II 

108TH CONGRESS 

1ST SESSION S. 1666

To amend the Public Health Service Act to establish comprehensive State 

diabetes control and prevention programs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 26, 2003

Mr. COCHRAN (for himself and Mr. KENNEDY) introduced the following bill; 

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

A BILL

To amend the Public Health Service Act to establish comprehensive State diabetes control and prevention programs, and for other purposes.

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Diabetes Prevention 

5 and Treatment Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Diabetes occurs in 2 forms, type 1 and type 

9 2 diabetes. Type 1 diabetes usually occurs during 
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1 childhood or adolescence and type 2 diabetes, which 

2 accounts for more than 9 out of 10 cases of diabe3 tes, usually occurs after age 40. Type 1 diabetes is 

4 a disease that results from the body’s failure to 

5 produce insulin, the hormone that ‘‘unlocks’’ the 

6 cells of the body, allowing glucose, or sugar, to enter 

7 and fuel the cells. People with type 1 diabetes must 

8 take daily insulin injections to stay alive. Type 2 di9 abetes results from insulin resistance, a condition in 

10 which the body cannot properly use insulin and can11 not make enough insulin to compensate for the in12 creased bodily need. Although some people with type 

13 2 diabetes also require daily insulin injections, often 

14 type 2 diabetes can be controlled through healthy 

15 diet, nutrition, and lifestyle changes. If not, medica16 tion and insulin shots may be used to control diabe17 tes. 

18 (2) There are approximately 17,000,000 individuals in the United States with diabetes, almost 1 19 ⁄3

20 of whom are unaware that they have the disease. 

21 (3) Diabetes is the sixth leading cause of death 

22 in the United States, contributing to over 200,000 

23 deaths every year. 

24 (4) Another 16,000,000 individuals in the 

25 United States have a condition known as ‘‘pre-diabe-
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1 tes’’, or impaired glucose tolerance. Unless treated, 

2 ‘‘pre-diabetes’’ dramatically increases the risk for 

3 developing type 2 diabetes and increases the risk of 

4 heart disease by nearly 50 percent. 

5 (5) Prevention efforts against type 2 diabetes 

6 that consisted of diet and exercise (such as cutting 

7 fat and calories and walking at least 30 minutes, 5 

8 days a week, resulting in a 5- to 7-percent weight 

9 loss) lowered the incidence of type 2 diabetes by 58 

10 percent. 

11 (6) There is a growing epidemic of type 2 dia12 betes in children and adolescents that may be linked 

13 to obesity and physical inactivity. Type 2 diabetes 

14 now accounts for between 8 and 46 percent of all 

15 new cases of diabetes among children who are re16 ferred to pediatric centers for care. 

17 (7) Diabetes is also a major contributor to 

18 heart disease, stroke, and high blood pressure. In 

19 adults, diabetes is the leading cause of new blind20 ness, end-stage renal failure, and nontraumatic 

21 lower limb amputations. People with diabetes are 2 

22 to 4 times more likely than the general population 

23 to have heart disease or to suffer a stroke. 

24 (8) Diabetes disproportionately affects commu25 nities of color. Type 2 diabetes is prevalent at rates 
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1 2.6 times higher among American Indians and Alas2 ka Natives than among whites. African-American 

3 adults have a 100-percent higher rate, and His4 panics a 90-percent higher rate, of type 2 diabetes 

5 than whites. 

6 (9) The African-American and Hispanic death 

7 rates from diabetes are twice that for whites. Among 

8 American Indians and Alaska Natives, the death 

9 rate from diabetes is 3 times higher than for whites. 

10 (10) More than 1 out of every 10 health care 

11 dollars, and at least 1 out of 4 dollars provided 

12 under the medicare program carried out under title 

13 XVIII of the Social Security Act, are spent on indi14 viduals in the United States with diabetes. 

15 (11) The economic cost of diabetes is conserv16 atively estimated at $132,000,000,000 annually. 

17 This includes $92,000,000,000 in direct medical ex18 penditures and $40,000,000,000 attributable to dis19 ability and premature mortality. 

