What do we need to know as we sit here today? 

Dr. RODGERS. Thank you for your question, Senator. What is 

driving the—certainly the increase in type 1 diabetes in individuals 

who, historically, have not had, you know, the sort of genetic predisposition seems to be something in the environment. And again, 

I think we are going to learn, as I mentioned earlier, from this 

TEDDY Study, what are some of those environmental triggers. 

We are also seeing, in answer to your earlier question, diabetes 

occurring at a much younger age, type 2 diabetes, and this may be 

the increase that you are referring to in the State of Alabama in 

young individuals as well. Some of that is the effect of lifestyle 

choices in terms of getting less physical activity, sort of being involved mostly behind a screen, you know, the video screen, or a television screen, or some other screen—— 

Senator BRITT. Put those devices down. 

Dr. RODGERS [continuing]. And not being as active as you may 

remember. Our food choices, for example. Those seem to be contributing to being overweight, and that in itself acts as—it makes the 
34 

insulin that is in our body not work as well as it should, a condition called insulin resistance. And so I think, you know, there are 

multiple factors that are driving it, but it certainly is related to a 

change in the environment. 

One final thing that I would say, and it certainly is true in Alabama, and others, you know. You may be aware that Alabama has 

one of the highest frequencies of gestational diabetes in any State 

in the country. And research that we have funded indicates that a 

mother who develops type—who develops gestational diabetes not 

only is that a higher risk for ultimately developing diabetes themselves, but the infant who is in that environment during her developing gestational diabetes, is also at a subsequent high risk. 

And that way you can imagine if that individual is a girl, ultimately, when she becomes a mother she may also pass that down 

at a younger and younger age. So that certainly is a contributing 

factor as well. And we are trying to break that cycle through some 

very innovative research efforts at the moment. 

Senator BRITT. Thank you so much. I see that my time has expired, but I just want to tell all of you: You inspire me. Please keep 

telling your story. Keep being vigilant. And we have work to do up 

here. And we are certainly committed to doing it. Thank you. 

Dr. RODGERS. Thank you, Senator. 

[Applause.] 

Vice Chair COLLINS. Thank you. 

Senator Murkowski. 

Senator MURKOWSKI. Thank you Madam—thank you Madam 

Chairman. And to those of you who are gathered here, whether you 

are the children in front of us, or the supporters, the caregivers, 

the parents, the friends, thank you. Thank you for your advocacy 

on behalf of yourself and others. Over the years, I have had so 

many different visits from young Alaskans who have come to me, 

and they have got their little story booklet, and there is pictures 

showing them over the years as they have—as they have dealt with 

their diabetes, but also what they have done as individuals who are 

brave enough, willing to make the long trip to Washington, DC, to 

come and tell their stories. So I join my colleagues up here to encourage you to do more of the same. 

Somewhere out there is Samantha from Wasilla. There, she is 

right up front there. Sam, I am looking forward to visiting with 

you. But it is—it is an effort, it is an effort. And I know that as 

young kids, you just want to be like everybody else, and everybody 

else; does not have an insulin pump; everybody else does not have 

to prick their finger; everybody else does not have to do what you 

are going through; everybody else’s moms and dads and caregivers 

do not worry about them and what is happening with their blood 

sugar levels. But this is why, this is why, again, you need to share 

your story. You need to make sure that others understand not only 

what you are going through, but why it is so important that we 

find—we find that cure, we find that treatment. So thank you for 

what you continue to do. 

I want to direct my question here to Dr. Rodgers. And many of 

us have asked this same question along the same line, Senator 

Tester, Senator Hyde-Smith, and now just Senator Britt. In trying 

to understand a little bit more about some of the environmental ex-
35 

posures that may contribute to risk of developing type 1 diabetes 

in my State. Of course, we are very, very rural in Alaska. We 

have—in the overall Alaskan population, we have a rate of 7.5 percent of Alaskans that have diabetes. Alaska Natives have a higher 

rate at 8.5 percent of our population. So it is significant for us. 

