II 

111TH CONGRESS 

1ST SESSION S. 2734 

To amend the Public Health Service Act with respect to the prevention 

of diabetes, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 5, 2009 

Mr. FRANKEN (for himself and Mr. LUGAR) 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 with respect to 

the prevention of diabetes, 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 Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 The Congress makes the following findings: 

8 (1) According to the Centers for Disease Con9 trol and Prevention (CDC), the prevalence of diabeVerDate Nov 24 2008 05:59 Nov 06, 2009 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2734.IS S2734

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1 tes in the United States has more than doubled in 

2 the past quarter-century. 

3 (2) The CDC reports that there are now more 

4 than 23,600,000 people in the United States living 

5 with diabetes and another 57,000,000 individuals 

6 with ‘‘pre-diabetes’’ in the United States, which 

7 means that they have higher than normal blood glu8 cose levels or are at increased risk of developing dia9 betes based on multiple risk factors. 

10 (3) In 2002, the landmark Diabetes Prevention 

11 Program (DPP) study found that lifestyle changes, 

12 such as diet and exercise, can prevent or delay the 

13 onset of type 2 diabetes, and that participants who 

14 made such lifestyle changes reduced their risk of 

15 getting type 2 diabetes by 58 percent with some re16 turning to normal blood glucose levels. 

17 (4) The New York Times has reported that life18 style-based interventions to control diabetes have re19 sulted in positive outcomes for patients, yet despite 

20 these successes, such interventions were often 

21 unsustainable. While insurance companies cover the 

22 treatments of complications of unchecked diabetes, 

23 they tend not to cover the cheaper interventions to 

24 prevent such complications. 


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1 (5) Emerging research and demonstrations 

2 projects funded by the National Institutes of Health 

3 and the CDC in partnership with Indiana University 

4 and the YMCA show that a carefully designed group 

5 lifestyle intervention can be delivered for less than 

6 $300 per year in community settings and can 

7 achieve similar weight loss results to the DPP for 

8 adults with pre-diabetes. 

9 (6) Diabetes carries staggering costs. In 2007, 

10 the total amount of the direct and indirect costs of 

11 diabetes was estimated at $174,000,000,000 accord12 ing to the American Diabetes Association. 

13 (7) The Urban Institute reported that if the na14 tion makes a substantial investment in a national 

15 program that supports group-based structured life16 style intervention programs for individuals at-risk of 

17 developing type 2 diabetes offered by trained non-cli18 nicians in community settings, the Nation could save 

19 $191,000,000,000 over 10 years and achieve a 50 

20 percent reduction in diabetes cases among partici21 pants. 

22 (8) There is a need to increase the availability 

23 of effective community-based lifestyle programs for 

24 diabetes prevention and offer incentive payments to 

25 health care providers who refer at-risk patients for 


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1 enrollment in such programs to prevent diabetes, re2 duce complications, and lower the costs associated 

3 with diabetes treatment in the United States, and 

4 the Federal Government should encourage efforts to 

5 replicate the results of the Diabetes Prevention Pro6 gram on a wider scale. 

7 SEC. 3. NATIONAL DIABETES PREVENTION PROGRAM. 

8 Title III of the Public Health Service Act (42 U.S.C. 

9 241 et seq.) is amended by inserting after section 317T 

10 the following: 

11 ‘‘SEC. 317U. NATIONAL DIABETES PREVENTION PROGRAM. 

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

13 the Director of the Centers for Disease Control and Pre14 vention, shall establish a national diabetes prevention pro15 gram targeted at persons at high risk for diabetes of all 

16 ages in order to eliminate the preventable burden of diabe17 tes. 