20 (12) Reducing the progression of pre-diabetes 

21 to diabetes with the level of success achieved by the 

22 National Institutes of Health’s Diabetes Prevention 

23 Program could save $4,290,000,000 annually. 
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1 TITLE I—CENTERS FOR DISEASE 

2 CONTROL AND PREVENTION 

3 SEC. 101. COMPREHENSIVE STATE DIABETES CONTROL 

4 AND PREVENTION PROGRAMS. 

5 Part B of title III of the Public Health Service Act 

6 (42 U.S.C. 243 et seq.) is amended by striking section 

7 316 and inserting the following; 

8 ‘‘SEC. 316. STATE DIABETES CONTROL AND PREVENTION 

9 PROGRAMS. 

10 ‘‘(a) IN GENERAL.—The Secretary, acting through 

11 the Director of the Centers for Disease Control and Pre12 vention and in consultation with appropriate agencies, 

13 shall support comprehensive diabetes control and preven14 tion programs by awarding grants to eligible entities to 

15 provide public health surveillance, prevention, and control 

16 activities, and to assure affordable, high-quality diabetes 

17 care. 

18 ‘‘(b) ELIGIBILITY.—A State or territory is an eligible 

19 entity under this section. 

20 ‘‘(c) USE OF FUNDS.—Consistent with the com21 prehensive diabetes control and prevention plan submitted 

22 under subsection (d), an eligible entity that receives a 

23 grant under this section may use funds received under 

24 such grant to—
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1 ‘‘(1) conduct health and community research, 

2 including research on behavioral interventions, to 

3 prevent type 1 and 2 diabetes (including the develop4 ment of related complications) and the onset of type 

5 2 diabetes in persons with pre-diabetes or persons at 

6 high risk for developing diabetes; 

7 ‘‘(2) conduct demonstration projects, including 

8 community-based programs of diabetes control and 

9 prevention, and similar collaborations with academic 

10 institutions, hospitals, community centers, health in11 surers, researchers, health professionals, and non12 profit organizations; 

13 ‘‘(3) conduct public health surveillance and epi14 demiological activities relating to the prevalence of 

15 type 1 and 2 diabetes and assessing disparities in di16 abetes control and prevention, including such dis17 parities in underserved populations; 

18 ‘‘(4) provide public information and education 

19 programs; and 

20 ‘‘(5) provide education and training for health 

21 professionals, including allied health professionals. 

22 ‘‘(d) APPLICATION.—An eligible entity that seeks 

23 funding under this section shall submit an application to 

24 the Secretary at such time, in such manner, and con25 taining such information as the Secretary may require, in-
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1 cluding a comprehensive plan for diabetes-related preven2 tion and control strategies and activities to be undertaken 

3 or supported by the eligible entity, which—

4 ‘‘(1) is developed with the advice of stake5 holders from the public, private, and nonprofit sec6 tors with expertise relating to diabetes control, pre7 vention, and treatment; 

8 ‘‘(2) is intended to reduce the incidence, mor9 bidity, and mortality of type 1 and 2 diabetes, with 

10 a priority on preventing and controlling diabetes in 

11 at-risk populations and reducing disparities in un12 derserved populations; and 

13 ‘‘(3) describes the diabetes-related services and 

14 activities to be undertaken or supported by the eligi15 ble entity.’’. 

16 SEC. 102. CDC DIABETES CONTROL AND PREVENTION AC17 TIVITIES. 

18 Part B of title III of the Public Health Service Act 

19 (42 U.S.C. 243 et seq.) (as amended by section 101) is 

20 further amended by inserting after section 316, the fol21 lowing: 

22 ‘‘SEC. 316A. DIABETES CONTROL, PREVENTION, AND RE23 SEARCH ACTIVITIES. 

24 ‘‘(a) IN GENERAL.—The Secretary, acting through 

25 the Director of the Centers for Disease Control and Pre-
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1 vention, and in collaboration with appropriate agencies, 

2 shall conduct, support, and promote the coordination of 

3 research, including translational and preventive investiga4 tions and studies, demonstrations and pilot programs, 

5 training and studies relating to surveillance, control, and 

6 prevention of type 1 and 2 diabetes (including the develop7 ment of related complications) and the onset of type 2 dia8 betes in persons with pre-diabetes or persons at high risk 

9 for developing diabetes. 

