I
107TH CONGRESS
2D SESSION
H. R. 5482
To prevent and cure diabetes and to promote and improve the care of
individuals with diabetes for the reduction of health disparities within
racial and ethnic minority groups, including the African-American, His-
panic American, Asian American and Pacific Islander, and American
Indian and Alaskan Native communities.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 26, 2002
Ms. DEGETTE
(for herself, Mr. NETHERCUTT, Mr. BONILLA, Mrs.
CHRISTENSEN, 
Mr. 
REYES, 
Ms. 
MILLENDER-MCDONALD, 
Mr.
HAYWORTH, Mr. RODRIGUEZ, Mr. UNDERWOOD, Mr. JACKSON of Illinois,
Mr. WELDON of Pennsylvania, Mr. LEWIS of Georgia, Mr. GREEN of
Texas, Ms. NORTON, and Mr. HINOJOSA) introduced the following bill;
which was referred to the Committee on Energy and Commerce
A BILL
To prevent and cure diabetes and to promote and improve
the care of individuals with diabetes for the reduction
of health disparities within racial and ethnic minority
groups, including the African-American, Hispanic Amer-
ican, Asian American and Pacific Islander, and American
Indian and Alaskan Native communities.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Diabetes Prevention
Access and Care Act’’.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Hispanic Americans, African-Americans,
Asian Americans and Pacific Islanders, and Amer-
ican Indians and Alaskan Native populations suffer
from the highest incidence of diabetes and from the
highest rates of diabetes complications, and these
rates are steadily increasing to epidemic proportions.
(2) Within the United States, diabetes in-
creased from 6.9 percent to 7.3 percent during the
period 1999 to 2000, affecting every age group and
socioeconomic level.
(3) Type 2 diabetes accounts for 90 to 95 per-
cent of diagnosed diabetes cases among these popu-
lations.
(4) Another 16,000,000 individuals in the
United States have a condition known as ‘‘pre-diabe-
tes,’’ or Impaired Glucose Tolerance (IGT). Unless
treated, pre-diabetes dramatically increases the risk
for developing type 2 diabetes and increases the risk
of heart disease by nearly 50 percent. As with diabe-
tes, this condition also disproportionately affects mi-
nority populations.
(5) Physical inactivity and obesity are the main
contributing risk factors to the rising numbers of di-
abetes cases within these racial and ethnic minority
populations.
(6) Critical facets of daily living that can con-
tribute to diabetes risk can be modified including
poor diet, lack of recess and physical education for
children, specific eating habits for families and
adults that may be culturally indicative to the mi-
nority group, and psychological factors that may
interfere with proper meal planning and dietary edu-
cation.
(7) For certain socioeconomic groups, unhealthy
food is the only nutritional source available within
the community, such as fast food in poor areas. Ad-
ditionally, there are limited options for physical ac-
tivity within certain neighborhoods, communities, or
geographical areas.
(8) Type 2 diabetes is also being increasingly
diagnosed in adolescents in high numbers within
these populations. This is partly due to nonnutri-
tional diets and a lack of physical activity.
(9) The most effective prevention and control
strategies include: increased physical activity, im-
proved nutrition, quality diabetes care, and improved
self-management practice.
(10) Multiple acute and chronic complications
result from poor diabetes diagnosis, care, and man-
agement. There is a need for prevention strategies
and measures in order to educate individuals about
diabetes and its complications, and to decrease cur-
rent numbers within these populations.
(11) Recent discoveries regarding disparities in
health care among these populations have identified
a need for culturally sensitive modes of treatment
that are conducive to the lifestyle of the patient: Pa-
tients and consumers should be guaranteed effective,
understandable, and respectful care that is provided
in a manner that properly addresses their cultural
health beliefs, practices, and preferred language.
(12) Effective communication, cultural conflict
resolution, and cultural differences on health pro-
motion and disease prevention should be addressed.
TITLE I—RESEARCH
SEC. 101. RESEARCH.
Part P of title III of the Public Health Service Act
(42 U.S.C. 280g et seq.) is amended by inserting after
section 399N the following section:
‘‘SEC. 399O. DIABETES; MINORITY HEALTH AND HEALTH
DISPARITIES RESEARCH.
‘‘(a) NATIONAL INSTITUTES OF HEALTH.—
‘‘(1) IN GENERAL.—The Director of the Na-
tional Institutes of Health shall expand, intensify,
conduct, coordinate, and support research and other
activities with respect to pre-diabetes and diabetes,
particularly type 2, in minority populations, includ-
ing research to identify clinical, socioeconomic, geo-
graphical, cultural, and organizational factors that
contribute to type 2 diabetes in such populations.
