[Senate Hearing 111-908] [From the U.S. Government Publishing Office] S. Hrg. 111-908 TYPE 1 DIABETES RESEARCH: REAL PROGRESS AND REAL HOPE FOR A CURE ======================================================================= HEARING before the COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS UNITED STATES SENATE of the ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION __________ JUNE 24, 2009 __________ Available via the World Wide Web: http://www.fdsys.gov Printed for the use of the Committee on Homeland Security and Governmental Affairs U.S. GOVERNMENT PRINTING OFFICE 51-789 WASHINGTON : 2010 ----------------------------------------------------------------------- For sale by the Superintendent of Documents, U.S. Government Printing Office, http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center, U.S. Government Printing Office. Phone 202�09512�091800, or 866�09512�091800 (toll-free). E-mail, [email protected] COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS JOSEPH I. LIEBERMAN, Connecticut, Chairman CARL LEVIN, Michigan SUSAN M. COLLINS, Maine DANIEL K. AKAKA, Hawaii TOM COBURN, Oklahoma THOMAS R. CARPER, Delaware JOHN McCAIN, Arizona MARK L. PRYOR, Arkansas GEORGE V. VOINOVICH, Ohio MARY L. LANDRIEU, Louisiana JOHN ENSIGN, Nevada CLAIRE McCASKILL, Missouri LINDSEY GRAHAM, South Carolina JON TESTER, Montana ROLAND W. BURRIS, Illinois MICHAEL F. BENNET, Colorado Michael L. Alexander, Staff Director Aaron M. Firoved, Professional Staff Member Brandon L. Milhorn, Minority Staff Director and Chief Counsel Priscilla H. Hanley, Minority Professional Staff Member Trina Driessnack Tyrer, Chief Clerk Patricia R. Hogan, Publications Clerk and GPO Detailee Laura W. Kilbride, Hearing Clerk C O N T E N T S ------ Opening statements: Page Senator Collins.............................................. 1 Senator Lieberman............................................ 3 Senator Lautenberg........................................... 4 Senator Burris............................................... 5 Senator Shaheen.............................................. 5 Senator Akaka................................................ 6 Senator Specter.............................................. 17 Prepared statements: Senator Lieberman............................................ 27 Senator Collins.............................................. 28 WITNESSES Wednesday, June 24, 2009 Mary Tyler Moore, International Chairman, Juvenile Diabetes Research Foundation............................................ 7 Griffin P. Rodgers, M.D., Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services........ 11 Sugar Ray Leonard, Retired Professional Boxer.................... 14 Nicholas J. Jonas, Singer, Songwriter, and Actor, Jonas Brothers. 15 Hannah Ryder, Delegate, JDRF Children's Congress, Cumberland, Maine.......................................................... 19 J. Patrick Lacher III, Delegate, JDRF Children's Congress, South Glastonbury, Connecticut....................................... 20 Asa Kelly, Delegate, JDRF Children's Congress, Charlotte, North Carolina....................................................... 21 Ellen Gould, Mother of Delegates Patrick, Samuel, Sarah, and Oliver Gould, JDRF Children's Congress, Nashville, Tennessee... 22 Alphabetical List of Witnesses Gould, Ellen: Testimony.................................................... 22 Prepared statement........................................... 59 Jonas, Nicholas J.: Testimony.................................................... 15 Prepared statement with an attachment........................ 53 Kelly, Asa: Testimony.................................................... 21 Prepared statement........................................... 58 Lacher, J. Patrick, III: Testimony.................................................... 20 Prepared statement........................................... 57 Leonard, Sugar Ray: Testimony.................................................... 14 Prepared statement........................................... 51 Moore, Mary Tyler: Testimony.................................................... 7 Prepared statement........................................... 30 Rodgers, Griffin P., M.D.: Testimony.................................................... 11 Prepared statement........................................... 34 Ryder, Hannah: Testimony.................................................... 19 Prepared statement........................................... 56 APPENDIX Responses to post-hearing questions for the Record from Dr. Rodgers........................................................ 61 TYPE 1 DIABETES RESEARCH: REAL PROGRESS AND REAL HOPE FOR A CURE ---------- WEDNESDAY, JUNE 24, 2009 U.S. Senate, Committee on Homeland Security and Governmental Affairs, Washington, DC. The Committee met, pursuant to notice, at 8:51 a.m., in room SD-342, Dirksen Senate Office Building, Hon. Susan M. Collins, presiding. Present: Senators Lieberman, Akaka, Burris, and Collins. Also Present: Senators Specter, Lautenberg, and Shaheen. OPENING STATEMENT OF SENATOR COLLINS Senator Collins. Good morning. The hearing will come to order. I so appreciate this opportunity to hold this hearing to examine the devastating impact that juvenile diabetes has on children and their families. This is the fifth Juvenile Diabetes Research Foundation (JDRF) Children's Congress that I have had the honor to Chair, and I am particularly grateful to my good friend, the Chairman of the Committee, Senator Lieberman, for turning the gavel over to me this morning. He will be joining us shortly, as will other Members. But we are starting a bit early because at 10 a.m., unexpectedly, we are going to have an impeachment proceeding begin in the Senate. This was totally unanticipated, so it makes the schedule a bit harder this morning. So what we will do is we will go up until that time, then we will take a break, and then we will reconvene. So we are going to try to start early and get as much done as we can. I want to begin by welcoming the delegates who are here today. It is wonderful to see all the boys and girls who have come from every State in the Union to be with us today, and we also have some students from foreign countries as well. We have 150 delegates who have traveled to Washington from every State in the country and from around the world. They are going to help those of us who serve in Congress better understand just what it is like to have diabetes, how serious it is, and how important it is that we all work together to try to find a cure. I also want to give a special welcome to the delegates from my home State of Maine: 11-year-old Hannah Ryder of Cumberland is here, she is sitting in the first row; and 8- year-old Cole Buchanan of Falmouth is here. And, Cole, why don't you put your hand up so we can see you. Very good. Thank you. Also here today are the grandchildren of two Senators, Senator Lautenberg and Senator Shaheen, and the Senators are going to be joining us as special members of the Committee just for today. As the founder and Co-Chair of the Senate Diabetes Caucus, I have learned so much about this disease during the past 12 years and the heartbreak and difficulties that it causes for so many families as they await a cure. Diabetes is a life-long condition that affects people of every age, race, and nationality. Moreover, it is estimated that diabetes accounts for more than $174 billion of our Nation's annual health care costs. Health spending for people with diabetes is almost double what it would be if they did not have the disease. These statistics are overwhelming, and they compel us to act. But what really motivated me to devote so much energy and time to diabetes is meeting more and more families--like our delegates today--whose lives have been forever changed by diabetes. I will never forget, back in 1998 when I was a newly elected Senator, meeting with a family from Maine whose son had diabetes. At that time, I did not know anything about the disease, but this family taught me so much. And I will never forget this 10-year-old boy looking up at me and saying, ``I wish I could just take one day off from having diabetes.'' And I bet the children who are here today feel like that, too. So that is why it is so important that you have traveled to Washington today to tell your stories. You put a human face on all of the statistics, and you help us focus better on what Congress must do to ultimately conquer this terrible disease. Juvenile diabetes is the second most common chronic disease affecting children. Moreover, it is one that they never outgrow. An average child with diabetes will have to take more than 50,000 insulin shots in a lifetime. Moreover, these injections must be balanced with regular meals and daily exercise, and blood sugar levels must be closely monitored throughout their lives through frequent testing. While the discovery of insulin was a landmark breakthrough in the treatment of diabetes, it is not a cure, and people with Type 1 diabetes face the constant challenge of working to avoid life-threatening complications. Thankfully, there is good news for people with diabetes. Since I founded the Senate Diabetes Caucus, funding for diabetes research has more than tripled, and last year we spent more than $1 billion on diabetes research. As a consequence, we are seeing some encouraging breakthroughs, and we are on the threshold of a number of important discoveries. Advances in technology, like continuous glucose monitors, are helping patients better control their blood glucose levels. These advances are also moving us closer to our long-term goal of an artificial pancreas. And drugs originally designed for cancer therapy are showing tremendous potential for treating diabetic eye disease. While we can be pleased at the progress we are making, this is no time to let up. We have two choices: We can either sit back and continue to pay the bills and endure the suffering, or we can aggressively pursue a national strategy aimed at curing this disease. The good news is that there is strong support for more research funding in Congress, and that is thanks to all of you who are here today. It is that strong grass-roots effort that is led by JDRF that has helped to convince so many Members of Congress. That is why we were able to extend the Special Diabetes Program