February 1, The Honorable Jeanne Shaheen United States Senate 520 Hart Senate Office Building Washington, DC Dear Senator Shaheen:

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1 February 1, 2013 The Honorable Jeanne Shaheen United States Senate 520 Hart Senate Office Building Washington, DC Dear Senator Shaheen: On behalf of the nearly 26 million Americans with diabetes and the 79 million more with prediabetes, the American Diabetes Association is pleased to offer its support for the National Diabetes Clinical Care Commission Act. This legislation establishes the National Diabetes Clinical Care Commission within the Department of Health and Human Services which is charged with evaluating federal programs that support appropriate clinical care for people with prediabetes and diabetes and providing recommendations on how to better coordinate and leverage program resources. The Commission has a number of responsibilities under the legislation including: evaluating federal programs and identifying critical gaps in an effort to support clinicians who provide care to people with prediabetes and diabetes; expanding education and awareness to health care professionals where necessary; and reviewing and recommending effective methods for outreach and dissemination of educational resources related to diabetes prevention and treatments. This legislation will improve education and awareness about prediabetes and diabetes, further efforts to prevent diabetes, and lead to fewer cases of undiagnosed prediabetes and diabetes. Furthermore, clinicians will be better equipped to provide necessary services and treatments to people with prediabetes and diabetes allowing for improved disease management and reduced risk for severe complications such as blindness, amputations, heart disease and kidney failure. The total annual cost of diabetes and its complications, including undiagnosed diabetes, prediabetes and gestational diabetes was an estimated $218 billion in 2007, and will continue to grow unless our country takes action. The Association thanks you for your leadership in introducing the National Diabetes Clinical Care Commission Act which will improve coordination of federal diabetes programs and help stop the diabetes epidemic. If you have any questions or need further assistance, please do not hesitate to contact Tekisha Dwan Everette, Managing Director, Federal Government Affairs at teverette@diabetes.org or Gina M. Gavlak, RN, BSN Chair, National Advocacy Committee National Office 1701 North Beauregard Street Alexandria, VA Tel: Fax: Diabetes Information Call DIABETES ( ) Online: The Association gratefully accepts gifts through your will. The Mission of the American Diabetes Association is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

2 26 Broadway, 14 th Floor New York, NY t: f: Jeffrey Brewer President & CEO March 7, 2013 Alan J. Garber, MD, PhD, FACE President American Association of Clinical Endocrinologists 245 Riverside Avenue, Suite 200 Jacksonville, FL Dear Dr. Garber: I write to share JDRF s support for the National Diabetes Clinical Care Commission Act. While JDRF s mission focuses on research to find a cure for type 1 diabetes and to advance technologies so that people with diabetes can better manage their disease in the interim, JDRF recognizes that this legislation is not only an important priority for AACE but would also serve to improve diabetes care delivery and outcomes for patients with diabetes. As the national cost of diabetes continues to rise, it makes sense to ensure federal resources are leveraged most effectively and efforts are well coordinated so that patients receive the best possible care. Thank you for bringing this legislation to our attention. I look forward to continuing to work with you to advance our mutual interest of helping those with diabetes while we work towards a cure. Jeffrey Brewer President and Chief Executive Officer