‘‘(2) CERTAIN
ACTIVITIES.—Activities under
paragraph (1) regarding type 2 diabetes in minority
populations shall include the following:
‘‘(A) Research on behavior and obesity, in-
cluding research through the obesity research
center that is sponsored by the National Insti-
tutes of Health.
‘‘(B) Research on the causes and effects of
health care access disparities and racial dis-
crimination, including research to identify the
following:
‘‘(i) Linguistic difficulties and lan-
guage barriers of diabetes diagnosis, treat-
ment, and care within these populations.
‘‘(ii) Environmental barriers in access-
ing transportation to health centers and
health care providers.
‘‘(iii) Financial difficulties of health
care financing and delivery to receive treat-
ment.
‘‘(iv) Diabetes care and treatment dis-
crimination against individuals with diabe-
tes in prisons, the workplace, and schools.
‘‘(v) The manner in which racial
stereotypes evolve, persist, shape expecta-
tions, and affect interpersonal interactions
with diabetes diagnosis, treatment, and
education.
‘‘(vi) The manner in which patient
and provider relationships can be strength-
ened by greater diversity in the health pro-
fessions for diabetes care.
‘‘(C) Research on environmental factors
that may contribute to the increase in type 2
diabetes, which shall be conducted or supported
through the National Institute of Environ-
mental Health Sciences and the National
Human Genome Research Institute.
‘‘(D) Support for new methods to identify
environmental triggers and genetic interactions
that lead to the development of type 1 and type
2 diabetes in minority newborns with a high ge-
netic susceptibility to the disease. Such research
should follow the newborns through puberty,
which is a high-risk period for developing type
1 diabetes, and—increasingly—type 2 diabetes.
‘‘(E) Research to identify genes that pre-
dispose individuals to the onset of developing
type 1 and type 2 diabetes and to develop com-
plications with the goal of developing improved
prevention and treatment strategies.
‘‘(F) Research to prevent complications in
individuals who have already developed diabe-
tes, such as attempting to identify the genes
that predispose individuals with diabetes to the
development of complications, as well as meth-
ods and alternative therapies to control blood
glucose.
‘‘(G) The support of ongoing research ef-
forts examining the level of glycemia at which
adverse outcomes develop during pregnancy and
to address the many clinical issues associated
with minority mothers and fetuses during dia-
betic and gestational diabetic pregnancies.
‘‘(b) CENTERS FOR DISEASE CONTROL AND PREVEN-
TION.—
‘‘(1) IN
GENERAL.—The Secretary, acting
through the Director of the Centers for Disease
Control and Prevention, shall conduct and support
research and other activities with respect to diabetes
in minority populations.
‘‘(2) CERTAIN
ACTIVITIES.—Activities under
paragraph (1) regarding diabetes in minority popu-
lations shall include the following:
‘‘(A) Expanding the National Diabetes
Laboratory for translational research, and the
identification of genetic and immunological risk
factors associated with diabetes.
‘‘(B) Enhancing the National Health and
Nutrition Examination Survey on eating and di-
etary habits, with a focus, including cultural
and socioeconomic factors, on Hispanic Amer-
ican, African-American, American Indian and
Alaskan Native, and Asian American and Pa-
cific Islander communities.
‘‘(C) Establishing and implementing model
demonstration projects to design, implement,
and evaluate effective diabetes prevention and
control interventions.
‘‘(D) Increased funding for the Translating
Research Into Action for Diabetes study to con-
duct interventions for improving the quality of
diabetes care received by these populations in
managed care settings.
‘‘(E) Prevention research within the Divi-
sion of Diabetes Translation to better under-
stand how to influence healthcare systems
changes to improve quality of care being deliv-
ered to such populations.
‘‘(F) Within the Division of Diabetes
Translation, carrying out model demonstration
projects to design, implement, and evaluate ef-
fective diabetes prevention and control interven-
tion for these populations.
‘‘(G) Carrying out culturally appropriate
community-based interventions within the Divi-
sion of Diabetes Translation designed to ad-
dress issues and problems experienced by these
populations.
‘‘(H) Conducting applied research within
the Division of Diabetes Translation on health
systems, community, and communication inter-
ventions to reduce those barriers of discrimina-
tion, and reduce health disparities within these
populations with diabetes.
‘‘(I) Conducting applied research on pri-
mary prevention within the Division of Diabetes
Translation to reduce those barriers within var-
ious arenas of discrimination, and reduce diabe-
tes-related health disparities within these popu-
lations with diabetes.