10 ‘‘(b) ACTIVITIES.—Activities that the Secretary shall 

11 conduct, support, and promote as described in subsection 

12 (a) shall include—

13 ‘‘(1) the collection, analysis, and publication of 

14 biennial data on the prevalence and incidence of type 

15 1 and 2 diabetes and of pre-diabetes, in coordination 

16 with activities undertaken under section 317H; 

17 ‘‘(2) the development of uniform data sets for 

18 public health surveillance and clinical quality im19 provement activities; 

20 ‘‘(3) the identification of evidence-based and 

21 cost-effective public health best practices, including 

22 practices and models developed through grants 

23 awarded under section 316; 

24 ‘‘(4) the development of early detection and 

25 prevention programs, such as screening to identify 
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1 diabetic retinopathy and to prevent blindness, as 

2 well as neuropathy, nephropathy, peripheral vascular 

3 disease, podiatric examinations to prevent foot ul4 cers, and lower extremity amputations; and 

5 ‘‘(5) the establishment and operation of a na6 tional diabetes laboratory to develop and improve 

7 laboratory methods to assist in the diagnosis, treat8 ment, and prevention of diabetes, including the de9 velopment of less invasive ways to monitor blood glu10 cose, such as nonmydriatic retinal imaging, and to 

11 prevent hypoglycemia, and the improvement of exist12 ing glucometers that measure blood glucose. 

13 ‘‘(c) PRIORITY.—The Secretary shall give priority to 

14 programs and activities to reduce disparities in diabetes 

15 prevention, diagnosis, management, and care for high-risk 

16 or underserved populations. Such programs and activities 

17 may include—

18 ‘‘(1) refinement of the National Health and Nu19 trition Examination Survey to address the lifestyle 

20 of such populations; 

21 ‘‘(2) enhanced efforts to develop culturally ap22 propriate interventions; and 

23 ‘‘(3) strategies to enhance the quality, accuracy, 

24 and timeliness of diabetes-related morbidity and 

25 mortality data for such populations. 
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1 ‘‘(d) COLLABORATIVE ACTIVITIES.—The activities 

2 described in subsection (b) may be conducted in collabora3 tion with eligible entities that are awarded a grant under 

4 section 316. 

5 ‘‘(e) TRAINING AND TECHNICAL ASSISTANCE.—The 

6 Secretary may provide training, technical assistance, sup7 plies, equipment, and services, and may detail any officer 

8 or employee of the Department of Health and Human 

9 Services, to State and local health agencies, or to any pub10 lic or nonprofit entity designated by a State health agency, 

11 with respect to the planning, development, and operation 

12 of any program or service carried out pursuant to sub13 section (a) or in lieu of grant funds provided under section 

14 316. 

15 ‘‘(f) IMPROVEMENT OF MORTALITY DATA COLLEC16 TION.—

17 ‘‘(1) ASSESSMENT.—The activities described in 

18 subsection (b)(1) shall include an assessment of dia19 betes as a primary or underlying cause of death and 

20 analysis of any under-reporting of diabetes as a pri21 mary or underlying cause of death in order to pro22 vide an accurate estimate of yearly deaths related to 

23 diabetes. 

24 ‘‘(2) DEATH CERTIFICATE ADDITIONAL LAN25 GUAGE.—In carrying out the activities described in
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1 subsection (b)(1), the Secretary may promote the 

2 addition of language to death certificates to improve 

3 collection of diabetes mortality data, including add4 ing questions for the individual certifying to the 

5 cause of death regarding whether the deceased had 

6 diabetes and whether diabetes was an immediate, 

7 underlying, or contributing cause of or condition 

8 leading to death. 

9 ‘‘(g) REPORT.—

10 ‘‘(1) IN GENERAL.—The Director shall submit 

11 to the Committee on Health, Education, Labor, and 

12 Pensions of the Senate and the Committee on En13 ergy and Commerce of the House of Representatives 

14 annual reports describing the activities undertaken 

15 under this section and section 316. 