I was in the North Slope, which is the furthest north area, small 

villages up there, and went through the grocery stores, as much as 

you can call them a grocery stores. But the fact of the matter is, 

there is no fresh produce. In other words, there is no lettuce, lettuce; there is no carrots; there is no peas; there might be some occasional potatoes; there is no fruit. So how do you get—how do you 

get your vegetables, how do you get your fruits? Well, you might 

get them frozen if you are lucky. You might get your fruit in heavy 

fructose syrup. But the reality is, is the diet is a consideration for 

us and a huge concern. So as you are looking at, not only the access 

in rural areas to health care that can provide for screening, that 

can provide for that treatment. I am worried about areas where we 

simply, we are a literal food desert when it comes to those healthy 

foods. And as many in our rural villages have transitioned from 

subsistence foods to the commercial processed foods, it has resulted 

in escalating rises of diabetes. 

So I am assuming, Dr. Rodgers, as you are looking at this in your 

TEDDY Study, this part of your review is also under careful consideration. 

Dr. RODGERS. Absolutely, Senator. That is an area that I think 

we are going to learn from some, you know, general principles that 

will illuminate a lot of the origin, you know, of this condition, particularly type 1 diabetes. But I think the factors that you just outline, particularly, you know, food islands, are areas, and the types 

of food really, may be pushing up the numbers of individuals at 

risk for type 2 diabetes, as well. 

And even those with type 1 diabetes, of course the food is, you 

know, very important in terms of maintaining, you know, relatively 

constant levels of blood sugar throughout the day. You know, our 

role has really been in trying to develop the science basis to allow 

you to inform your policy decisions. One of the things that we are 

doing, that I will just say quickly, as we have an effort called TimeSensitive Studies in which we—when there is going to likely be a 

change in policy, for example, the development of rail systems, or 

you know, new food delivery systems or things like that, in an effort to diminish the amount of overweight and obesity or perhaps 

making foods better available. 

And we want to see whether it really does have an impact. We 

try to get these investigators to get rapidly funded for these studies 

so they can get baseline information very quickly. And then as policies are enabled or established, one can then study 6 months, a 

year, 2 years later, to really test the hypothesis on the effectiveness 

of such legislation. So something to sort of keep in mind, we really 

try to take a multi-faceted approach to our research. 

And again, as I mentioned earlier, rural health is certainly an 

area of enormous disparities that, I think, we have to keep our eye 

on. 

Senator MURKOWSKI. Thank you for that. 
36 

And Madam Chairman, I want to thank you and Senator Shaheen, all those that have been working so aggressively on this. 

You know, Senator Kennedy articulated very well that the efforts 

that we are making to reduce the costs of insulin, make it affordable, well it may be, it may sound like a lot of money. I think when 

we evaluate and consider the cost to our overall health care system 

when not properly diagnosed, when not screened early enough, 

when not given the treatments necessary, those are the costs that 

are out of sight and are something that we have to address. So I 

am with him on his, ‘‘Yada, yada, yada’’ or as I said, ‘‘Blah, blah, 

blah.’’ It is kind of the same thing. Let us do more than just talk 

about it. Let us make sure that access is there until we can find 

the treatment. 

Thank you for your leadership on this. 

Senator KENNEDY. Thank you for that. 

[Applause.] 

Vice Chair COLLINS. Senator Peters, thank you so much for your 

patience and your graciousness. 

Senator PETERS. Well, thank you, Madam Chair. And all I can 

say is, ‘‘Wow.’’ I have never been to a Committee hearing like this. 

I have not been around all that long, but I have been long enough 

to know that this does not normally happen here in Washington, 

to see so many people, all of these folks in front of me, all of these 

young folks. Thank you for coming here to Washington. Thank you 

for making sure your voice is heard. Thank you for your activism. 

It inspires me to see this, and also shows our democracy is alive 

and well when we have young folks that are engaged in this. So 

thank you for being here. 

Dr. Rodgers, I will ask my first question. And first of all, I just 

want to say I am grateful to JDRF for its partnership with the 

Elizabeth Weiser Caswell Diabetes Institute at the University of 

Michigan, in my home State, which is improving health outcomes 

for people with type 1 diabetes by developing just a comprehensive 

understanding of type 1 diabetes, metabolism, and adolescence in 

young adults as well as people with long-standing type 1 diabetes. 