3 January 15, 2013 The Honorable Jeanne Shaheen Senator U.S. Senate 520 Hart Senate Office Building Washington, DC Suite F Street, NW Washington, DC Tel Fax Federal Affairs Department Dear Senator Shaheen, On behalf of the American Academy of Ophthalmology, I am writing to offer our strong support of the National Diabetes Clinical Care Commission Act which is aimed at improving the quality of diabetes care in the United States. The legislation establishes a commission, comprised of private and public sector members, to evaluate all of the government s current approaches to diabetes care and provide recommendations on improvements, integration and on new approaches to address this major public health concern. Nearly 26 million Americans in the United States have diabetes. Anyone with diabetes is at risk for diabetic eye disease which can include diabetic retinopathy, cataracts, and glaucoma, and diabetes is the leading cause of new cases of blindness among adults aged 20 to74 years of age. Diabetic retinopathy, the most common diabetic eye disease, affects more than 4.4 million Americans age 40 and older. Nearly all patients with type 1 diabetes, and greater than 60% of patients with type 2, develop retinopathy within the first two decades of the disease. The economic and societal costs of vision impairment and eye disease are significant and growing. The annual direct medical costs (including outpatient, inpatient, and prescription drug services) for Americans age 40 and older with diabetic retinopathy is $490 million. The Academy applauds your efforts to ensure the federal government fully leverages all existing resources to ensure that diabetes patients are receiving the highest quality of care possible. The National Diabetes Clinical Care Commission Act is a significant step in our nation s fight against diabetes and its consequences. We look forward to working with you on securing the legislation s passage. Gregory Kwasny, MD Secretary for Federal Affairs American Academy of Ophthalmology

4 April 9, 2013 The Honorable Jeanne Shaheen The Honorable Susan Collins 520 Hart SOB 413 Dirksen SOB Washington, DC Washington, DC Dear Senators Shaheen and Collins: The members of the Diabetes Advocacy Alliance TM (DAA) would like to express our support for S. 539, the National Diabetes Clinical Care Commission Act. The vision of the DAA is to influence change in the US health care system to improve diabetes prevention, detection and care, and we believe that this legislation is a giant step forward in coordinating and thereby strengthening the nation s efforts to address diabetes. The National Diabetes Clinical Care Commission as established in S. 539 will be comprised of diabetes experts, including health care providers who work directly with people with diabetes, patient advocates, and federal agency representatives most involved in diabetes activities. We applaud the provisions of this legislation to improve the quality of diabetes care delivered, especially given that the Commission will evaluate federal efforts; seek to eliminate redundancies; identify the most effective policies; and make recommendations to the Secretary of Health and Human Services to leverage the federal investment in diabetes to improve patient outcomes and reduce the burden of the disease. We believe that successful execution of these provisions will provide needed strategic and coordinated direction to the efforts to combat diabetes in America. The diabetes epidemic continues to grow. In 2012, the nation spent $245 billion on diabetes, an increase of 41 percent from 2007 and over 62 percent of the cost for diabetes care is borne by the federal government. According to the Centers for Disease Control and Prevention (CDC), one in three adults could have diabetes by 2050 if current trends continue. This important legislation will help us forge a more effective path for addressing diabetes in the United States and ultimately help to alter the significant human and economic toll of the disease. The DAA thanks you for your leadership on this critical diabetes issue with S. 539 and for your advocacy on behalf of the 26 million Americans already living with the disease and the 79 million Americans at high risk for diabetes. Academy of Nutrition and Dietetics American Association of Clinical Endocrinologists American Association of Diabetes Educators American Clinical Laboratory Association American Diabetes Association

5 American Podiatric Medical Association Novo Nordisk Inc. Results for Life The Endocrine Society VSP Vision Care

6 Formerly named in honor of Lawson Wilkins 6728 Old McLean Village Drive McLean VA BOARD OF DIRECTORS PRESIDENT Steven D. Chernausek, MD Oklahoma City, OK PRESIDENT-ELECT Morey W. Haymond, MD Houston, TX SECRETARY Peter Lee, MD Hershey, PA TREASURER Karen Rubin, MD Hartford, CT PAST PRESIDENT Janet H. Silverstein, MD Gainesville, FL AT LARGE DIRECTORS Stephen M. Rosenthal, MD San Francisco, CA Charlotte Boney, MD Providence, RI Mark Palmert, MD, PhD Toronto, ON March 11, 2013 Senator Jeanne Shaheen U.S. Senate Room 520 Hart Senate Office Bldg. Washington, D.C ATT: Alison MacDonald Dear Senator Shaheen: On behalf of the Pediatric Endocrine Society (PES), I am pleased to inform you that the PES Board of Directors wishes to register its support for the legislation to create the National Diabetes Clinical Care Commission. We look forward to working with all interested parties to advance this important initiative so that children may benefit from the work of this new commission. The Pediatric Endocrine Society represents over 1200 members who are working daily in patient care, research and teaching in order to Advance the care of infants, children and adolescents who have endocrine disorders. PES Management Team Executive Director George K. Degnon, CAE Association Manager Christy McGinty Levine Steven D. Chernausek, MD President of PES PES Annual Meeting May 4 May 7, 2013 Washington, DC