16 ‘‘(2) CONTENT.—The reports shall include an—

17 ‘‘(A) evaluation of the accuracy of data re18 garding the incidence, prevalence, complica19 tions, and costs of diabetes; and 

20 ‘‘(B) projections regarding trends in each 

21 of the areas described in subparagraph (A). 

22 ‘‘(3) AVAILABILITY.—The Director shall make 

23 such reports publicly available in print and on the 

24 Centers for Disease Control and Prevention website. 
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1 ‘‘SEC. 316B. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated to carry out 

3 sections 316 and 316A, $120,000,000 for fiscal year 

4 2004, and such sums as may be necessary for each of fis5 cal years 2005 through 2008.’’. 

6 TITLE II—IMPROVING THE 

7 QUALITY OF DIABETES PRE8 VENTION AND CARE 

9 SEC. 201. DIABETES CARE QUALITY IMPROVEMENT 

10 GRANTS. 

11 Part B of title III of the Public Health Service Act 

12 (42 U.S.C. 243 et seq.) (as amended by section 102) is 

13 further amended by inserting after section 316B the fol14 lowing: 

15 ‘‘SEC. 316C. IMPROVING QUALITY OF DIABETES PREVEN16 TION AND CARE. 

17 ‘‘(a) IN GENERAL.—After completion of activities 

18 under subsection (d), the Secretary, acting through the 

19 Director of the Centers for Disease Control and Preven20 tion, and in collaboration with the Director of the Agency 

21 for Healthcare Research and Quality, shall award competi22 tive grants to eligible entities to apply the best practices 

23 identified by the Secretary under subsection (d) for diabe24 tes prevention and control. 

25 ‘‘(b) ELIGIBILITY.—An entity is eligible for a grant 

26 under this section if such entity is—
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1 ‘‘(1) a State, territory, Indian tribe, tribal orga2 nization, public or nonprofit entity; or 

3 ‘‘(2) a partnership of an entity described in 

4 paragraph (1) and an appropriate private sector or5 ganization. 

6 ‘‘(c) PRIORITY.—In awarding grants under this sec7 tion, the Secretary shall give priority to eligible entities 

8 that propose to carry out programs to reduce disparities 

9 in diabetes prevention and control for high-risk or under10 served populations. 

11 ‘‘(d) BEST PRACTICES.—

12 ‘‘(1) IN GENERAL.—Not later than 1 year after 

13 the date of enactment of this section, the Secretary 

14 shall identify evidence-based best practices, evidence15 based guidelines and other effective models for dia16 betes prevention and control, which may be adopted 

17 and applied by eligible entities under this section. 

18 ‘‘(2) SPECIFIC BEST PRACTICES.—Best prac19 tices, as described in paragraph (1), may include—

20 ‘‘(A) State or community-based interven21 tions, school-based screening, care and preven22 tion programs, health systems improvement 

23 strategies, and health and environmental poli24 cies that promote improved nutrition and phys25 ical activity; 
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1 ‘‘(B) case management or disease manage2 ment quality improvements programs; 

3 ‘‘(C) appropriate communication, training, 

4 or regional outreach and health promotion ini5 tiatives, including Internet-based initiatives; or 

6 ‘‘(D) models developed or validated by dia7 betes research and training centers established 

8 under section 431. 

9 ‘‘(e) APPLICATION.—An eligible entity that seeks 

10 funding under this section shall prepare and submit to the 

11 Secretary an application at such time, in such manner, 

12 and containing such information as the Secretary deter13 mines to be necessary, including information regarding 

14 how such entity would use funds received under this sec15 tion to supplement activities carried out under such enti16 ty’s comprehensive diabetes control and prevention plan 

17 under section 316. 