The Institute was started by the Weiser-Caswell family in Michigan, in which the father and two of his three sons were diagnosed 

with type 1 diabetes. And Elizabeth Caswell became absolutely relentless in her pursuit for more diabetes research, education, and 

treatment. 

The JDRF Center of Excellence at the Caswell Diabetes Institute 

has been identifying new ways to control diabetes and to prevent 

the absolute devastating consequences of diabetes, allowing them 

to provide better care as well as health outcomes for people with 

type 1 diabetes. 

Specifically, the University of Michigan Center of Excellence Research takes cutting-edge approaches to identifying predictive 

markers and therapeutic targets for type 1 diabetes complications. 

The Center of Excellence also studies relationships among metabolic profiles, brain function, and stress allowing us to identify new 

ways to minimize the mental health burdens also associated with 

type 1 diabetes. 

So my question for you, sir, is, how does the institute at the University of Michigan rely on Special Diabetes Program funding spe-
37 

cifically? And what would the Institute be able to accomplish if we 

increase this funding? 

Dr. RODGERS. Thank you, Senator. I can say that the NIDDK has 

really been supporting research infrastructure at the University of 

Michigan for quite some time. In fact, one of the original NIDDKsupported, diabetes research center, going back to 1977, was at the 

University of Michigan, and I think they have had a substantial 

funding from that time moving forward. So it really is doing, you 

know, great work. 

In terms of type 1 diabetes, in fact, it is doing extremely cuttingedge research. I had mentioned earlier about the TrialNet involvement in developing the first drug that is FDA-approved that can 

delay the onset of Type 1 Diabetes by at least 3 years. Well, one 

of those major sites is at the University of Michigan. And the University of Michigan is actually also very actively involved in a—a 

co-lead, in fact, the SDP-supported Diabetes Foot Consortium, 

which aims to study the diabetic wound healing. 

They also actually have a diabetes—a center for diabetes 

translational research in which you work to develop the evidence 

to then put that into practice and get that implemented. And so 

there are many, many areas that that University should be very 

proud of, and we are certainly proud of it. 

So having additional funding will allow some very bright ideas 

of which I am sure there are many, many more at that center and 

others to move forward. And this SDP support will allow them to 

sort of, you know, get some of the things that are on the wish list 

moving forward much more rapidly. 

Senator PETERS. Right. Good to hear. As you have talked about 

in some of your previous testimony, diabetes is an insidious disease 

that impacts folks of all age groups. And we have to be thinking 

about it very broadly about all of the impact that it has. So I just 

want to ask a quick question related to Medicare and for older 

adults with Medicare. 

Medicare will not cover nutrition therapy services for individuals. 

And you have talked about the importance of nutrition in your testimony. Medical Nutrition Therapy is not just a critical service for 

people with diabetes, it can also have the potential to help 88 million Americans with pre-diabetes. 

So that is why I introduced with Senator Capito, who was here 

earlier, the Preventing Diabetes and Medicare Act, with my colleagues on the Committee to extend that coverage—Medicare coverage for Medical Nutrition Therapy Services with pre-diabetes and 

risk factors for developing type 2 diabetes. 

Real quickly, at Dr. Rodgers, do you believe that this coverage 

is essential and it will actually bring down costs in the long run? 

Dr. RODGERS. Senator, I really cannot sort of—to discuss or speculate, you know, in terms of the funding of another agency. What 

I can say is that we have worked with diabetes prevention program 

on sort of a landmark study in which we were able to show that 

either a medication or intensive lifestyle changes in people who 

have pre-diabetes and that lifestyle changes included changes to 

their nutrition, and at least 30 minutes of exercise, five times a 

week, greatly reduce one’s risk of going from pre-diabetes, this is 

type 2 diabetes, to diabetes, by some 57 percent. 
38 

The study ultimately led to CMS providing coverage for people 

over 65 because we had included in this diabetes prevention a substantial number of individuals that could be actually looked at, separately, and ultimately their staff made a calculation that providing this as a benefit for people on Medicare was cost effective 

even as early as 2 years. So one component of that is nutrition, but 

again, I cannot begin to speculate on more of that. 