‘‘(c) ADDITIONAL PROGRAMS.—
‘‘(1) IN
GENERAL.—In addition to activities
under subsections (a) and (b), the Secretary shall
conduct and support research and other activities
with respect to diabetes within minority populations.
‘‘(2) CERTAIN
ACTIVITIES.—Activities under
paragraph (1) regarding diabetes in minority popu-
lations shall include the following:
‘‘(A) Through the National Institutes of
Health and the Centers for Disease Control and
Prevention, identifying culturally sensitive ap-
proaches to research, including the clinical, cul-
tural, socioeconomic, and organizational factors
that contribute to high levels of diabetes within
such populations.
‘‘(B) Expanding the National Diabetes
Education Program.
‘‘(C) Through the National Center on Mi-
nority Health and Health Disparities, the Office
of Minority Health under section 1707, the
Health Resources and Service Administration,
the Centers for Disease Control and Prevention,
and the Indian Health Service, establishing
partnerships within minority populations to
conduct studies on cultural, familial, and social
factors that may influence health promotion, di-
abetes management, and prevention.
‘‘(D) Through the Indian Health Service,
in collaboration with other appropriate Federal
agencies, conducting research on ethnic and cul-
turally appropriate diabetes treatment, care,
prevention, and services by health care profes-
sionals to the American Indian population.
‘‘(d) DEFINITION.—For purposes of this section, the
term ‘minority populations’ means racial and ethnic mi-
nority groups within the meaning of section 1707.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) NATIONAL INSTITUTES OF HEALTH.—For
the purpose of carrying out subsection (a), there are
authorized to be appropriated such sums as may be
necessary for fiscal year 2003 and each subsequent
fiscal year.
‘‘(2) CENTERS
FOR
DISEASE
CONTROL
AND
PREVENTION.—For the purpose of carrying out sub-
section (b), there are authorized to be appropriated
such sums as may be necessary for fiscal year 2003
and each subsequent fiscal year.
‘‘(3) ADDITIONAL PROGRAMS.—For the purpose
of carrying out subsection (c), there are authorized
to be appropriated such sums as may be necessary
for fiscal year 2003 and each subsequent fiscal
year.’’.
SEC. 102. DIABETES MELLITUS INTERAGENCY COORDI-
NATING COMMITTEE.
Section 429 of the Public Health Service Act (42
U.S.C. 285c–3) is amended by adding at the end the fol-
lowing subsection:
‘‘(d)(1) In addition to other duties established in this
section for the Diabetes Mellitus Interagency Coordinating
Committee, such Committee shall—
‘‘(A) assess the current activities of all current
Federal health programs to determine their ade-
quacy as a systemic method of addressing the im-
pact of diabetes mellitus on minority populations;
‘‘(B) undertake strategic planning activities to
develop an effective and comprehensive Federal plan
to address diabetes mellitus within communities of
color which will involve all appropriate Federal
health programs; and
‘‘(C) conduct the implementation of such a plan
throughout all Federal health programs.
‘‘(2) The Federal plan under paragraph (1)(B)
shall—
‘‘(A) include steps to address issues including,
but not limited to, type 1 and type 2 diabetes in
children and the disproportionate impact of diabetes
mellitus on minority populations; and
‘‘(B) remain consistent with the programs and
activities identified in sections 399O through 399R,
as well as remaining consistent with the intent of
the Diabetes Prevention Access and Care Act.
‘‘(3) For purposes of this subsection, the term ‘mi-
nority populations’ means racial and ethnic minority
groups within the meaning of section 1707.
‘‘(4) For the purpose of carrying out this subsection,
there are authorized to be appropriated such sums as may
be necessary for fiscal year 2003 and each subsequent fis-
cal year.’’.
TITLE II—TREATMENT
SEC. 201. TREATMENT.
Part P of title III of the Public Health Service Act,
as amended by section 101 of this Act, is amended by in-
serting after section 399O the following section:
‘‘SEC. 399P. DIABETES; TREATMENT FOR MINORITY POPU-
LATIONS.
‘‘(a) IN GENERAL.—The Secretary shall conduct and
support programs to treat diabetes in minority popu-
lations.
‘‘(b) NATIONAL INSTITUTES OF HEALTH.—With re-
spect to the National Institutes of Health, activities under
subsection (a) regarding the treatment of diabetes in mi-
nority populations shall include the following:
‘‘(1) Through the National Institute of Mental
Health, providing for comprehensive mental health
services and treatment for individuals within such
populations who experience mental barriers to prop-
er diabetes care.