for 2 more years through September 2011. It is critical to our efforts to find better treatments, a means of prevention, and, ultimately, a cure. I am hopeful that this morning's hearing will help us generate even more support, and you are so key to that effort. Again, I want to thank our Chairman, who has been such a wonderful advocate, for allowing me to hold this hearing this morning. Chairman Lieberman, thank you, and forgive me for beginning early because of the schedule. OPENING STATEMENT OF CHAIRMAN LIEBERMAN Chairman Lieberman. Thank you, Madam Chairman. I just want to indicate for the press here that Senator Collins has not pulled off a coup. [Laughter.] She is chairing this meeting at my request in recognition of her principled and really passionate leadership here in Congress, along with others like Senator Lautenberg, on behalf of the recognition of the impact of diabetes, particularly juvenile diabetes, and really extraordinary advocacy, effective advocacy for Federal support for the kind of research that is leading to dramatically improved treatment and I know with a certainty will lead us to a cure one day. So I am just very honored to be able to sit here today with Senator Collins. This is actually a very exciting day in this Committee every year--exciting because of the feeling of progress we have every year; frankly, exciting just because, no matter how attractive the witnesses are, we never have as beautiful a group as we have to look at today. I will also say that the witnesses on the first panel generate a lot of excitement. I do find that it is generationally affected. [Laughter.] For instance, the younger members of my office, pages and interns, are quite excited that Nick Jonas is here. I am thrilled to be in a room with Mary Tyler Moore and Sugar Ray Leonard. I do not want to date myself, Sugar, but I would be excited to be in a room with Mr. Robinson. [Laughter.] Anyway, your presence means a lot, and, Dr. Rodgers, obviously yours does as well. Just to say very briefly, this is an extraordinary story about the blessings of life that each of us receive from God, and the fact that we are given these amazing bodies that are miraculous, but not perfect, and sometimes a lot of us have a problem with our bodies. This one goes back a long ways in history--diabetes. But what is amazing are two things. One is the extraordinary technological research, unimaginable just a short time ago, that is allowing so much better treatment and will get us to a cure. The second is the absolutely inspirational message that all of you and, frankly, all the people that all of us know who have diabetes--there is hardly a person that I know in the Senate or just anywhere who does not have family members or friends who are dealing with diabetes. I bet that is true of all of us here on the panel, and the way in which you manage this problem every day is an inspiration to all of us. Because somebody once said to me a long time ago, in life there is no one who does not either get pushed down or stumble sometimes. It is just the nature of life. The question is: Do you get up? And how do you get up? And the reality is, as I look at the panel and the beautiful, exuberant, slightly restless faces in front of me, that is what this is all about. So you are all winners, and together, under the leadership of Senator Collins, we will be winners in this fight against diabetes. Thank you, Madam Chairman. I look forward to hearing these witnesses and, of course, the second panel of witnesses, including a celebrity of our own from Connecticut. Thank you. Senator Collins. Thank you, Mr. Chairman. I would now like to recognize Senator Lautenberg. Senator Lautenberg, thank you for joining us this morning. OPENING STATEMENT OF HON. FRANK R. LAUTENBERG, A U.S. SENATOR FROM THE STATE OF NEW JERSEY Senator Lautenberg. Thank you, Senator Collins, for inviting me to the Committee today. It is a deeply personal issue for me, and I appreciate the chance to work with you and Senator Lieberman, and I thank you not only for the invitation but for the work you have chosen to do here. It touches so many of us. As Senator Lieberman said, there is not anybody that I know who does not know someone who suffers from diabetes. And I am delighted to be here, honored to be here with these young people and with our friends at the witness table. It takes a lot to turn a struggle into strength, but all of you have done that, and we all benefit from your strength, like our witnesses. The issue is very personal to me. I am deeply committed to keeping our children in this country of ours healthy, and I love and care deeply for my diabetic grandchild. Her name is Maddie Birer. Maddie, raise your hand, please. And she came down with the disease unexpectedly, as it probably always happens, but she is like many others. She has turned to treatment. She has proven something. She is doing well. She is energetic. She plays soccer. She even scores goals--doing everything an 11-year-old girl dreams of doing. We are inspired by those of you who are at the witness table, and Mary Tyler Moore and Nick Jonas visited with me in the office today, and I never knew I was that popular. [Laughter.] But the crowd was at my door, and when I tried to sing, Nick suggested I stick with my day job and not bother. Mr. Leonard and Dr. Rodgers, thank you all because one of the things that you are doing by your presence here is establishing the fact that life continues, that life can be terrific, and that all of these beautiful children who are here get an inspiration from you, as all of us do. And we have to get to work, my friends on this Committee, Senator Collins and the other Members of the Committee, and make sure that we teach America how to save money and how to save heart because if we do the things that are necessary, do the research that is necessary, we can change all of this, and we will not be sitting around mentioning the statistics of $174 billion a year just to care for diabetics. If we want to do something smart, we have to put the effort in. And I am grateful to you and to all of you, especially to you guys, for being as inspirational as you are this day. Thank you very much. [Applause.] Senator Collins. Senator Burris. OPENING STATEMENT OF SENATOR BURRIS Senator Burris. Thank you very much, Madam Ranking Member, and Chairman Lieberman, Members of the Committee. It is certainly an opportunity for me to be able to address this issue with this importance and being impressed by this distinguished panel, Madam Chairman. I must apologize because I am due at another hearing in about 10 minutes, so my leaving will not be any reflection on my support for this major issue. It is a pleasure to be here to witness the relationship that exists between Congress and the Juvenile Diabetes Research Foundation. It is an effort like this and the continued work of the National Institute of Diabetes and Digestive and Kidney Diseases that give diabetes research and education such a bright future. I understand that 24 million families are affected by diabetes. I use the term ``families'' because diabetes does not only affect individuals; it also affects their support groups and all the families that are associated with them. I am especially concerned about the impact of diabetes on the minority population. Twenty-five percent of African Americans in this country have been or will be diagnosed with diabetes. We need to continue to educate and reach out to minorities that have not had access to the benefits of the research being conducted today. I want to thank all of the witnesses who appeared here today as well as the delegates from the Children's Congress, this tremendous group of our future right in front of us, who came here today to raise awareness about this issue. And, Dr. Rodgers, I just hope that there is some way we can reach those African American males who fail to really own up to the fact that they have diabetes and that we can certainly save ourselves tremendous dollars in health care costs by early intervention, early treatment, and early diagnosis. So I certainly will be doing everything I can, and I want to extend my heartfelt thanks to our witnesses on panels 1 and 2. Thank you very much, Madam Chairman. Senator Collins. Thank you. Senator Shaheen, we are delighted to welcome you today, too. OPENING STATEMENT OF HON. JEANNE SHAHEEN, A U.S. SENATOR FROM NEW HAMPSHIRE Senator Shaheen. Thank you very much, Senator Collins. Thank you for your leadership in addressing diabetes, and I thank you and Senator Lieberman for holding this hearing today. I am very honored to be here to have an opportunity to say a few words at this hearing. I had the opportunity Monday night to be at the JDRF dinner and hear from all of you young people who are here and know what compelling witnesses you are to what we have to do to find a cure for diabetes. Like most of us involved in health policy, I have long supported the importance of research to find cures for diabetes and other diseases, but this issue really became personal for me when my granddaughter Ellie was diagnosed about a year and a half ago. Ellie, where are you? And so I have seen the challenges that Ellie and her family face. I know what it is like to test multiple times a day, to deal with daily injections, to figure out whether you are eating too many carbohydrates and whether the exercise that you are doing and the other challenges of daily life are affecting what kind of injections you need to do, and I know, like all of you, that a cure is within our reach. And we just have to support research. We have to make sure that help is there to find this cure. I want to thank also the panelists who are here for your willingness to talk about what it is like to live with diabetes on a daily basis and what a difference that has made for everyone who has juvenile diabetes. I remember when Ellie was diagnosed and thinking about what her future was going to be, and when she found out Nick Jonas had diabetes, she realized that everything would be OK, that she could deal with this. So thank you all very much for your participation here and for all of the Children's Congress who are here. Thanks for the work that you are doing because together we are going to find a cure for this disease. [Applause.] Senator Collins. Thank you. Senator Akaka, I am pleased to call on