18 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section, 

20 $50,000,000 for fiscal year 2004, and such sums as may 

21 be necessary for each of fiscal years 2005 through 2008.’’. 
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1 SEC. 202. ENHANCEMENT OF DIABETES EDUCATION AND 

2 OUTREACH. 

3 Part P of title III of the Public Health Service Act 

4 (42 U.S.C. 243 et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘SEC. 399O. NATIONAL DIABETES EDUCATION AND OUT7 REACH. 

8 ‘‘(a) PURPOSE.—The Secretary, acting through the 

9 Diabetes Mellitus Interagency Coordinating Committee, 

10 shall coordinate a national diabetes education program to 

11 support, develop, and implement education initiatives and 

12 outreach strategies appropriate for both type 1 and 2 dia13 betes. Such activities may include public awareness cam14 paigns, public service announcements and community 

15 partnership workshops, as well as programs targeted at 

16 businesses and employers, managed care organizations, 

17 and health care providers. 

18 ‘‘(b) PRIORITY.—The Secretary shall emphasize 

19 translation of new scientific and clinical findings into uti20 lizable information for health care providers and patients. 

21 The Secretary shall also give priority to reaching high-risk 

22 or underserved populations. 

23 ‘‘(c) COLLABORATION.—In carrying out this section, 

24 the Secretary shall consult and collaborate with stake25 holders from the public, private, and nonprofit sectors
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1 with expertise relating to diabetes control, prevention, and 

2 treatment. 

3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

5 $15,000,000 for fiscal year 2004 and such sums as may 

6 be necessary for each of fiscal years 2005 through 2008.’’. 

7 SEC. 203. DIABETES QUALITY MEASURES. 

8 Section 912 of the Public Health Service Act (42 

9 U.S.C. 299b–1) is amended by adding at the end the fol10 lowing: 

11 ‘‘(d) QUALITY MEASURES.—In carrying out sub12 section (a), the Director shall—

13 ‘‘(1) develop and periodically update, lists of 

14 scientifically validated, evidence-based quality meas15 ures for assessing and improving clinical services 

16 and counseling related to diabetes; and 

17 ‘‘(2) support the development and validation of 

18 needed measures.’’. 

19 SEC. 204. DIABETES QUALITY IMPROVEMENT PROGRAM. 

20 (a) DIABETES QUALITY IMPROVEMENT PROGRAM.—

21 The Secretary of Health and Human Services, acting 

22 through the Director of the Centers for Disease Control 

23 and Prevention, shall establish a Diabetes Quality Im24 provement Program to disseminate and promote the wide25 spread use of national performance measures for diabetes 
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1 care and for quality improvement to all diabetes preven2 tion and control programs under the authority of the Sec3 retary. The National Diabetes Quality Improvement Pro4 gram shall promote the adoption of these national per5 formance measures to public and private health care sys6 tems providing care to persons with diabetes and expand 

7 the number and scope of public-private partnerships im8 plementing such Program. 

9 (b) EVALUATION.—The Secretary of Health and 

10 Human Services, acting through the Director of the Agen11 cy for Healthcare Research and Quality and the Director 

12 of the Centers for Disease Control and Prevention, shall 

13 undertake an evaluation of quality improvement initiatives 

14 supported under this section. 

15 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to carry out this section, 

17 such sums as may be necessary for each of fiscal years 

18 2004 through 2008. 

19 SEC. 205. MONITORING THE QUALITY AND DISPARITIES IN 

20 DIABETES CARE. 

21 Part A of title IX of the Public Health Service Act 

22 (42 U.S.C. 299 et seq.) is amended by adding at the end 

23 the following: 
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1 ‘‘SEC. 904. AREAS OF SPECIAL EMPHASIS. 

2 ‘‘The Secretary, acting through the Director, shall in3 corporate within the annual quality report required under 

4 section 913(b)(2) and the annual disparities report re5 quired under section 903(a)(6), scientific evidence and in6 formation appropriate for monitoring the quality and safe7 ty of diabetes care and identifying, understanding, and re8 ducing disparities in care.’’. 

