(I) In States with significant Asian popu-
lations, Asians were 1.5 to 2 times as likely as 
whites to have diagnosed diabetes. 
(3) Diabetes carries staggering costs: 
(A) In 2002, the total amount of the direct 
and indirect costs of diabetes was estimated at 
$132,000,000,000 according to the American 
Diabetes Association. 
(B) 18 percent of the Medicare population 
has diabetes but spending on this group of peo-
ple consumes 32 percent of the Medicare budg-
et according to the Center for Medicare & Med-
icaid Services. 
(4) Diabetes is deadly. According to the Centers 
for Disease Control and Prevention: 
(A) In 2002, according to death certificate 
reports, diabetes contributed to an official num-
ber of 224,092 deaths. 
(B) Diabetes is likely to be seriously 
underreported as studies have found that only 
35 percent to 40 percent of decedents with dia-
betes had it listed anywhere on the death cer-
tificate and only about 10 percent to 15 percent 
had it listed as the underlying cause of death. 
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(5) Diabetes complications carry staggering eco-
nomic and human costs for our country and health 
system: 
(A) According to death certificate reports, 
diabetes contributes to over 224,000 deaths a 
year, although this number is likely vastly 
underreported. 
(B) The risk for stroke is 2 to 4 times 
higher among people with diabetes. 
(C) Diabetes is the leading cause of new 
blindness in America, causing approximately 
18,000 new cases of blindness each year. 
(D) Diabetes is the leading cause of kidney 
failure in America, accounting for 44 percent of 
new cases in 2002. 
(E) In 2002, 44,400 Americans with dia-
betes began treatment for end-stage kidney dis-
ease and a total of 153,730 were living on 
chronic dialysis or with a kidney transplant as 
a result of their diabetes. 
(F) In 2002, approximately 82,000 ampu-
tations were performed on Americans with dia-
betes. 
(G) Poorly controlled diabetes before con-
ception and during the first trimester of preg-
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nancy can cause major birth defects in 5 per-
cent to 10 percent of pregnancies and sponta-
neous abortions in 15 percent to 20 percent of 
pregnancies. 
(6) Diabetes is unique because many of its com-
plications and tremendous costs are largely prevent-
able through early detection, better education on di-
abetes self-management, and improved delivery of 
available medical treatment: 
(A) 
According 
to 
the 
Agency 
for 
Healthcare Research and Quality, appropriate 
primary care for diabetes complications could 
have saved the Medicare and Medicaid pro-
grams $2,500,000,000 in hospital costs in 2001 
alone. 
(B) According to the Diabetes Prevention 
Project sponsored by the National Institutes of 
Health, lifestyle interventions such as diet and 
moderate physical activity for those with 
prediabetes reduced the development of diabetes 
by 58 percent; among Americans aged 60 and 
over, lifestyle interventions reduced diabetes by 
71 percent. 
(C) Research shows detecting and treating 
diabetic eye disease can reduce the development 
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of severe vision loss by 50 percent to 60 per-
cent. 
(D) Research shows comprehensive foot 
care programs can reduce amputation rates by 
45 percent to 85 percent. 
(E) Research shows detecting and treating 
early diabetic kidney disease by lowering blood 
pressure can reduce the decline in kidney func-
tion by 30 percent to 70 percent. 
SEC. 2. MEDICARE DIABETES SCREENING COLLABORATION 
AND OUTREACH PROGRAM. 
(a) ESTABLISHMENT.—With respect to diabetes 
screening tests provided for under the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003 
(Public Law 108–173) and for the purposes of reducing 
the number of undiagnosed beneficiaries with diabetes or 
prediabetes in the Medicare program, the Secretary of 
Health and Human Services (in this section referred to 
as the ‘‘Secretary’’), in collaboration with the Director of 
the Centers for Disease Control and Prevention (in this 
section referred to as the ‘‘Director’’), shall— 
(1) review uptake and utilization of the diabetes 
screening benefit to identify and address any exist-
ing problems with regard to utilization and data col-
lection mechanisms to accurately track uptake; 
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(2) establish an outreach program to identify 
existing efforts by agencies and by the private and 
nonprofit sectors to increase awareness among Medi-
care beneficiaries and providers of the diabetes 
screening benefit; and 
(3) maximize economies of scale, cost effective-
ness, and resource allocation in increasing utilization 
of the diabetes screening benefit. 