you for your remarks. OPENING STATEMENT OF SENATOR AKAKA Senator Akaka. Thank you very much, Ranking Member Collins and Chairman Lieberman. Thank you for conducting this hearing today, and thank you for your leadership on this important issue. Diabetes is a very serious health problem in my home State of Hawaii. Diabetes is a disease that disproportionately affects Native Hawaiians, Pacific Islanders, and Asian Americans. In Hawaii, Native Hawaiian, Japanese, and Filipino adults are twice as likely to be diagnosed with diabetes as compared to Caucasian residents. Diabetes can be extremely difficult for patients to manage. Taking insulin injections and carefully monitoring blood sugar levels are not easy tasks. Even with careful management, diabetes contributes significantly to other health problems, such as heart disease, stroke, eye disease and blindness, and kidney disease. However, there are promising research efforts underway which we will learn more about today. We must continue to increase the funding for diabetes research to develop improved methods to treat, manage, and prevent diabetes. I also want to thank Ms. Moore and the Juvenile Diabetes Research Foundation for all of their efforts to improve the lives of so many people. In addition, I thank all of the witnesses for appearing today, including Dr. Rodgers, Mr. Leonard, Mr. Jonas, and our JDRF advocates who are seated here. I am particularly pleased to see one of my constituents, Devin Rettke. Will you raise your hand? Hi, Devin. All the way from Hawaii. I look forward to hearing from the witnesses who will share their experiences in managing their diabetes. Again, Chairman Lieberman, Ranking Member Collins, thank you for holding this hearing. I look forward to continuing to work with all of you to improve the lives of individuals suffering from diabetes. Thank you very much. Senator Collins. Thank you very much. Leading off our first panel this morning is Mary Tyler Moore. Although many of us know her from her extensive work on television and in film and in the theater, her strong advocacy on behalf of people with diabetes is why she is here today. And it has been such a pleasure to work with Mary Tyler Moore over the years. She is always our lead-off witness every time we convene the Children's Congress. She serves as the International Chairman of the Juvenile Diabetes Research Foundation, so it is a great honor to have her with us today. Next we will hear from Dr. Griffin Rodgers, who is the Director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH). Dr. Rodgers will highlight the advances and opportunities in the area of juvenile diabetes research and will provide us with some examples of the research that is supported by the Special Diabetes Program. Our next witness, Sugar Ray Leonard, is one of the legendary sports icons. A winner of the gold medal in boxing in the 1976 Olympics, Mr. Leonard's illustrious career also includes three National Golden Glove titles, two Amateur Athletic Union championships, and the 1975 Pan-American Games crown. A champion in the ring, Mr. Leonard is also a champion for people with diabetes, and he has served as the International Chairman of the Juvenile Diabetes Foundation Walk for a Cure. And last, but certainly not least, what has set young hearts aflutter in the Congress today, we will hear from Nick Jonas of the phenomenally successful Jonas Brothers. Nick was diagnosed with Type 1 diabetes in 2005, but that certainly has not slowed him down at all. In the last 2 months, Nick and his brothers have launched a new TV show, released their third album, and begun a world concert tour. So we are delighted that all of these distinguished witnesses could be with us today, and, Ms. Moore, we are going to start with you. Thank you. TESTIMONY OF MARY TYLER MOORE,\1\ INTERNATIONAL CHAIRMAN, JUVENILE DIABETES RESEARCH FOUNDATION Ms. Moore. Good morning to all of you, Senator Collins, Senator Lieberman, and Members of this Committee. I want to thank you for your leadership and commitment to sustaining robust Federal funding for diabetes research. Your efforts are resulting in real progress and real hope for millions of Americans personally affected by Type 1 diabetes. --------------------------------------------------------------------------- \1\ The prepared statement of Ms. Moore appears in the Appendix on page 30. --------------------------------------------------------------------------- I am honored to be accompanied today by all of these terrific young delegates and special guests who surround us in this chamber and join me on the panel. We sincerely thank you for providing us the opportunity to testify about the issues that we know all too well--life with Type 1 diabetes and our hope for a cure. Ten years ago, Tommy Solo--an 8-year-old JDRF volunteer from Boston--had a big idea. He was looking for something he could do to move us closer to a cure, and he thought, ``Why not have kids with diabetes, like me, go to Washington, DC, and tell Congress we need their help?'' Even at age 8, Tommy understood, intuitively, what JDRF's Moms and Dads and people personally affected by Type 1 had always known: When confronted by challenges to our personal well-being, the solution starts with our willingness to share our stories, make our case, and ask others to join us as partners in our cause. Senators, we are grateful to you for welcoming our Children's Congress delegates to these rooms over the years since, for listening to us, and for remembering us and our partnership for a cure with your legislative leadership and support. But because our work together will not be done until we have found a cure, here we are again today. More than 150 child delegates from across the United States and several countries join me to participate in the 10th anniversary Children's Congress. We acknowledge the remarkable progress we have made, and we reflect on the challenges which remain. As many of you know, I have endured the ups and downs of Type 1 diabetes for almost 40 years. And as all of these children and their families can attest, every day tests our determination to lead a normal life. Each day I check my blood sugar several times. I count the carbohydrates of what I am going to eat, I take multiple insulin injections, and I exercise. Even with this structured regimen, terrific doctors, and the loving support of my husband, Robert, my blood sugars can still fluctuate tremendously. If I do not take enough insulin, my sugars can go dangerously high--which, over time, can lead to long-term complications such as blindness, nerve damage, kidney failure, and a host of other serious ailments. If I take too much insulin, my sugars can drop frighteningly low, which can acutely lead to feeling really sick and cold and anxious and lost and, in turn, lead to unconsciousness, seizures, or worse. I actually had my first hint of impending long-term complications of diabetes in 1981 after only about 11 years of having this disease. I truly wish the technology that is available today and the understanding that we now have about how to manage diabetes was available when I was first diagnosed. Back then, to get an idea of what your blood sugar was, we relied on urine tests. They were not all that accurate, timely, or helpful. I did the best that I could to control my blood sugars, but it was a really difficult task. And my doctors, even if they wanted to, could not really push me to do what was, as a practical matter, not really doable. As a result, by 1981, I was well on my way to having vision- threatening diabetic retinopathy. I was not alone. Diabetic retinopathy is the leading cause of adult onset blindness. I was terrified. How was I going to continue the things I loved most--dancing, horseback riding--if I went blind? At the time I was diagnosed with Type 1, there was no simple treatment to prevent diabetic retinopathy. But when my retinas started to show evidence of damage due to diabetes, there was, thankfully, a new procedure that was available called ``laser photocoagulation.'' It was not without its costs, however, because in order to halt the progression of diabetic retinopathy and save the ``central vision,'' the laser must literally burn holes in the peripheral retina. So the combination of the disease itself and its vision- preserving treatment has resulted in my having a difficult time seeing when it is dark or when I am in a room that is not well lit. My peripheral vision, and vision below my waist, is also very limited. Simple things like navigating curbs on a street or changes in levels between rooms in an unfamiliar home, or seeing one of my precious pups taking a nap in an unexpected, unusual place, or recognizing a welcoming hand that has been extended patiently waiting for me to shake it are all challenges of the first order. For years, I kept the full impact of my diabetes under wraps. While people knew I had Type 1 and that I was a long- time, outspoken advocate for a cure and International Chairman of JDRF, the general public did not know the extent to which diabetes affected my day-to-day life. But recently, at the prompting of a lovely young woman named Diane Revzin, and her father, Phil, I wrote a book about living with diabetes. Diane is a 19-year-old fellow diabetic; Phil is a book publisher. My book is titled ``Growing Up Again: Life, Loves, and Oh Yeah, Diabetes.'' It chronicles my battles with Type 1 in the context of my broader life experience and career, and I hope it informs and even inspires people facing similar challenges. Though I am not here to promote my book, I am happy to note that all my proceeds from its sale will be donated to JDRF to advance research for a cure. As JDRF's International Chairman, I am actually just one volunteer in an army of determined moms, dads, children, loved ones, and friends personally affected by diabetes. We are not sitting back waiting for the cure. These children before you have built lemonade stands, created walk teams, held bake sales, and organized car washes. Most importantly, they have spoken out about their lives with diabetes and shown, by their courage and hard work, that they can accomplish anything-- including being an important part of finding their own cures. Overall, JDRF's efforts have enabled us to contribute over $1.3 billion to diabetes research since our founding in 1970 and over $150 million last year alone. But curing diabetes is an enormous task. We cannot do it alone. And that is why we are here. We are so grateful that this Committee and Congress as a whole have been our true partners in the fight to cure Type 1 diabetes and its complications. The Special Diabetes Program, which has been renewed by Congress four times since it was first enacted in 1997, currently provides $150 million a year for Type 1 diabetes research. This critical funding has led to some remarkable advances--including real progress in developing new therapies that are potentially life-changing for all of us sitting before you today. Dr. Griffin Rodgers, the Director of the NIDDK, will elaborate more on the scientific progress that we have seen, thanks to the Special Diabetes Program funding. But there are a few areas of research that I would like to touch on today myself. Researchers are using the Special Diabetes Program funds to find a way to prevent and reverse diabetic retinopathy. This is very exciting work, and it gives me great hope, especially for children and young adults with Type 1. As a result of these advances, people with diabetes may be able to live with far less fear of visual loss and have an alternative to laser surgery. Major advances are also being made in the development of new devices called continuous glucose monitors (CGMs). By measuring blood sugars automatically every few minutes and graphically showing the results and the up and down trends, CGMs help people to better understand their diabetes and to avoid extreme highs and lows. Teams of researchers are now working hard to connect CGMs with insulin pumps via a control algorithm--I need to brush up on my science--thereby creating a truly automated system, an artificial pancreas. This will closely mimic the blood sugar control workings of a human pancreas. This intelligent pump will administer insulin based on a person's blood sugar level and whether it is rising or falling. Human clinical trials are already underway, and the early results are very encouraging. In short, with your help, we are making real progress toward discovery, development, and delivery of cures and significantly improving on our health outcomes. To keep this progress, however, Congress must renew the Special Diabetes Program in 2010. Without your help, we face a 35-percent cut in Federal funding for Type 1 diabetes--a cut that could turn hope into despair. With your help, new life-changing therapies and cures will finally be within our reach. Every parent of these delegates here today, every parent of every child ever diagnosed with Type 1 diabetes makes a promise to them. We will do everything we can to find a cure for you. We promise. As their Chairman and ``oldest delegate,'' I am proud to be leading our 2009 Children's Congress Delegates in their efforts this week. As we have started to do in this special hearing, today our goal is to persuade our Senators and Representatives to also make a promise. We hope you will ``promise to remember us'' when you vote on the Special Diabetes Program and other important issues that affect all of us with diabetes. The energy and commitment of families affected by Type 1 and the strong support of champions like you on Capitol Hill make me certain that we will soon be able to turn the promising research made possible by JDRF and the Special Diabetes Program into our ``promises kept for a cure.'' Thank you from the bottom of my heart for all that you do for these children, for me, and for all others who are touched by Type 1 diabetes. I look forward to continuing to work with you as we pursue our mutual goal of a cure. And I will be with you, I promise. Thank you. [Applause.] Senator Collins. Thank you so much, Ms. Moore, for an excellent statement. Dr. Rodgers, welcome. TESTIMONY OF GRIFFIN P. RODGERS, M.D.,\1\ DIRECTOR, NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES, NATIONAL INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Dr. Rodgers. Thank you. Mr. Chairman, Senator Collins, and Members of the Committee, as Director of the National Institute of Diabetes and Digestive and Kidney Diseases, I want to thank you for your invitation to testify at this hearing on Type 1 diabetes. And on behalf of NIDDK and the other Institutes and Centers at the National Institutes of Health, I am pleased to report that we are vigorously pursuing research into Type 1 diabetes and its complications--along with the Juvenile Diabetes Research Foundation and other research partners with whom we share these important goals. --------------------------------------------------------------------------- \1\ The prepared statement of Dr. Rodgers appears in the Appendix on page 34. --------------------------------------------------------------------------- As Ms. Moore mentioned, support provided by the Special Statutory Funding Program for Type 1 Diabetes Research has led to exciting progress, even since I had the privilege of testifying before you in 2007. But before I tell you about some of that progress, I would like to take a moment to recognize the extraordinary efforts and contributions of others who are testifying here today. Ms. Moore has been a tireless leader in the fight against Type 1 diabetes and is a great inspiration to patients, to advocates, and to researchers around the world. Following his boxing career, Mr. Leonard turned his attention to another fight--the fight against diabetes--and has been the JDRF's International Chair of the Walk for the Cure. And Mr. Jonas has become a national advocate for young people with diabetes. In fact, Nick recently worked with our National Diabetes Education Program to create a new public service announcement campaign, and he has also teamed up with our Type 1 diabetes TrialNet investigators to develop a public service announcement on the importance of participating in research studies. I also want to acknowledge the children and their parents who will testify today and who are attending this hearing and, indeed, the millions of other children and parents across the country. They are our true heroes in advancing the cause of diabetes research, and many are taking part in government- sponsored trials that would not be possible without their desire and commitment to help prevent and find a cure for diabetes. Mr. Chairman, Senator Collins, the need to pursue the prevention and cure of diabetes through research is greater than ever. New data clearly indicate that the incidence of Type 1 diabetes is rising in some populations, and this is supported by evidence from the Search for Diabetes in Youth study, which is providing the first comprehensive incidence and prevalence data for diabetes among American children. And so we are thinking big, working toward a hope for a cure for those who have Type 1 diabetes and an effective approach to prevent diabetes in those at risk. It is through research that we will work toward these goals and have already made great progress. This past year, astonishing advances were reported in the genetics of Type 1 diabetes. Today at least 40 genes are known to influence the likelihood of developing Type 1 diabetes. That is four times the number that were available 2 years ago when I testified before this Committee. Why is this important? Well, because identifying genes may lead to potential new avenues for therapeutic and preventive advances and treatments, and even on a personalized and more customized basis, it may allow us to direct therapy. Moreover, because we have identified genetic variants that account for more than half of the genetic risk, we can identify individuals at high risk of developing Type 1 diabetes and, thus, give them the opportunity to enroll in clinical trials aimed at preventing the disease. We have also laid the groundwork to discover the environmental factors that have led some but not all people with a genetic predisposition to Type 1 diabetes to develop the disease. The Environmental Determinants of Diabetes in the Young (TEDDY) has screened over 350,000 newborns for the presence of the most important genetic risk factor for Type 1 diabetes and has identified 17,000 with this risk factor and has enrolled now 6,670 children in this study. These children will be followed until they are 15 years of age so that we can discover the environmental contributors to Type 1 diabetes. This achievement represents tremendous progress toward amassing the most data and samples on newborns at risk for autoimmunity and Type 1 diabetes in the world. Discovery of an infectious trigger could lead to a vaccine to prevent Type 1 diabetes, or the development of dietary factors could yield a simple dietary intervention to lower the risk in those at risk for the disease. In another clinical effort, our TrialNet researchers have just reported that therapy used in the treatment of non- Hodgkin's lymphoma and rheumatoid arthritis can substantially preserve the function of insulin-producing beta cells in people recently diagnosed with Type 1 diabetes. Patients taking the medication rituximab had better blood sugar control and required less insulin than those who took a placebo. We are now considering how to build on this success and to test whether rituximab and other treatments with agents called anti-CD3 can actually prevent Type 1 diabetes. Other researchers are working toward intervention to treat and ultimately cure diabetes, such as new sources of insulin- producing cells. These include induced pluripotent stem cells which could be derived from a patient's skin, triggered to develop into insulin-producing cells or pancreatic cells that do not normally produce insulin but could be programmed to do so. This research is at a more preliminary stage in its investigation, but it is already yielding very promising results. Approaches such as these could ultimately lead to a day when people with Type 1 diabetes have easier and better diabetes control and perhaps are entirely free of injected insulin, where their bodies once again can produce the insulin that they need to regulate blood glucose, to avoid both the acute episodes of low blood sugar, or hypoglycemia, and the long-term complications associated with high blood sugar. At the same time, we are working to help those with Type 1 diabetes take the fullest advantage of existing technologies to control their diabetes. For example, recent