9 TITLE III—NATIONAL 

10 INSTITUTES OF HEALTH 

11 SEC. 301. ENHANCEMENT OF DIABETES RESEARCH AND 

12 TRAINING CENTERS. 

13 (a) IN GENERAL.—Section 431(a)(1) of the Public 

14 Health Service Act (42 U.S.C. 285c–5(a)(1)) is amended 

15 by striking ‘‘Consistent with applicable recommendations 

16 of the National Commission on Diabetes,’’ and inserting 

17 ‘‘Consistent with applicable recommendations of the Dia18 betes Research Working Group and with updated strategic 

19 research plans developed through the Diabetes Mellitus 

20 Interagency Coordinating Committee,’’. 

21 (b) AUTHORIZED RESEARCH.—Section 

22 431(a)(1)(B)(i) of the Public Health Service Act (42 

23 U.S.C. 285c–5(a)(1)(B)(i)) is amended by inserting 

24 ‘‘basic, clinical, behavioral, translational, and preventa25 tive’’ before ‘‘research’’. 
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1 (c) EDUCATION AND TRAINING.—Section 431(a)(2) 

2 of the Public Health Service Act (42 U.S.C. 285c–5(a)(2)) 

3 is amended by striking ‘‘paragraph (1)(B)(ii).’’ and insert4 ing ‘‘paragraph (1)(B)(ii). Such funds may also be used 

5 for pre- and post-doctoral research fellowship training and 

6 for research career development, meeting such require7 ments as the Secretary may prescribe.’’. 

8 SEC. 302. DIABETES RESEARCH PLANNING AND COORDINA9 TION. 

10 Section 429 of the Public Health Service Act (42 

11 U.S.C. 285c–3) is amended by adding at the end the fol12 lowing: 

13 ‘‘(d) The Diabetes Mellitus Interagency Coordinating 

14 Committee shall develop and periodically update a stra15 tegic research plan for diabetes, building upon and updat16 ing the overall scientific guidance provided by the 1999 

17 Strategic Plan of the congressionally established Diabetes 

18 Research Working Group. In engaging in strategic re19 search planning for diabetes, the Committee shall address 

20 broad, multiple avenues of current and emerging research 

21 needs and opportunity, including clinical research in dia22 betes, the genetics of diabetes, diabetes in children and 

23 youth, and diabetes in underserved or high-risk popu24 lations. The Committee shall also coordinate the efforts 

25 of the National Diabetes Education Program.’’. 
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1 SEC. 303. GENETICS OF DIABETES. 

2 Title IV of the Public Health Service Act (42 U.S.C. 

3 281 et seq.) is amended by inserting after section 430 the 

4 following: 

5 ‘‘SEC. 430A. GENETICS OF DIABETES. 

6 ‘‘The Diabetes Mellitus Interagency Coordinating 

7 Committee, in collaboration with the Directors of the Na8 tional Human Genome Research Institute, the National 

9 Institute of Diabetes and Digestive and Kidney Diseases, 

10 and the National Institute of Environmental Health 

11 Sciences, and other voluntary organizations and interested 

12 parties, shall—

13 ‘‘(1) coordinate and assist efforts of the Type 

14 1 Diabetes Genetics Consortium, which will collect 

15 and share valuable DNA information from type 1 di16 abetes patients from studies around the world; and 

17 ‘‘(2) provide continued coordination and sup18 port for the consortia of laboratories investigating 

19 the genomics of diabetes.’’. 

20 SEC. 304. RESEARCH AND TRAINING ON DIABETES IN UN21 DERSERVED AND MINORITY POPULATIONS. 

22 (a) RESEARCH.—Subpart 3 of part C of title IV of 

23 the Public Health Service Act (42 U.S.C. 285c et seq.) 

24 is amended by adding at the end the following:
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1 ‘‘SEC. 434B. RESEARCH ON DIABETES IN UNDERSERVED 

2 AND MINORITY POPULATIONS. 

3 ‘‘(a) IN GENERAL.—The Director of the Institute, in 

4 coordination with the Director of the National Center on 

5 Minority Health and Health Disparities and other appro6 priate institutes and centers, shall expand, intensify, and 

7 coordinate research programs on pre-diabetes, type 1 dia8 betes and type 2 diabetes in underserved populations and 

9 minority groups. 