‘‘(2) Through the National Center on Minority
Health and Health Disparities, recommending and
disseminating the guidelines of the American Diabe-
tes Association for nutrition exercise and diet for di-
abetes treatment and prevention.
cused health fields by expanding Minority Access to
Research Careers (MARC) program internships and
mentoring opportunities for recruitment.
‘‘(c) CENTERS FOR DISEASE CONTROL AND PREVEN-
TION.—With respect to the Centers for Disease Control
and Prevention, activities under subsection (a) regarding
education on diabetes in minority populations shall include
the following:
‘‘(1) Making grants for diabetes-focused edu-
cation classes or training programs on cultural sen-
sitivity and patient care within such populations for
health care providers.
‘‘(2) Carrying out public awareness campaigns
directed toward such populations to aggressively em-
phasize the importance and impact of physical activ-
ity and diet in regard to diabetes and diabetes-re-
lated complications.
‘‘(d) HEALTH RESOURCES AND SERVICES ADMINIS-
TRATION.—With respect to the Health Resources and
Services Administration, activities under subsection (a) re-
garding education on diabetes in minority populations
shall include the following:
‘‘(1) Providing additional funds for the Health
Careers Opportunity Program, Centers for Excel-
lence, and the Minority Faculty Fellowship Program
to partner with the Office of Minority Health under
section 1707 and the National Institutes of Health
to strengthen programs for career opportunities
within minority populations focused on diabetes
treatment and care.
‘‘(2) In partnership with the Health Resources
and Services Administration, develop a diabetes
focus within, and provide additional funds for, the
National Health Service Corps Scholarship program
to place individuals in areas that are disproportion-
ately affected by diabetes, to provide health care
services.
‘‘(3) Establishing a diabetes ambassador pro-
gram for recruitment efforts to increase the number
of underrepresented minorities currently serving in
student, faculty, or administrative positions in insti-
tutions of higher learning, hospitals, and community
health centers.
‘‘(4) Establishing a loan repayment program
that focuses on diabetes care and prevention.
‘‘(e) ADDITIONAL PROGRAMS.—Activities under sub-
section (a) regarding education on diabetes in minority
populations shall include the following:
‘‘(1) Through collaboration between the Health
Resources and Services Administration and the In-
dian Health Service, establishing a joint scholarship
and loan-repayment program for American Indians
health profession students.
‘‘(2) Providing funds for new and existing dia-
betes-focused education grants and programs for
present and future students and clinicians in the
medical field from minority populations, including
the following:
‘‘(A) Federal and State loan repayment
programs for health profession students within
communities of color.
‘‘(B) Providing funds to the Office of Mi-
nority Health under section 1707 for training
health profession students to focus on diabetes
within such populations.
‘‘(C) Providing funds to State and local
entities to establish diabetes awareness week or
day every month in schools, nursing homes, and
colleges through partnerships with the Office of
Minority Health under section 1707 and the
Health Resources and Services Administration.
‘‘(f) DEFINITION.—For purposes of this section, the
term ‘minority populations’ means racial and ethnic mi-
nority groups within the meaning of section 1707.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out subsections (a) and (e), there are author-
ized to be appropriated such sums as may be nec-
essary for fiscal year 2003 and each subsequent fis-
cal year.
‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For
the purpose of carrying out subsection (b), there are
authorized to be appropriated such sums as may be
necessary for fiscal year 2003 and each subsequent
fiscal year.
‘‘(3) CENTERS
FOR
DISEASE
CONTROL
AND
PREVENTION.—For the purpose of carrying out sub-
section (c), there are authorized to be appropriated
such sums as may be necessary for fiscal year 2003
and each subsequent fiscal year.
‘‘(4) HEALTH RESOURCES AND SERVICES AD-
MINISTRATION.—For the purpose of carrying out
subsection (c), there are authorized to be appro-
priated such sums as may be necessary for fiscal
year 2003 and each subsequent fiscal year.’’.
TITLE IV—HEALTH PROMOTION,
PREVENTION 
ACTIVITIES,
AND ACCESS
SEC. 401. HEALTH PROMOTION, PREVENTION ACTIVITIES,
AND ACCESS.
Part P of title III of the Public Health Service Act,
as amended by section 301 of this Act, is amended by in-
serting after section 399Q the following section:
‘‘SEC. 399R. DIABETES; HEALTH PROMOTION, PREVENTION
ACTIVITIES, AND ACCESS REGARDING MI-
NORITY POPULATIONS.
‘‘(a) NATIONAL INSTITUTES OF HEALTH.