data from a JDRF- funded study showed that CGMs were a valuable tool in patients 25 or older to achieve an impressive lowering of their blood hemoglobin A1c levels. And new NIH initiatives will study the way that people use data from these monitors, ultimately to help them use the devices more effectively. I would like to close by mentioning the success story of a person who has reached, I think, the pinnacle of a remarkable career after 46 years with Type 1 diabetes. Supreme Court nominee Sonia Sotomayor offers a striking portrait of success that stems not only from her achievements in the legal arena, but also from her remarkable vigilance with regard to her health and the high quality of care made possible by Type 1 diabetes research. Her story reminds us that a diagnosis of Type 1 diabetes in no way defines or limits the remarkable potential of children in this room. And it is not a story that could have been possible decades ago. People with Type 1 diabetes are living longer, healthier lives today than ever before. Current research offers hope for continuing improvements in care and perhaps even suggest that we may one day be able to prevent or cure this disease. I am grateful for the opportunity to share with you these few examples of recent advances and ongoing research efforts, many of which are made possible by the Special Diabetes Program. We continue to be inspired by the dedicated efforts of individuals affected by Type 1 diabetes and by organizations that represent them, such as the JDRF. We look forward to continuing to partner with the JDRF in research to combat Type 1 diabetes and its complications, and we continue to press forward in the fight against diabetes so that we can help all the children in this room and the many other Americans whom they represent here today. Improving their quality of life with the ultimate goal of curing their disease is the driving force behind all of our efforts. Thank you, Mr. Chairman and Senator Collins, for your leadership in calling for this hearing to continue focusing attention on the importance of Type 1 diabetes research and, of course, for your continued support for NIH research. And I will be pleased to answer any questions that you might have. Thank you. [Applause.] Senator Collins. Thank you, Dr. Rodgers. That is a very encouraging report. Mr. Leonard, thank you for being here today. Please proceed. TESTIMONY OF SUGAR RAY LEONARD,\1\ RETIRED PROFESSIONAL BOXER Mr. Leonard. Good morning Senator Collins, Senator Lieberman, and Members of the Committee. I truly appreciate this opportunity to appear before you today, and I would like to testify about the burden of diabetes and the need for continued research funding to cure this devastating disease. --------------------------------------------------------------------------- \1\ The prepared statement of Mr. Leonard appears in the Appendix on page 51. --------------------------------------------------------------------------- Once again, I would like to personally thank Senator Collins for her unwavering dedication to people with diabetes. And as a diabetes advocate, I know how grateful we are to have you as one of our champions. It is so wonderful to be here in Washington, DC, as part of the Juvenile Diabetes Research Foundation's Children's Congress. I grew up not too far from here, in Palmer Park, Maryland. My teenage years were spent in the boxing ring. During this time of personal accomplishments in the ring, privately my family faced challenges as my father struggled to manage his diabetes. We are not alone in this fight. Nationwide, more than 24 million people have diabetes, a chronic disease that imposes a huge emotional and financial burden on patients and their families. I know the toll that diabetes can take on a family. As I closed the book on my amateur boxing career, I planned to begin a new chapter in my life as a college student at the University of Maryland, but I had to face the reality of my father's illness and the incredible medical bills that resulted from his life with diabetes. My decision to turn professional was based on the desire to help my family cover the costs of my father's care. Due to the long list of complications associated with diabetes, the cost of this disease is overwhelming for any family. But it is also overwhelming for the Nation and our health care system. Diabetes costs are currently estimated at $174 billion each year--$116 billion in direct medical costs and $58 billion in lost productivity and disability. In California, where I now live, the direct and indirect costs of diabetes totaled more than $24 billion in 2007. Thankfully, the Juvenile Diabetes Research Foundation has partnered with the Federal Government to make a meaningful investment in diabetes research. I was proud to serve as an International Walk Chairman for JDRF, which has provided more than $1.3 billion in funding for Type 1 diabetes research over the years. And as Ms. Moore stated, last year alone, JDRF funded more than $150 million in diabetes research. With the leadership of Senator Collins and our many other diabetes champions on Capitol Hill, the Federal Government has been a key partner along our path toward a cure for diabetes. We are so thankful to Congress for renewing the Special Diabetes Program. That program provides $150 million each year for diabetes research at the National Institutes of Health and an equal amount for the treatment and prevention of diabetes in American Indian and Alaska Native populations. Since its inception in 1997, the Special Diabetes Program has funded research that has shed light on the causes of Type 1 diabetes, as well as who is at risk for developing the disease. The research funded by the Special Diabetes Program is unique because its discoveries are important not only to people with Type 1 diabetes but also to people who suffer from similar autoimmune diseases. The therapeutic advances in diabetes complications made possible through the Special Diabetes Program also apply to people with Type 2 diabetes, making this program a critical component of any effort to fight diabetes. Help us keep up the momentum behind this research by ensuring the renewal of the Special Diabetes Program. Life with diabetes is like life in the boxing ring. Some days you just do not have your ``A'' game and your opponent can get the best of you. Other days you are managing the fight well and able to outsmart and outbox your opponent. One of my most memorable fights was my re-match against Roberto Duran. I lost my welterweight crown to Duran just a few months earlier, and I could not wait to get my title back. In the re-match, I fought a smart and skillful match. With just seconds left in the eighth round, Roberto Duran turned his back, walked to his corner, threw his hands up, and said, ``No mas.'' He quit. Now, it would be easy for these children here today to say ``No mas.'' The fight against diabetes is a tough one. Some days nothing seems more difficult, more impossible, to battle. There are days we all think about saying ``No mas.'' But it is totally clear that these children have fight in them. They are willing to go as many rounds as it takes to beat this formidable opponent. And we have you in our corner. Thanks to congressional support for the Special Diabetes Program, the advancements made through research are bringing us closer to the cure that will allow these children to finally knock out diabetes. Once again thank you, and God bless. [Applause.] Senator Collins. Thank you, Mr. Leonard. Thank you so much for an inspiring statement. Mr. Jonas, it is great to have you here. TESTIMONY OF NICHOLAS J. JONAS,\1\ SINGER, SONGWRITER, AND ACTOR, JONAS BROTHERS Mr. Jonas. Good morning. My name is Nick Jonas, and I would like to thank you for having me here today. I would like to share my story of living with Type 1 diabetes and talk about the need to fund research to find a cure. --------------------------------------------------------------------------- \1\ The prepared statement of Mr. Jonas appears in the Appendix on page 53. --------------------------------------------------------------------------- First, I would like to thank you, Senator Collins, Senator Lieberman, and other Members of the Committee, but specifically Senator Collins for being such a champion for all of us with diabetes. Everyone here today for the Juvenile Diabetes Research Foundation's Children's Congress is grateful for your leadership on the Senate Diabetes Caucus and your commitment to people with Type 1 diabetes. We are lucky to have you pushing for policies that will bring us closer to a cure. Senator Collins. Thank you. Mr. Jonas. In one way or another, I have spent most of my life performing. I have been writing songs since I can remember, and I love sharing my passion for music. As a little kid, I sang in the choir at my dad's church and then performed on Broadway. As the Jonas Brothers, my brothers Joe, Kevin, and I have written songs, made albums, and toured the country, playing our music for people all over America. It was during a concert tour in 2005 that I was diagnosed with Type 1 diabetes. My brothers were the first to notice that I had lost a significant amount of weight--15 pounds in 2 weeks. I was thirsty all the time, and I had a bad attitude, which is unlike me. [Laughter.] It would have been easy to blame my symptoms on a hectic schedule. But my family knew I had to get to a doctor. The normal range for blood sugar is anywhere between 70 and 120. When we got to the doctor's office, we learned that my blood sugar was over 700. The doctor said that I had Type 1 diabetes, but I had no idea what that meant. The first thing I did was ask her, ``Am I going to die?'' She assured me that I was not going to die, but that I would have to manage this disease for the rest of my life. We went right to the hospital that night where I spent 3 days, including a crash course on getting my blood sugar in range and learning all about diabetes. It has not been easy, but diabetes technology has really helped me to manage my diabetes. At first, I took insulin shots, but it was just too hard on the road to give myself shots. I switched to a pump, which has been great. Since then, my A1c has come down, and I have been able to use the pump to better estimate how much insulin I need based on the carbohydrates I eat. I am also