(b) CONSULTATION.—In carrying out this section, 
the Secretary and the Director shall consult with— 
(1) various units of the Federal Government, 
including the Centers for Medicare & Medicaid Serv-
ices, the Surgeon General of the Public Health Serv-
ice, the Agency for Healthcare Research and Qual-
ity, the Health Resources and Services Administra-
tion, and the National Institutes of Health; and 
(2) entities with an interest in diabetes, includ-
ing industry, voluntary health organizations, trade 
associations, and professional societies. 
SEC. 3. ADVISORY GROUP REGARDING DIABETES AND 
CHRONIC 
ILLNESS 
EMPLOYEE 
WELLNESS 
INCENTIVIZATION AND DISEASE MANAGE-
MENT BEST PRACTICES. 
(a) ESTABLISHMENT.—The Secretary of Commerce 
shall establish an advisory group consisting of representa-
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tives of the public and private sector. The advisory group 
shall include representatives from the Department of 
Commerce, the Department of Health and Human Serv-
ices, the Small Business Administration, and public and 
private sector entities with experience in administering 
and operating employee wellness and disease management 
programs. 
(b) DUTIES.—The advisory group established under 
subsection (a) shall examine and make recommendations 
of best practices of chronic illness employee wellness 
incentivization and disease management programs in 
order to— 
(1) provide public and private sector entities 
with improved information in assessing the role of 
employee wellness incentivization and disease man-
agement programs in saving money and improving 
quality of life for patients with chronic illnesses; and 
(2) encourage the adoption of effective chronic 
illness employee wellness and disease management 
programs. 
(c) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the advisory group estab-
lished under subsection (a) shall submit to the Secretary 
of Health and Human Services, the Speaker and Minority 
Leader of the House of Representatives, and the Majority 
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Leader and Minority Leader of the Senate, the results of 
the examination under subsection (b)(1). 
SEC. 4. NATIONAL DIABETES REPORT CARD. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), in collaboration with the Director of the Centers 
for Disease Control and Prevention (referred to in this 
section as the ‘‘Director’’), shall prepare on a biennial 
basis a national diabetes report card (referred to in this 
section as a ‘‘Report Card’’) for the Nation and, to the 
extent possible, for each State. 
(b) CONTENTS.— 
(1) IN GENERAL.—Each Report Card shall in-
clude statistically valid aggregate health outcomes 
related to individuals diagnosed with diabetes and 
prediabetes including— 
(A) preventative care practices and quality 
of care; 
(B) risk factors; and 
(C) outcomes. 
(2) UPDATED
REPORTS.—Each Report Card 
that is prepared after the initial Report Card shall 
include trend analysis for the Nation and, to the ex-
tent possible, for each State, for the purpose of— 
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(A) tracking progress in meeting estab-
lished national goals and objectives for improv-
ing diabetes care, costs, and prevalence (includ-
ing Healthy People 2010); and 
(B) informing policy and program develop-
ment. 
(c) AVAILABILITY.—The Secretary, in collaboration 
with the Director, shall make each Report Card publicly 
available, including by posting the Report Card on the 
Internet. 
SEC. 5. IMPROVEMENT OF VITAL STATISTICS COLLECTION. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), acting through the Director of the Centers for 
Disease Control and Prevention and in collaboration with 
appropriate agencies and States, shall— 
(1) promote the education and training of phy-
sicians on the importance of birth and death certifi-
cate data and how to properly complete these docu-
ments, including the collection of such data for dia-
betes and other chronic diseases; 
(2) encourage State adoption of the latest 
standard revisions of birth and death certificates; 
and 
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(3) work with States to re-engineer their vital 
statistics systems in order to provide cost-effective, 
timely, and accurate vital systems data. 
(b) DEATH CERTIFICATE ADDITIONAL LANGUAGE.— 
In carrying out this section, the Secretary may promote 
the addition of language to death certificates to improve 
collection of diabetes mortality data, including the addi-
tion of a question for the individual certifying to the cause 
of death regarding whether the deceased had diabetes. 
SEC. 6. STUDY ON APPROPRIATE LEVEL OF DIABETES MED-
ICAL EDUCATION. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall, in collaboration with the Institute of Medi-
cine and appropriate associations and councils, conduct a 
study of the impact of diabetes on the practice of medicine 
in the United States and the appropriateness of the level 
of diabetes medical education that should be required prior 
to licensure, board certification, and board recertification. 
(b) REPORT.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary shall submit 
a report on the study under subsection (a) to the Commit-
tees on Ways and Means and Energy and Commerce of 
the House of Representatives and the Committees on Fi-
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nance and Health, Education, Labor, and Pensions of the 
Senate. 
Æ 
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