The national clinical care commission report to congress: recommendations to better leverage federal policies and programs to prevent and control diabetes

Authors: SCHILLINGER, DEAN - University Of California San Francisco (UCSF); BULLOCK, ANN - Indian Health Service; POWELL, CLYDETTE - George Washington University Medical Center; Fukagawa, Naomi; GREENLEE, CAROL - Western Slope Endocrinology Llc; TOWNE, JANA - Indian Health Service; GONZALVO, JASMINE - Purdue University; LOPATA, AARON - Health Resources & Services Administration; COOK IV, WILLIAM - Ascension Saint Agnes Health Center; HERMAN, WILLIAM - University Of Michigan; ALBRIGHT, ANN - Centers For Disease Control And Prevention (CDC) - United States; BOLEN, SHARI - Case Western Reserve University (CWRU); BOLTRI, JOHN - Northeastern University; CHONG, WILLIAM - Food And Drug Administration(FDA); CONLIN, PAUL - Department Of Veterans Affairs; DOKUN, AYOTUNDE - University Of Iowa; HAWKINS, MEREDITH - Albert Einstein College Of Medicine; IDZIK, SHANNON - University Of Maryland; LEAKE, ELLEN - Juvenile Diabetes Research Foundation; LINDER, BARBARA - National Institute Of Diabetes And Digestive And Kidney Diseases; MARX, BARRY - US Department Of Health And Human Services (HHS); SCHUMACHER, PAT - Centers For Disease Control And Prevention (CDC) - United States; SHELL, DONALD - Department Of Defense; STROGATZ, DAVID - Bassett Health Care Network; TRACER, HOWARD - US Department Of Health And Human Services (HHS); WU, SAMUEL - US Department Of Health And Human Services (HHS)

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/1/2022
Publication Date: 1/30/2023
Citation: Schillinger, D., Bullock, A., Powell, C., Fukagawa, N.K., Greenlee, C.M., Towne, J., Gonzalvo, J.D., Lopata, A.M., Cook Iv, W., Herman, W.H., Albright, A., Bolen, S., Boltri, J.M., Chong, W., Conlin, P.R., Dokun, A., Hawkins, M., Idzik, S., Leake, E., Linder, B., Marx, B., Schumacher, P., Shell, D., Strogatz, D., Tracer, H., Wu, S. 2023. The national clinical care commission report to congress: recommendations to better leverage federal policies and programs to prevent and control diabetes. Diabetes Care. 46(2):255-261. https://doi.org/10.2337/dc22-1587.
DOI: https://doi.org/10.2337/dc22-1587

Interpretive Summary: Diabetes mellitus is one of the major non-communicable diseases affecting a significant portion of the global population. One of the duties of the National Clinical Care Commission (NCCC) was to make recommendations to improve federal education, awareness, and dissemination activities related to diabetes prevention and treatment. A myriad of factors at the individual, community and societal levels influence diabetes risk and the treatment of the disease with minimal complications. The NCCC acknowledged that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be addressed as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions to facilitate the prevention and treatment of diabetes. This paper summarized the goals, methods and outcomes of the work of the NCCC.

Technical Abstract: The National Clinical Care Commission (NCCC) was established by Congress in 2017 and convened by the Secretary of Health and Human Services to make recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications in the United States. The NCCC determined that diabetes must be addressed as both a societal problem and a medical problem and developed a guiding framework that incorporated elements of the socioecological and chronic care models. It formed three subcommittees to assess federal policies and programs and make recommendations 1) at the general population level, 2) for high-risk individuals with prediabetes, and 3) for people with diabetes and its complications. It surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non-health-related federal agencies. It held 12 public meetings, solicited public comments, met with numerous stakeholders and key informants, and performed comprehensive literature reviews. The final report, transmitted to Congress in January 2022, contained 39 specific recommendations including three foundational recommendations: 1) that policies be implemented to ensure that all Americans have access to comprehensive and affordable health insurance; 2) that health equity be a guiding principle for all federal policies and programs addressing diabetes; and 3) that a National Diabetes Strategy be developed and an Office of National Diabetes Policy be established to coordinate an all-of-government approach to address diabetes prevention and treatment and monitor progress. At the general population level, the NCCC recommended that the activities of non-health-related federal agencies that address agriculture, food, housing, transportation, commerce, and the environment be coordinated with those of health-related federal agencies to affirmatively address the upstream social and environmental conditions that contribute to diabetes and its complications. For individuals at high-risk for diabetes, the NCCC recommended that federal policies and programs be strengthened to increase awareness of prediabetes, that the availability of, referral to, and insurance coverage for intensive lifestyle intervention programs for diabetes prevention be expanded; and that data be assembled and presented to the Food and Drug Administration to seek approval of metformin for diabetes prevention. For people with diabetes and its complications, the NCCC recommended that barriers to proven-effective treatments for diabetes and its complications be removed, the size and competence of the workforce to treat diabetes and its complications be increased, and new payment models be implemented to support access to lifesaving medications and proven-effective treatments for diabetes and its complications. The NCCC strongly encourages the public to support these recommendations and the Congress and the Department of Health and Human Services to enact them expeditiously for the benefit of all Americans at risk for and living with diabetes.