considering getting a continuous glucose monitor, but for now, I still prick my finger. I do that up to 12 times a day, including right before I began this testimony. While technology has made it much easier to manage my diabetes, technology is not a cure. Insulin is not a cure. Like everyone here today, I know that the promise of a cure lies only in research. I am grateful that Congress renewed the Special Diabetes Program last year, which has helped researchers make important discoveries into what causes Type 1 diabetes. This vital program has also funded research to test new drugs and therapies that could treat or cure patients with Type 1 diabetes and may even lead to an artificial pancreas one day. I ask that each of you join me in supporting the renewal of the Special Diabetes Program next year so that the researchers can continue their work on a cure for diabetes. My life depends on it. All of our lives depend on it. After I was diagnosed with Type 1 diabetes, I wrote a song called ``A Little Bit Longer'' about dealing with diabetes. I would like to submit a copy of the full song for the record,\1\ but I would like to read one of the verses, which explains my outlook on living with diabetes: --------------------------------------------------------------------------- \1\ The song submitted by Mr. Jonas for the record appears in the Appendix on page 55. --------------------------------------------------------------------------- ``All this time goes by / Still no reason why / A little bit longer / And I'll be fine. / Waitin' on a cure / But none of them are sure. / A little bit longer / And I'll be fine.'' Diabetes has changed my life. But I know that I have benefited from the government's investment in diabetes research. With the help of Congress, I will only have to wait a little bit longer for a cure. In the meantime, I have decided not to let diabetes slow me down. In just the last 2 months, my brothers and I launched a new TV series, released our fourth album, and began a world concert tour. My approach to managing my diabetes is to focus on simple wins--little things I can do each day to achieve my goals. Over time, these everyday victories can make a big difference in your life--just like every research advancement moves us along on our path to find a cure. While on that path, I want to be a positive face for diabetes. I want to show kids with Type 1 diabetes--like all the kids sitting with me today-- that they can live their dreams while living with diabetes. Thank you for the opportunity to appear before you today, and thank you for your commitment to diabetes research. With your help, a little bit longer and we will all be fine. [Applause.] Senator Collins. Thank you for that. Thank you so much, Nick. Your song really sums it up so well and is great and inspiring advice for all the young people who are here. I want to acknowledge that we have been joined by Senator Arlen Specter from Pennsylvania. He has been a leading advocate of NIH funding, and we are delighted that he has joined us this morning. Senator Specter, thank you for being here. If you would like one minute, we will give you a moment. OPENING STATEMENT OF HON. ARLEN SPECTER, A U.S. SENATOR FROM THE STATE OF PENNSYLVANIA Senator Specter. I do not think I will need all of the minute. Thank you, Mr. Chairman and Ranking Member, for convening this important hearing. This is quite a demonstration, and juvenile diabetes is an ailment that ought to be conquered, and can be. And I wanted to come, even though I am not on this Committee, just to say a word to urge you as advocates, urge you as lobbyists to get behind additional funding for the National Institutes of Health. Ms. Moore joined this crusade about 20 years ago. I have some pictures of her hanging in my office. And with the concurrence of Senator Harkin, we have increased NIH funding from $12 to $30 billion and added $10 billion in the stimulus package. I would like to see the floor set at $40 billion, so I came to urge you to utilize your efforts to help raise that money, which is the best way to cure juvenile diabetes. Thank you very much. Senator Collins. Thank you. Senator Lieberman, do you want to start with questions? We are going to do very limited questions because we shortly are going to have to go to the floor. Chairman Lieberman. Thanks, Senator Collins. I just want to say a word about Senator Specter. Politics gets a bad name often for good reason, particularly the kind of legislative horse trading that goes on here. But earlier this year, when the so-called stimulus package was up to try to help our economy recover, create jobs, improve the quality of life, the truth is that the Democratic Majority Leader was about three votes short of the 60 votes needed to pass that program. It was very important to our country. Senator Specter was one of those potential votes, and Senator Collins was right there with him. And Senator Specter, supported by Senator Collins, did not ask for some sort of parochial project. He said, ``I am not going to vote for this unless you increase funding for NIH up to $10 billion.'' And he was so stubborn. He is really an ornery guy. [Laughter.] And supported again by Senator Collins, in the end, to get their votes, the leadership along with President Obama had to raise, I think, from $3 or $4 billion up to $10 billion the amount of money given to NIH. Think of all the good that will do in supporting research that will lead to better treatments and cures for diseases like diabetes. So I want you to join me in a round of applause for Senator Specter. [Applause.] Senator Specter. Thank you. Chairman Lieberman. Senator Collins, these three witnesses have been so eloquent. Mary Tyler Moore, Sugar Ray Leonard, and Nick Jonas, your stories make you not just role models for people with Type 1 diabetes but really inspirations for anybody who listened. I do not have a question to ask. I want your words to stand. I am going to yield to you, Madam Chairman. Senator Collins. Thank you, Senator Lieberman. I, too, found the statements so eloquent that there is little to ask. But let me, nevertheless, just ask a couple of questions. Mr. Leonard, you brought up a very good point about the impact of diabetes on the whole family. Could you talk in a little more detail about your family's struggle in coping with your father's illness? Mr. Leonard. When I returned home from the Olympics in 1976, I was ready to attend the University of Maryland. But we noticed that there was a change in my father's attitude, his personality, and once he was diagnosed as being diabetic, the medical bills were astronomical. And for some reason, a friend of mine told me, he said, ``Ray, if you turn professional, you can make some money.'' So I turned professional. I became a professional boxer-- because I had no intentions whatsoever. I became a professional boxer to pay the medical bills. And thank God my father regained his health, and I said to myself, this is not a bad career. So I continued. [Laughter.] I continued on and had an illustrious career. Senator Collins. Thank you. Dr. Rodgers, I am going to submit a question to you for the record. It is fascinating learning about the 40 genes that have been identified. I am also very interested in environmental triggers and whether the NIH has been able to isolate any environmental triggers. But I am going to ask that for the record because I know that is a long subject. Let me just thank this panel for your outstanding testimony and commitment. It really could not have been better. You helped put a human face on the issues that we are discussing. The updates on the medical research are inspiring to all of us and very encouraging, and, of course, Ms. Moore, your being a champion for juvenile diabetes for so many decades means so much. Mr. Jonas, your sharing your personal experience I know is so encouraging to these young people. So thank you all for being here. We are going to recess for a half-hour. We will try to reconvene with the second panel at 10:30, or as soon as we can get back. Thank you so much. [Applause.] [Recess.] Senator Collins. The hearing will come back to order. You are an obedient group. We got it instantly quiet. That is very impressive. I am delighted to welcome our next panel of witnesses this morning. It consists of children and family members who know firsthand what it is like to live with diabetes. Our witnesses on this panel are Hannah Ryder of Cumberland, Maine; Patrick Lacher of South Glastonbury, Connecticut; Asa Kelly of Charlotte, North Carolina; and Ellen Gould of Nashville, Tennessee, who will be testifying on behalf of her children--Patrick, Samuel, Sarah, and Oliver. So I am delighted to welcome all of you here today. Your panel is so important to all of us. And, Hannah, because you and I are both from the great State of Maine, I am going to call on you first. [Laughter.] Thank you, Hannah, go ahead. TESTIMONY OF HANNAH RYDER,\1\ DELEGATE, JDRF CHILDREN'S CONGRESS, CUMBERLAND, MAINE Ms. Ryder. Thank you for inviting me to testify. I am Hannah Ryder, and I am from Cumberland, Maine. Three years ago my life changed forever when I was diagnosed with Type 1 diabetes. --------------------------------------------------------------------------- \1\ The prepared statement of Ms. Ryder appears in the Appendix on page 56. --------------------------------------------------------------------------- After being in the hospital for 4 days, I hoped that I was cured when I got home. But I soon figured out that this was not going away when my parents kept checking my blood sugar, giving me shots, and measuring all my food. Everyone kept asking me how I was feeling. Before I could go back to school or play on a sports team, we had to meet with all of the nurses, teachers, and coaches, and anyone else that my parents thought could help keep me safe. Sometimes I do not like all the attention, but I know it is the attention that is going to keep me safe, and it is the attention like this that is going to help find a cure. Diabetes not only affects me physically, it affects me emotionally as well. Sometimes I get mad, especially when people say things like I am lucky I missed a class because my blood sugar got too low. Or I get sad when people eat some of my favorite foods and say how good they are, and I cannot eat them because I have celiac, which