‘‘(1) IN
GENERAL.—The Secretary, acting
through the Director of the National Institutes of
Health, shall provide access to proper care of diabe-
tes for minority populations.
‘‘(2) CERTAIN
ACTIVITIES.—Activities under
paragraph (1) regarding proper care of diabetes in
minority populations shall include the following:
‘‘(A) Providing funds for research to as-
sess and identify the number of individuals af-
fected by socioeconomic and environmental bar-
riers to diabetes health care access, including
research regarding language, transportation,
daily routine, lifestyle, and housing.
‘‘(B) Through the National Center on Mi-
nority Health and Health Disparities, identi-
fying the manner in which health care pro-
viders, community health centers, and hospitals
provide proper options and education on avail-
able services for diabetes care, management,
and prevention, including identifying the effects
of differences in the cultures of staff and pa-
tients on clinical and other workforce encoun-
ters.
‘‘(b) CENTERS FOR DISEASE CONTROL AND PREVEN-
TION.
‘‘(1) IN
GENERAL.—The Secretary, acting
through the Director of the Centers for Disease
Control and Prevention, shall carry out culturally
appropriate diabetes health promotion and preven-
tion programs for minority populations.
‘‘(2) CERTAIN
ACTIVITIES.—Activities under
paragraph (1) regarding culturally appropriate dia-
betes health promotion and prevention programs for
minority populations shall include the following:
‘‘(A) Expanding the Diabetes Control Pro-
gram (currently existing in all the States and
territories).
‘‘(I) Providing funds for surveillance sys-
tems and strategies for strengthening existing
systems to improve the quality, accuracy, and
timelines of morbidity and mortality diabetes
data for such populations.
‘‘(c) DEFINITION.—For purposes of this section, the
term ‘minority populations’ means racial and ethnic mi-
nority groups within the meaning of section 1707.
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) NATIONAL INSTITUTES OF HEALTH.—For
the purpose of carrying out subsection (b), there are
authorized to be appropriated such sums as may be
necessary for fiscal year 2003 and each subsequent
fiscal year.
‘‘(2) CENTERS
FOR
DISEASE
CONTROL
AND
PREVENTION.—For the purpose of carrying out sub-
section (c), there are authorized to be appropriated
such sums as may be necessary for fiscal year 2003
and each subsequent fiscal year.’’.
TITLE V—ADDITIONAL
PROGRAMS
SEC. 501. ADDITIONAL PROGRAMS.
(a) EDUCATION REGARDING CLINICAL TRIALS.—The
Secretary of Health and Human Services (referred to in
this section as the ‘‘Secretary’’) shall carry out education
and awareness programs designed to increase participa-
tion of minority populations in clinical trials.
(b) MINORITY RESEARCHERS.—The Secretary shall
carry out mentorship programs for minority researchers
who are conducting or intend to conduct research on dia-
betes in minority populations.
(c) SUPPLEMENTING CLINICAL RESEARCH REGARD-
ING CHILDREN.—The Secretary shall make grants to sup-
plement clinical research programs to assist such pro-
grams in obtaining the services of health professionals and
other resources to provide specialized care for children
with type 1 and type 2 diabetes.
(d) DEFINITION.—For purposes of this section, the
term ‘‘minority populations’’ means racial and ethnic mi-
nority groups within the meaning of section 1707 of the
Public Health Service Act.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated such sums as may be necessary for fis-
cal year 2003 and each subsequent fiscal year.
TITLE VI—STUDIES
SEC. 601. STUDIES.
(a) INSTITUTE
OF MEDICINE.—The Secretary of
Health and Human Services (referred to in this section
as the ‘‘Secretary’’) shall request the Institute of Medicine
to conduct a study to determine the extent and impact
of the shortage of adult and pediatric endocrinologists spe-
cializing in diabetes, and to submit a report describing the
findings of the study to the Secretary, to the Committee
on Energy and Commerce of the House of Representa-
tives, and to the Committee on Health, Education, Labor,
and Pensions of the Senate. The Secretary shall ensure
that the report includes recommendations on changes in
Federal policies that would increase the number of adult
and pediatric endocrinologists specializing in diabetes.
(b) AGENCY
FOR HEALTHCARE RESEARCH
AND
QUALITY.—The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality, shall
conduct a study to determine whether minority children
with diabetes have better or worse outcomes than non-
minority children. The study shall include a determination
of the extent to which minority children have access to
and participate in disease management programs, and
have access to and use medical devices such as continuous
glucose monitoring systems, insulin pumps, and artificial
pancreas.
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