10 ‘‘(b) RESEARCH.—The research described in sub11 section (a) shall include research on—

12 ‘‘(1) behavior, including diet and physical activ13 ity and other aspects of behavior; 

14 ‘‘(2) environmental factors related to type 2 di15 abetes that are unique to, more serious, or more 

16 prevalent, among underserved or high-risk popu17 lations; 

18 ‘‘(3) research on the prevention of complica19 tions, which are unique to, more serious, or more 

20 prevalent among minorities, as well as research on 

21 how to effectively translate the findings of clinical 

22 trials and research to improve methods for self-man23 agement and health care delivery; and 

24 ‘‘(4) genetic studies of diabetes, consistent with 

25 research conducted under section 430A. 
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1 ‘‘(c) DEFINITION.—In this section, the term ‘minor2 ity group’ has the meaning given the term ‘racial and eth3 nic minority group’ in section 1707. 

4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated for purposes of carrying 

6 out this section $20,000,000 for fiscal year 2004 and such 

7 sums as may be necessary for each of fiscal years 2005 

8 through 2008.’’. 

9 (b) DIVISION DIRECTORS.—Section 428 of the Public 

10 Health Service Act (42 U.S.C. 285c–2) is amended—

11 (1) in subsection (b)(1), by inserting ‘‘(includ12 ing research training of members of minority popu13 lations in order to facilitate their conduct of diabe14 tes-related research in underserved populations and 

15 minority groups)’’ after ‘‘research programs’’; and 

16 (2) by adding at the end the following: 

17 ‘‘(c) DEFINITION OF MINORITY GROUP.—In this sec18 tion, the term ‘minority group’ has the meaning given the 

19 term ‘racial and ethnic minority group’ in section 1707.’’. 

20 SEC. 305. AUTHORIZATION OF APPROPRIATIONS. 

21 Subpart 3 of part C of title IV of the Public Health 

22 Service Act (42 U.S.C. 285c et seq.) (as amended by sec23 tion 304(a)) is amended by adding at the end the fol24 lowing: 
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1 ‘‘SEC. 434C. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘For the purpose of carrying out this subpart with 

3 respect to the programs of the National Institute of Diabe4 tes and Digestive and Kidney Diseases, other than section 

5 434B, there are authorized to be appropriated such sums 

6 as may be necessary for each of fiscal years 2004 through 

7 2008.’’. 

8 TITLE IV—REDUCING DIABETES 

9 AMONG CHILDREN AND YOUTH 

10 SEC. 401. PROGRAMS OF CENTERS FOR DISEASE CONTROL 

11 AND PREVENTION. 

12 Part B of title III of the Public Health Service Act 

13 (42 U.S.C. 243 et seq.) is amended by striking section 

14 317H and inserting the following: 

15 ‘‘SEC. 317H. DIABETES IN CHILDREN AND YOUTH. 

16 ‘‘(a) SURVEILLANCE ON TYPE 1 DIABETES.—The 

17 Secretary, acting through the Director of the Centers for 

18 Disease Control and Prevention and in consultation with 

19 the Director of the National Institutes of Health, shall de20 velop a sentinel system to collect data on type 1 diabetes, 

21 including the incidence and prevalence of type 1 diabetes 

22 and shall establish a national database for such data. 

23 ‘‘(b) TYPE 2 DIABETES IN YOUTH.—The Secretary 

24 shall implement a national public health effort to address 

25 type 2 diabetes in youth, including—
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1 ‘‘(1) enhancing surveillance systems and ex2 panding research to better assess the prevalence and 

3 incidence of type 2 diabetes in youth and determine 

4 the extent to which type 2 diabetes is incorrectly di5 agnosed as type 1 diabetes among children; 

6 ‘‘(2) standardizing and improving methods to 

7 assist in the diagnosis, treatment, and prevention of 

8 diabetes including developing less invasive ways to 

9 monitor blood glucose to prevent hypoglycemia such 

10 as nonmydriatic retinal imaging and improving exist11 ing glucometers that measure blood glucose; and 

12 ‘‘(3) developing methods to identify obstacles 

13 facing children in traditionally underserved popu14 lations to obtain care to prevent or treat type 2 dia15 betes. 