a lot of people with Type 1 diabetes have too. But I feel happy to have family and friends that help me out, like my walk team, Hannah's Heroes. This year my team did a bunch of fundraisers. We walked in the Diabetes Walk. We had a yard sale with all of the stuff my family does not use. We had a bake sale and a lemonade stand. So far, we have raised over $5,000. I hope that we raised enough money with our team, and I hope that Congress gives scientists the rest of the money that they need because I really do not want other kids to get diabetes. In school this year, I had to write a paper about what I would do if I was President of the United States. One thing I said I would do is have more walks to raise money to help find a cure for diseases like diabetes. My mom says that a cure can be found soon and that doctors and scientists get money that they need to work on it from walks and from Congress. So I am doing my part, and my family and friends are, too. Someday I hope to go to culinary school and open my own small restaurant. I am really hoping that I will not need to include a carbohydrate count on the menu. Thank you, Members of the Committee, and particularly my Senator, Senator Collins, for helping in the fight to cure Type 1 diabetes. Please keep up the good work, and I will, too. [Applause.] Senator Collins. Thank you, Hannah. That was great. Patrick, please go ahead. TESTIMONY OF J. PATRICK LACHER III,\1\ DELEGATE, JDRF CHILDREN'S CONGRESS, SOUTH GLASTONBURY, CONNECTICUT Mr. Lacher. Senator Collins and Senator Lieberman, thank you for inviting me to testify today. My name is Patrick Lacher. I am 13 years old, and I have had juvenile diabetes for over 3 years. --------------------------------------------------------------------------- \1\ The prepared statement of Mr. Lacher appears in the Appendix on page 57. --------------------------------------------------------------------------- My family and I decided to participate in the 2005 JDRF Walk to Cure Diabetes near my home town in South Glastonbury, Connecticut, to support my dad, who has had juvenile diabetes since he was 19. Little did I know that just 2 weeks later, I would be diagnosed with juvenile diabetes. The next 2 days became the hardest in my life. I had a crash course in how to manage my diabetes. The last thing in the mind of a 9-year-old is managing diabetes, but I had to accumulate all that knowledge practically over night. Even though I had watched my dad take care of his diabetes, I never realized how much of my day would be spent dealing with this disease. Though over time it has become easier, I can never cease to pay attention to diabetes and the daily challenges it brings. When I go to a friend's house, even for just a few hours, I have to have a plan. I have to know how active I am going to be, what I am going to eat, and how both will affect me. I have to bring my blood sugar tester and other supplies, such as juice, snacks, or glucose tablets, so I am always prepared for anything that can happen. My bag that carries all of these items is like my right arm. I can never leave it behind. All of this responsibility has been mine since I was a 9-year-old. There are many reasons why a cure is important to me. The most important reason is that it would help not just me, but the millions of other people living with this disease. Just think, if we could improve the lives of millions of children and adults around the world, why wouldn't we? Curing diabetes would also save our country a lot of money since the cost of diabetic supplies and health care is enormous. Another reason a cure is important to me is that it would make my life a whole lot easier. I would be able to sleep over at a friend's house without worrying about my blood sugar, not to mention how worried my parents are when I am away from home. I would be able to eat just as much as my friends do at birthday parties, and I would even be able to order dessert all the time like my little brother does. I cannot wait for that day. I would not have to carry a bag everywhere I go. I could be free. Like Hannah, I am doing my part to help find a cure. With the support of my family and friends, I have had over 100 walkers on my team in the 2008 Walk to Cure Diabetes. I have also spoken at the walk and other JDRF functions to help people understand just how difficult it is to live with diabetes and how they can help. From the day I was diagnosed, I always knew in my heart and believed passionately that we would cure this. And now with all the advances I have seen in just the past 3 years, I know a cure is within our grasp. And that is what keeps me vigilant every day so that my body is ready when a cure is found. It is my hope that one day I can tell my children and grandchildren, ``Can you believe I had diabetes?'' And they will say, ``What is diabetes?'' And I can tell them about how Congress and JDRF worked together to fund research for the cure. Thank you for letting me share my story with you. I look forward to answering any questions you may have. [Applause.] Senator Collins. Thank you, Patrick. Great job. Asa, we are delighted to have you here today. Please go ahead. TESTIMONY OF ASA KELLY,\1\ DELEGATE, JDRF CHILDREN'S CONGRESS, CHARLOTTE, NORTH CAROLINA Ms. Kelly. Good morning. I am Asa Kelly. I am 16 years old and from Charlotte, North Carolina. And like my friends Hannah and Patrick, I am relatively new to the diabetes world. Just over a year ago, on May 29, 2008, I went to the doctor because I was tired and thirsty all the time. The doctor ran some tests, which showed my blood sugar was 362, about three times the normal. I was diagnosed with Type 1 diabetes and was immediately admitted to the hospital. --------------------------------------------------------------------------- \1\ The prepared statement of Ms. Kelly appears in the Appendix on page 58. --------------------------------------------------------------------------- At the hospital, I learned about the different types of insulin I would have to take until there is a cure. The diabetes educator taught me how to check my sugar, draw up insulin, and give myself a shot. She taught me the warning signs of high and low blood sugar and how to treat them. From then on I realized that I was in control of my health and that diabetes is very manageable--a little scary, but manageable. At first when I was discharged, I was scared about giving myself insulin without someone constantly watching me, but I quickly learned. Type 1 diabetes called for some major changes in my life. Testing blood sugar many times daily, counting carbohydrates, and checking ketones are just a few things that I go through. Finding a cure would relieve a lot of the stress it takes me and others to be healthy. I could focus on my school work better and not have to step out of class to deal with a bout of hypoglycemia, which makes my teachers nervous. A cure would also take a load off my parents. My parents trust the workers at my church, the friends who I hang out with, and my school to take care of me because they are not always present to do so. Diabetes is a disability, but I am not disabled. Many people treat me different and feel like I have to be watched more often. But the truth is I am an active teenager, a diehard Carolina Panther and North Carolina Tar Heel fan, a scholar, and a good friend. One of my major goals in life is to actually go to the University of North Carolina at Chapel Hill to become a doctor. I am not going to let diabetes ruin my life. But I deep down hope that I do not have to contend with the daily challenges for much longer. I ask you, as Members of Congress, to support research issues to find a cure. Over 3 million Americans suffer from this disease, and many of them are children and teens just like me and my friends here. A cure would give us freedom to carry on a normal life without taking a break to check our blood or have a snack. I want Congress to feel the urgency of this issue, that it is a daily struggle not just something we can take a break from doing. It is our life style and all choices are made due to it. Please continue to support research efforts to find a cure. A cure would truly change my life, my family's life, and the lives of almost everyone in this room today. Thank you. [Applause.] Senator Collins. Thank you. Nice job, Asa. That was terrific. Mrs. Gould, welcome. TESTIMONY OF ELLEN GOULD,\1\ MOTHER OF DELEGATES PATRICK, SAMUEL, SARAH, AND OLIVER GOULD, JDRF CHILDREN'S CONGRESS, NASHVILLE, TENNESSEE Mrs. Gould. Good morning. Thank you for the opportunity to speak to you today about my family's story of living with Type 1 diabetes and our hope for a cure. I am Ellen Gould from Nashville, Tennessee, and joining me are my children: Patrick, who is 17 today. --------------------------------------------------------------------------- \1\ The prepared statement of Mrs. Gould appears in the Appendix on page 59. --------------------------------------------------------------------------- Senator Collins. Happy Birthday, Patrick. [Applause.] Mrs. Gould. And Sam, who is 12; Sarah, who is 10; and Oliver, my 5-year-old. Yes, all four of them have Type 1 diabetes, and helping them manage their disease can be quite a challenge. Our journey with Type 1 diabetes started in July 2004 when Patrick was diagnosed. My husband and I had noticed he was rapidly losing weight, constantly thirsty, and unusually tired. A trip to the pediatrician turned into a hospital stay, with the required boot camp of sorts, where we received a crash course on diabetes management. And we needed one. There was no diabetes in our family history. Patrick quickly learned how to manage his blood sugar, but for an active teenager going through growth spurts, controlling his blood sugar was often a challenge. Today, Patrick uses shots because the years of having diabetes has left scar tissue where he would insert his infusion sets, so a pump is not his best option. Type 1 diabetes hit home again in January 2006. Sarah began to show the similar symptoms as Patrick had just 2 years earlier. We were devastated all over again. Fortunately, her brother was and still is an excellent role model, and we had a lot of experience with highs, lows, and sick days under our belt. So she was able to quickly adapt to the routine. Unlike her brother, she wears a pump, which requires different