18 ‘‘(b) PROGRAM.—The program under subsection (a) 

19 shall include the following: 

20 ‘‘(1) GRANTS FOR COMMUNITY-BASED DIABE21 TES PREVENTION PROGRAM MODEL SITES FOR PER22 SONS AT HIGH RISK FOR DIABETES.—The Secretary 

23 may award grants to recognized eligible entities— 


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1 ‘‘(A) to support community-based diabetes 

2 prevention model sites that work with the 

3 health care delivery system— 

4 ‘‘(i) to identify persons at high risk 

5 for diabetes; and 

6 ‘‘(ii) to refer such persons to or pro7 vide such persons with cost-effective group8 based lifestyle intervention programs; and 

9 ‘‘(B) to evaluate— 

10 ‘‘(i) methods for ensuring the 

11 scalability of recognized community-based 

12 diabetes prevention model sites nationally; 

13 ‘‘(ii) the health and economic benefits 

14 of a national diabetes prevention program 

15 for persons at high risk for diabetes in cer16 tain age groups, including the pre-Medi17 care population; 

18 ‘‘(iii) emerging approaches to identify 

19 and engage persons at high risk for diabe20 tes in health care and community-based 

21 programs; 

22 ‘‘(iv) novel strategies for linking com23 munity-based program delivery with exist24 ing clinical services; and 


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1 ‘‘(v) the costs and cost effectiveness of 

2 clinic-community linkages. 

3 ‘‘(2) RECOGNITION PROGRAM.—The Secretary 

4 shall develop and implement a program under which 

5 the Secretary recognizes, and re-recognizes on an 

6 annual basis, eligible entities that deliver commu7 nity-based diabetes prevention services. To be recog8 nized under this paragraph, an eligible entity shall— 

9 ‘‘(A) describe its system for obtaining re10 ferral from health care professionals for persons 

11 at high risk for diabetes; 

12 ‘‘(B) provide proof that the entity’s staff 

13 have been trained as diabetes prevention pro14 gram lifestyle interventionists and the entity 

15 has a system in place to ensure that staff re16 ceive timely training updates; 

17 ‘‘(C) agree to maintain a community board 

18 (for purposes of advising the entity’s commu19 nity-based diabetes prevention program) whose 

20 membership includes— 

21 ‘‘(i) a person at high risk for diabetes 

22 who has completed a lifestyle intervention; 

23 ‘‘(ii) a health care professional who 

24 refers persons at high risk for diabetes to 

25 lifestyle intervention programs; 


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1 ‘‘(iii) community leaders; 

2 ‘‘(iv) representatives of the health in3 surance industry; and 

4 ‘‘(v) representatives of employers, 

5 businesses, and nonprofit organizations 

6 that are committed to offering healthy food 

7 and physical activity opportunities for resi8 dents; 

9 ‘‘(D) agree to provide data to the Sec10 retary for outcome evaluation monitoring pur11 poses and quality improvement, including data 

12 regarding the number of persons served, partic13 ipant attendance, completion rates, weight loss 

14 obtained, participant satisfaction, and referring 

15 clinician satisfaction; 

16 ‘‘(E) develop a plan for communications 

17 between referring clinicians and community18 based diabetes prevention program model sites; 

19 ‘‘(F) agree to make available to the Sec20 retary copies of materials used in the entity’s 

21 community-based diabetes prevention program; 

22 and 

23 ‘‘(G) provide evidence to the Secretary of 

24 quality checks on trainers. 


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1 ‘‘(3) TRAINING AND OUTREACH.—In partner2 ship with State diabetes prevention and control pro3 grams, academic institutions, and a national net4 work of community-based nonprofit organizations fo5 cused on health and well-being, the Secretary shall 

6 develop and implement, directly or through grants to 

7 eligible entities— 

8 ‘‘(A) a curriculum development and train9 ing program for diabetes prevention master and 

10 lifestyle intervention instructors to ensure con11 sistency in— 

12 ‘‘(i) the principles of type 2 diabetes 

13 prevention programming throughout the 

14 United States; and 

15 ‘‘(ii) the collection of outcomes data 

16 for quality assurance; 

17 ‘‘(B) community outreach programs to 

18 identify community and provider groups to par19 ticipate in the national diabetes prevention pro20 gram and coordinate quality assurance pro21 grams at the local level in partnership with 

22 community-based organizations; and 

23 ‘‘(C) a national partner outreach program 

24 to identify and work with national partners— 


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1 ‘‘(i) to identify workers in the commu2 nity to complete training under subpara3 graph (A); and 

4 ‘‘(ii) to facilitate the recognition of eli5 gible entities under paragraph (2). 