Senator PETERS. Right. Well, thank you. Just, in closing off my 

comments, Madam Chair, is just to, again, thank you, for all of you 

being here. I think it is clear from what you have been hearing 

from my colleagues on this Committee, we are all committed to attacking this insidious disease. We have got to stay together, be focused on it, but I want to have a hopeful message, too, with all of 

you sitting here in front of me, with your bright, smiling faces, 

which have a great wonderful life ahead of you, yes you do as well. 

That I think we are probably living in one of the most exciting 

times in human history, in what you have to look forward to in the 

years ahead in terms of scientific advances. I mean we are looking 

at things like artificial intelligence, we are looking at synthetic biology, we have got all sorts of new technologies that are coming on 

board that will literally revolutionize our world in very exciting 

ways. And I am confident, as long as we stay together, as long as 

we lock arms, as long as we speak with one voice, we are going to 

defeat this disease. We are going to have ability to treat people 

with diabetes, and we are going to do it together. And we will succeed. Thank you very much 

[Applause.] 

Vice Chair COLLINS. Thank you so much, Senator Peters; and I 

am proud to be a co-sponsor of your Medical Nutrition Therapy bill. 

I think it is a great idea. 

I am just going to ask, very quickly, a couple of closing questions 

because we have a vote on, and I know you need to get on to the 

rest of your program. 

Mr. Harris, I wanted to ask a question of you from the perspective of being a parent—a parent of a son with type 2—type 1 rather, who was diagnosed at such an early age, at age 2. And I would 

ask you what advice do you have to other parents? And I would 

like you to focus, particularly, on the Black community because 

Black teens have the largest increase in prevalence of type 1 diabetes. 

Mr. HARRIS. Well, I would say that starting off, it is it is absolutely a devastating—you know, to find out, the news is absolutely 

devastating. The thing that we really tried to do was make sure 

that we found a support system of people we could talk to try to 

gain some knowledge, and that is one of the things that is great 

about today, is that the awareness, people being aware of it, and 

aware of the need for funding, and all of those things is really important. 

But as a parent, I know the thing that we learned early on is 

that it is a moving target, trying to keep your numbers correct, trying to keep up with the advances in technology that are happening, 

and all those kinds of things. 

And the thing I would just say to parents is do not beat yourself 

up about it. We actually had a nurse that was helping us, that 
39 

trained us in how to manage the disease back in the old days 

where it was still, you know, the finger pokes, and the syringes, 

and all of that. And she actually came to help us one night, and 

Max actually went low. And this is somebody who is a professional, 

who is teaching people how to, you know, deal with the disease, 

and she called us in a panic and said, ‘‘Oh, he went low.’’ And we 

said, ‘‘Yeah.’’ 

[Laughter.] 

Mr. HARRIS. So I think having that real world experience helped 

her as someone who was then teaching other parents. And even the 

parents I talked to over the last couple of days, that is the thing 

I have tried to always say to them, is just, you know, it is a moving 

target, it is not always going to be right, but you figure it out, you 

deal with it. It is one of those things, too, that as soon as you think 

you have got it figured out, you know, something changes, because 

the thing about—particularly the young people here today—is they 

are growing. So you know, their bodies are going to change, their 

attitudes about diabetes are going to change, and all of those 

things. So I think that the parental support is very important. 

I think across all communities—I know we talk about insulin affordability, I know that is a big piece of this also, that you have 

the tools to manage the disease in the right way. And I am also 

struck by one of the things that is happening where I think a cure 

is the destination, and I think we all agree upon that as the destination. Sometimes we disagree, even if we know where the destination is, we disagree on how we are going to get there. 

What I have been encouraged in this room is that the destination 

of finding the cure has been the most important thing that we all 

agree upon. But I also have to say that I love the fact that we are 

also talking about, I guess, the road to get to the cure, to make 

sure that that road is an affordable road, that it is a smooth road, 

as smooth as it can possibly be. 

