In 1974, the National Diabetes Mellitus Research and Education Act established the National Commission on Diabetes. This group established the first long-term plan to address diabetes prevention and treatment in the US, leading to improved funding for related research, treatment programs, and eventually the National Diabetes Prevention Program (NDPP). 

This commission’s recommendations resulted in federal policies that addressed the US diabetes epidemic and helped save millions with prediabetes and diabetes from related health complications.  

While just under 2.3% of Americans had diagnosed diabetes in 1975, the prevalence has increased to 8.7% since then. The 1974 report mainly focused on improving medical and healthcare interventions, but today we have a better grasp of the social determinants of health and their impact on diabetes. 

In 2018, the National Clinical Care Commission (NCCC) was formed to review the state of federal diabetes prevention and treatment policies and form recommendations for improving the national response to this epidemic. The NCCC states that “diabetes in the US cannot simply be viewed as a medical or health care problem, but also must be addressed as a societal problem that cuts across many sectors.” 

To accomplish this, the report examines sectors of government related to food, housing, commerce, transportation, and the environment, in addition to health, to incorporate diabetes prevention and treatment policies.

“Broadly speaking, there are effective [diabetes] policies and programs in place” said Jasmine Gonzalvo, a pharmacist and diabetes care and education specialist (DCES), “When you get into the details, that’s where there are a lot of opportunities for improvement.” 

Gonzalvo was the only pharmacist and DCES on the NCCC. She explained that “the expertise of the commission allowed us to drill down into opportunities in policy where there could be improvement.”

In December 2021, the NCCC submitted its final report to Congress. The report, “Leveraging Federal Programs to Prevent and Control Diabetes and its Complications,” contained recommendations to address diabetes prevention and control in the general population and those at high risk for developing type 2 diabetes, including the treatment of diabetes and its complications. 

The following are the NCCC’s overarching recommendations:

• To coordinate and monitor federal efforts relevant to diabetes and to ensure trans-agency collaboration, an Office of National Diabetes Policy should be created and given responsibility to develop and implement a national diabetes strategy across health care and non-health focused federal agencies. 
• Federal policies and programs should ensure that people at risk for or with diabetes have access to comprehensive, high-quality, and affordable health care.
• Health equity should be considered in every new or existing federal policy or program that impacts people at risk for or with diabetes. This is essential to eliminate unintended and adverse impacts on health disparities. 

“The NCCC report provides a holistic approach, addressing upstream factors driving the increasing wave of diabetes, as well as barriers to care and prevention of diabetes and its complications,” said George Huntely, CEO of the Diabetes Leadership Council, referring to factors such as income, food insecurity, and access to healthcare. “The good news is that focusing on societal drivers of diabetes, like obesity, will reap benefits across the full spectrum of chronic diseases.”  

Diabetes prevention in the general population

Over 96 million people in the US have prediabetes which accounts for 38% of the US population. To more effectively prevent the onset of prediabetes in the US, NCCC advises the government to engage “those federal agencies whose primary focus is not on health but whose policies and programs play an important role in shaping the social and environmental contexts that influence diabetes incidence and complications.” 

To accomplish this, they recommend the following:

• Improve funding and access for nutrition assistance programs like SNAP and WIC and decrease consumption of sugar-sweetened beverages.
• Increase breastfeeding rates through federal programs and paid maternity leave.
• Regulate food and beverage marketing to children and update food labeling policies and practices to prevent and control diabetes.
• Reduce exposure to toxins that can increase a person’s risk for diabetes and make environments more walkable to promote physical activity.
• Expand low-income housing opportunities in health-promoting environments.
• Improve research on the social and environmental conditions associated with diabetes.

Diabetes prevention in people at high risk

For those who already have prediabetes or are otherwise at high risk for getting diabetes, separate measures can be taken to avoid the onset of diabetes. For high risk populations, the NCCC recommends the following:

• Increasing awareness of prediabetes and the NDPP.
• Improve coverage of prediabetes screening and adopt clinical quality measures that support screening.
• Improving access to, participation in, and sustainability of type 2 diabetes prevention interventions such as the NDPP.
• Support research to develop new and better methods for preventing both type 1 and type 2 diabetes.

Diabetes treatment and complications

Over 37 million people in the US have diabetes, and without adequate care, they are at risk for serious health complications such as heart disease, kidney disease, and even death. The NCCC report explains that there is a “mismatch between available resources and the needs of persons living with diabetes.” 

To help people with diabetes avoid health complications, the NCCC recommends the following:

• Reducing barriers to diabetes self-management training, technologies and devices, expanding access to virtual care, and ensuring insulin is affordable and accessible.
• Supply healthcare providers treating people with diabetes with the resources needed to provide quality care.
• Ensuring adequate insurance coverage for effective diabetes treatments and care and developing a quality measure that improves safety measures and reduces risk of hypoglycemia.  

When asked which recommendations would have the greatest positive impact, Gonzalvo explains that the establishment of the Office of National Diabetes Policy would help “continue the work of the Commission” to create a more cohesive national diabetes effort.

It is unknown how the NCCC’s recommendations will be incorporated into federal policy. “With this roadmap now in front of them, will Congress have the will to do what is needed here for the benefit of the nation?” said Huntley, who encourages Congress to turn the NCCC report into action. 

If implemented, these measures could have a monumental impact on diabetes prevention and care in the US.