6 ‘‘(4) EVALUATION, MONITORING, AND TECH7 NICAL ASSISTANCE.—The Secretary shall provide 

8 quality assurance for each community-based diabetes 

9 prevention program model site funded under para10 graph (1) and, as necessary and feasible, for other 

11 recognized community-based diabetes prevention 

12 programs, through evaluation, monitoring, and tech13 nical assistance, including by— 

14 ‘‘(A) reviewing applications for recognition 

15 under paragraph (2); 

16 ‘‘(B) evaluating and monitoring program 

17 data including providing standardized feedback 

18 to sites for quality improvement; 

19 ‘‘(C) making de-identified data available to 

20 the public to ensure transparency of the rec21 ognition program under paragraph (2); 

22 ‘‘(D) conducting site visits and periodic au23 dits; 

24 ‘‘(E) providing technical assistance and a 

25 process for improving performance in sites not 


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1 meeting standards for recognition under para2 graph (2); and 

3 ‘‘(F) establishing a public registry of rec4 ognized eligible entities. 

5 ‘‘(5) APPLIED RESEARCH PROGRAMS.—The 

6 Secretary shall award grants to eligible entities to 

7 conduct diabetes prevention research that— 

8 ‘‘(A) advances the scalability of recognized 

9 community-based diabetes prevention program 

10 model sites nationally; 

11 ‘‘(B) examines model benefit and payment 

12 designs; and 

13 ‘‘(C) tests communications strategies to 

14 engage providers and targeted at-risk popu15 lations. 

16 ‘‘(6) STUDIES FOR DIABETES PREVENTION AND

17 MANAGEMENT.—To build on the findings of the na18 tional diabetes prevention program under this sec19 tion, the Secretary may conduct or support studies 

20 to manage, reduce, and prevent type 2 diabetes in 

21 at-risk populations, including consideration of fac22 tors such as nutrition, exercise education, and basic 

23 physical maintenance of healthy levels of cholesterol, 

24 body mass index, hemoglobin A1C, and blood pres25 sure rates. 


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1 ‘‘(c) REPORT TO CONGRESS.—Not later than the end 

2 of fiscal year 2011, and every 2 years thereafter, the Sec3 retary shall submit a report to the Congress on the imple4 mentation of this section, including the progress achieved 

5 in eliminating the preventable burden of diabetes. 

6 ‘‘(d) DEFINITIONS.—In this section: 

7 ‘‘(1) The term ‘eligible entity’ means— 

8 ‘‘(A) a State or local health department; 

9 ‘‘(B) a national network of community10 based organizations described in section 

11 501(c)(3) of the Internal Revenue Code of 1986 

12 that is focused on health and well-being; 

13 ‘‘(C) an academic institution; 

14 ‘‘(D) an Indian tribe or tribal organization 

15 (as defined in section 4 of the Indian Self-De16 termination and Education Assistance Act); or 

17 ‘‘(E) any other entity determined by the 

18 Secretary to be an eligible entity for purposes 

19 of this section. 

20 ‘‘(2) The term ‘person at high risk for diabetes’ 

21 means an individual who has higher than normal 

22 blood glucose levels or is at an increased risk for de23 veloping diabetes based on multiple risk factors. 

24 ‘‘(3) The term ‘recognized’ means recognized as 

25 provided for under subsection (b)(2). 


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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $80,000,000 for fiscal year 2011, and such sums as may 

4 be necessary for each subsequent fiscal year.’’. 

Æ 


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