prescriptions and different management. Shortly after Sarah's diagnosis, my husband and I learned about a clinical trial called TrialNet, which is funded by the Special Diabetes Program. Researchers were looking for children whose siblings had Type 1 to see if the children were at risk for developing Type 1. We immediately enrolled our family. The initial screening required a blood test. My heart sank when Sam and Oliver's results came back positive for diabetes antibodies, meaning they were clearly at risk of developing full-blown Type 1. Later tests indicated that Sam did have Type 1, although he was not showing the classic symptoms at that time. While we were dealing with helping a third child manage diabetes, at the age of 3, Oliver started taking a pill as part of the TrialNet study to see if the full onset of Type 1 could be delayed by months or years. We do not know if he received a placebo or oral insulin, but last fall he too was diagnosed with Type 1. He is a real trooper; he tests his own blood sugar and has learned to handle all the injections. As you can see, my husband and I have our hands full. While the kids are very responsible with their diabetes care, they still need oversight. We are constantly filling prescriptions, scheduling doctors' appointments, filling out forms for school and various activities, educating others, and making sure our kids are safe. We have four other children at home, so you can only imagine how busy our lives are. Finding a cure means everything to our family, and we are willing to be part of the solution even with juggling our already busy life. We are very active in our local JDRF chapter. We will do all we can to educate others and raise funds for a cure. We have participated in research studies and will continue to do so. This is not just about the Gould family. It is about the thousands of children who have to live with this terrible disease every day. It is about the thousands of children who are going to be diagnosed with this disease. While insulin therapy helps us manage this disease, insulin is not a cure. On many occasions, we carefully measure blood sugars, count carbohydrates, and inject what we think is just the right amount of insulin. And it is so discouraging when we measure just a few hours later and their blood sugar is way above the normal range. How many high blood sugars are too many? When will the long-term complications with their eyes, kidneys, or heart start to show? Sometimes we have to deal with the low blood sugars, like the Saturday morning several months ago when we were awakened by Sam, who had collapsed in his room, incoherent, because of a dangerously low blood sugar. It took us 20 minutes to get him back to normal. What happens the next time if we do not hear him? As their mother, I just want to reach out and make it better. I cannot. I cannot cure this disease, I cannot make it better for my kids. I need help. We are so very grateful that so many Senators and Representatives have been doing their part by being strong and vocal supporters of the Special Diabetes Program. It is our hope that the Special Diabetes Program will continue well into the future so that clinical trials, such as TrialNet, can continue and lead to better treatments and eventually a cure for Type 1 diabetes. Thank you. [Applause.] Senator Collins. Thank you very much. Mrs. Gould, you gave such moving testimony. One of the things I have learned about juvenile diabetes is it affects not just the child or, in your case, the children who suffer from the disease, but it has an impact on the whole family. Could you talk to us a little bit more about the impact on your other four children who do not have diabetes? What is the impact on their lives? Mrs. Gould. Well, they know just as much about counting carbohydrates and giving shots, and they help us, especially Oliver, test his blood sugar. He is learning to do it on his own, but sometimes he needs a little help. And Nicholas and Andrew, who are here with me today, both help a lot. They are 15 and 13. Our two youngest are 3 and 2. So they always ask, ``Well, when am I going to get diabetes, too?'' It is definitely part of our family. I think they feel very fortunate that they do not have it yet, but they go through the trials and tribulations with us all. And they are each tested every year through TrialNet for the presence of antibodies, and we are praying every time--we were just tested 2 weeks ago, the four who are not diabetic-- that they will not have it. But if they do test positive, we will also enroll them in the study because we are very committed that research has to have people to participate. And it is not everybody else's job to cure this. We have to be part of the cure. Senator Collins. Thank you. [Applause.] Senator Collins. Asa, I loved it when you said that you have diabetes and it is a disability, but that you are not disabled. And you have set such high goals for yourself, and I cannot wait someday to call you ``Dr. Kelly.'' I think that is just wonderful. Does it help you keep those high goals to hear from successful people like Mary Tyler Moore and Nick Jonas and Sugar Ray Leonard about how they have coped with diabetes themselves or in their family? Does that help encourage you? Ms. Kelly. Most definitely, it helps encourage me that this is not like a life sentence or whatever. I can still live my life. I think it actually speaks more to the outside public because a lot of people do not know about Type 1 diabetes because most of them just know about Type 2, because Type 1 is less common. It helps them to realize that we are just normal or whatever, that we had nothing to do with it, that it is just something that we are just composed of. Senator Collins. Thank you. Patrick, could you tell us what you would like people who do not have diabetes to know about what it is like for those of you who do, such as your classmates or your teachers? What would you like them to know? Mr. Lacher. Well, I do not think a lot of people actually understand just how much work and effort goes into even just a normal day with diabetes. You have to test your blood sugar. You have to count your carbohydrates. You have to bolus or give yourself a shot, whatever the case may be. And then you have to also manage your blood sugars in one way or another. So if everybody could even just understand how hard it is, I think it would make a whole lot of difference. Senator Collins. I think you are right. Do you think that it helped you adjust that you had seen your father cope with diabetes? Mr. Lacher. I think my dad's support and having seen him do it definitely had positive effects because I knew that my dad has done it, he seems all right. [Laughter.] Senator Collins. I bet he is better than all right. That is helpful. Thank you. Hannah, what is the hardest part of having diabetes for you? Ms. Ryder. Probably that you can never take a break. It is always with you, and my blood sugar never is really in the middle. I am always really high or kind of low. I think yesterday was the first good blood sugar I have had in a week. Senator Collins. That has to be difficult. It really must be. Is it also more complicated for you because you have celiac disease as well? Could you talk to us a little bit about that? Ms. Ryder. Well, since I cannot have wheat, sometimes if I feel low, I am at a place where I cannot find food that does not have wheat in it. So I have to eat glucose tabs or juice, and that is all I can have if I am low. Senator Collins. That is a challenge. I want to thank all of you for coming here today. We are about to have yet another vote, so rather than trying to go vote and come back, I think I will just give each of you an opportunity for any additional comments or anything else that you would like us to know. Hannah, is there anything else that you would like us to know? Ms. Ryder. No. Senator Collins. You are all set. Patrick. Mr. Lacher. No. Senator Collins. Asa. Ms. Kelly. No. Senator Collins. Mrs. Gould. Would any of your children like to say anything for us? Mrs. Gould. What would you like to say, Oliver? Senator Collins. You do not have to. It is not required. Mrs. Gould. Well, he had asked, ``Well, when is it going to be my turn to talk?'' So it is your turn, if you would like to say something, Oliver. Oliver Gould. I will let Patrick say something. Mrs. Gould. You want Patrick to say something? Senator Collins. Oliver has passed the microphone to Patrick. [Laughter.] Patrick Gould. I just want everybody to know that a cure is coming and to hang in there, just hang tight. That is what keeps me going, is that I know that it will be cured eventually and it will be cured soon. So everybody just needs to hang in there and do your best until we do not have to worry about this anymore. Senator Collins. Those are great words for us to close on. [Applause.] Senator Collins. Well, I, too, have some final words, and Hannah really reminded me of it, and that is, I know the theme of this Children's Conference is to promise to remember you, and I just want to give you my personal promise that I will remember you, and I will continue to do everything that I can to advance the research that will indeed someday lead to a cure. We have already seen such tremendous progress in better means of diagnosis, better means of treatment, and ultimately, if we all continue to push for more research and to work with the scientists, to participate in clinical trials, and if Congress continues to listen to you, the advocates, the families, I am confident that one day when we convene the Children's Congress, it will be to celebrate a cure. So thank you, particularly all the children who have come from all over the country. I want to tell each and every one of you how important you are to the search for a cure. When you go see your Senators and your Members of Congress, you help them understand just how important this is. So you are great advocates and ambassadors for the cause of juvenile diabetes. Thanks to your work, we were able to get the research dollars tripled in the last decade, and with your continued help, we one day will be here in this very room celebrating a cure. So thank you very much for your advocacy. It has been a great honor to be with you here this morning. This hearing is adjourned. 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