16 ‘‘(c) LONG-TERM EPIDEMIOLOGICAL STUDIES ON DI17 ABETES IN CHILDREN.—The Secretary, acting through 

18 the Director of the Centers for Disease Control and Pre19 vention and the Director of the National Institute of Dia20 betes and Digestive and Kidney Diseases, shall conduct 

21 or support long-term epidemiology studies in children with 

22 diabetes or at risk for diabetes. Such studies shall inves23 tigate the causes and characteristics of the disease and 

24 its complications. 
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1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section, 

3 $20,000,000 for fiscal year 2004 and such sums as may 

4 be necessary for each of fiscal years 2005 through 2008.’’. 

5 SEC. 402. PROGRAMS OF NATIONAL INSTITUTES OF 

6 HEALTH. 

7 Subpart 3 of part C of title IV of the Public Health 

8 Service Act (42 U.S.C. 285c et seq.) is amended by strik9 ing section 434A and inserting the following: 

10 ‘‘SEC. 434A RESEARCH ON DIABETES IN CHILDREN AND 

11 YOUTH. 

12 ‘‘(a) IN GENERAL.—Consistent with the Pediatric 

13 Research Initiative established under section 409D, the 

14 Director of the Institute shall expand, intensify, and co15 ordinate research programs and efforts of the National In16 stitutes of Health to treat, cure, and prevent diabetes in 

17 children. 

18 ‘‘(b) CLINICAL TRIAL INFRASTRUCTURE; INNOVA19 TIVE TREATMENTS.—The Secretary, acting through the 

20 Director of the National Institutes of Health, shall sup21 port clinical research centers and testing of innovative 

22 treatments for the prevention, detection, treatment, and 

23 cure of diabetes. Such treatments may include testing of 

24 islet cell transplantation, new insulin preparations, insulin 

25 delivery methods, and blood sugar monitoring devices.
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1 ‘‘(c) PREVENTION OF DIABETES.—The Secretary, 

2 acting through the appropriate agencies, shall provide for 

3 a national effort to prevent diabetes. Such effort shall pro4 vide for a combination of increased research and develop5 ment of prevention strategies, such as consideration of 

6 vaccine development, coupled with the appropriate ability 

7 to test the effectiveness of such strategies in clinical trials, 

8 including strategies to prevent the onset and progression 

9 of type 1 diabetes. 

10 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated to carry out this section 

12 such sums as may be necessary for each of fiscal years 

13 2004 through 2008.’’. 

14 TITLE V—REPORTS 

15 SEC. 501. SURGEON GENERAL’S REPORT ON THE PUBLIC 

16 HEALTH IMPACT OF DIABETES. 

17 (a) IN GENERAL.—The Surgeon General may pre18 pare a report on diabetes, including the prevalence of dia19 betes and the adequacy of data collection and analysis con20 cerning diabetes. 

21 (b) CONTENTS.—The report described in subsection 

22 (a) shall—

23 (1) set forth recommendations to address un24 derserved and high-risk populations; 
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1 (2) set forth recommendations to reduce the 

2 morbidity, mortality, and prevalence of diabetes in 

3 the United States; and 

4 (3) contain an action plan to implement the 

5 recommendations under paragraphs (1) and (2). 

6 (b) ISSUANCE OF REPORT.—Not later than 3 years 

7 after the date of enactment of this Act, the Surgeon Gen8 eral shall submit to the Committee on Health, Education, 

9 Labor, and Pensions of the Senate and the Committee on 

10 Energy and Commerce of the House of Representatives 

11 the report described in subsection (a). 

12 (c) DEFINITION OF DIABETES.—In this section, the 

13 term ‘‘diabetes’’ means type 1 diabetes and its complica14 tions, type 2 diabetes and its complications, and pre-diabe15 tes or impaired glucose tolerance. 

16 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 $1,000,000 for fiscal year 2004, and such sums as may 

19 be necessary for each of fiscal years 2005 and 2006.

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