And so I would just—I just want to say that I am here to support 

and my son, Max, was honored by JDRF a few years back and he 

said that he vows that he will be here until we find that destination—until we get to that destination of a cure. 

And the thing that I am encouraged about with all these young 

people here, is when they look back, and 10 years from now, or 

however many years down the road, they have kids and they have 

their families, and they are not going to have to have these conversations with their kids. It is going to be: What is diabetes? I 

have never heard of that before. 

Vice Chair COLLINS. That would be great. 

Mr. HARRIS. That is going to be the nice thing. So Senator Collins, I want to thank you for having me here today and allowing 

us all to speak and allowing all these young people to be here, because this is the future. And when diabetes is cured, each and everybody in this room is going to be a part of making that happen. 

[Applause.] 

Vice Chair COLLINS. Thank you. Well said. 

Elise, I know that Senator Shaheen wanted to be here today. So 

on her behalf, I am going to ask you a question. And that is, you 

live a very active life. You play all these sports. Could you tell us 
40 

how important it is that the technology that you use allows you to 

play those sports and to have a very fulfilling, active life? 

Ms. CATALDO. Yeah. Well, it is definitely a challenge, but the 

technology that we have nowadays helps so much. I am on the 

Omnipod which, it has a setting called Activity. And I put that on 

2 hours before training, or practice, or game, and 2 hours after. 

And it basically more closely monitors my blood sugars and gives 

me less insulin so that I do not go low. And that is so important. 

It has helped me so much. And that was also funded by the Special 

Diabetes Program. So I am really grateful for that. But it is really 

important to keep continuing that because playing in sports you 

can go dangerously low. 

Vice Chair COLLINS. Thank you. A great answer. 

And my final question is going to be for the President of JDRF. 

Doctor, we have worked so closely, Senator Shaheen and I, with 

you on the insulin question. And you have helped us, provided us 

with expertise in drafting our Insulin Act, which would reform the 

market to remove all of the perverse incentives that contribute to 

high prices, plus to put a $35 cap on monthly co-pays. And I think 

that is so important. It would also have important patient protection so that you do not have to go through prior approvals and all 

of the rigmarole that we hear about so often. 

So, we have talked about, today, that some of the manufacturers 

have lowered their price to $35. I do think that is in response to 

our legislation. I am glad they have done it, but I think that it is 

our legislation that caused them to do it. 

So, just to get you on the record, do you believe that it is important that we still pass Federal legislation like the Insulin Act that 

Senators Shaheen and I have introduced? 

Dr. KOWALSKI. Well, Senator Collins, thank you, and Senator 

Shaheen, so much, for your leadership on this topic. It is the number one topic I face when I travel around the country. And I am 

sure every parent in this room would bend your ear, that it is still 

a problem. 

We are fully aligned and supportive of the Insulin Act. No one 

in this country should go for lack of food or rent or a car payment 

for insulin which sustains their life. So we commend your work, 

and we will be supportive, and we look forward to seeing the Insulin Act pass. 

CONCLUSION OF HEARING

Vice Chair COLLINS. Thank you so much. Thank you. I want to 

thank everyone for being here today. I have frequently said that 

every time I chair the Children’s Congress, which I have done 

many, many times, I leave with a sense of renewed commitment. 

You inspire me. You saw that you inspired all of the Members who 

are here today, and you can make the difference when you go see 

your Members of Congress and urge them to support the Insulin 

Act, urge them to support the reauthorization of the Special Diabetes Program, which has been so successful in speeding up new 

technology that is making your lives better. 

Ultimately, we want a cure. And that is what we are all working 

toward. 
41 

So, thank you for coming from all over the country to be with us 

today. And a special thanks to Maria for coming with her mother 

from Yarmouth, Maine, to be with us today. 

With that, this hearing is—I have got to get the gavel to make 

it official—this hearing is now adjourned. 

[Applause.] 

[Whereupon, at 11:52 a.m., Tuesday, July 11, the hearing was 

concluded, and the committee was recessed, to reconvene subject to 

the call of the Chair.] 

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