7 8401 CONNECTICUT AVENUE, SUITE 900 CHEVY CHASE, MARYLAND TELEPHONE FAX January 17, 2013 The Honorable Jeanne Shaheen U.S. Senate 520 Hart Senate Office Building Washington, DC Dear Senator Shaheen: The Endocrine Society applauds your introduction of the National Diabetes Clinical Care Commission Act. The Society strongly endorses this important legislation and thanks you for your leadership on the issue. The Endocrine Society is the world's largest and most active professional organization of endocrinologists representing over 16,000 members worldwide. We are dedicated to quality research, patient care, and education. The Society supports your efforts to create the National Diabetes Clinical Care Commission (NDCC) to provide a formal mechanism for the federal government to coordinate and evaluate programs supporting appropriate clinical care for people with pre-diabetes and diabetes. We believe that the federal government needs a mechanism which allows direct and consistent contact with clinical expertise from professionals who work directly with patients with diabetes and those who implement federal policy. The National Diabetes Clinical Care Commission will also provide for the evaluation of the effectiveness of current and new federal programs to improve diabetes care and reduce the burden of the disease, including the Medicare diabetes screening benefit, the Annual Wellness Visit and other programs that may reduce the risk of diabetes and its complications. The Society sees a need for a new body to evaluate new delivery models in order to achieve the highest quality of diabetes care and optimal patient outcomes. Diabetes is the now the seventh leading cause of death in the United States. Diabetes affects 25.8 million people of all ages, 8.3 percent of the U.S. population, and that number is only growing. Diabetes is a rapidly growing epidemic and a public health threat and we urge Congress to make every attempt to combat that threat. We believe your legislation is a significant step in that direction as we now need a central hub of clinical thought leaders, Administration officials, and public health leaders to deal with this growing crisis. Thank you, Senator Shaheen, for recognizing the need for stronger coordination of diabetes care. We support your efforts and endorse the National Diabetes Clinical Care Commission Act. If we can be of assistance to you in any way, please contact Stephanie Kutler, Director of Government Affairs, at skutler@endo-society.org or William Young, Jr. MD, MSc President The Endocrine Society

8 March 27, 2013 The Honorable Jeanne Shaheen United States Senate 520 Hart Senate Office Building Washington, DC Dear Senator Shaheen: On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our support for S. 539, the National Diabetes Clinical Care Commission Act. According to the Centers for Disease Control and Prevention (CDC), nearly 26 million Americans have diabetes and another 79 million Americans have pre-diabetes; the CDC projects that as many as one in three American adults could have diabetes by 2050 if current trends continue. One in every 10 health care dollars and one in every three Medicare dollars is spent on diabetes and its complications. Your legislation will help to address these alarming statistics by creating a Commission that will focus on improving diabetes care delivery and patient outcomes. This Commission would be charged with conducting a comprehensive evaluation of current federal quality improvement initiatives and identifying gaps where new approaches are needed to improve the quality and cost-effectiveness of diabetes care delivered to patients. The Commission will also identify and eliminate duplication and assist in the coordination of federal quality improvement efforts across all federal agencies, as well as help to better leverage the significant federal investment in research by evaluating best practices and other resources and tools for diabetes health care professionals and patients. We believe the Commission created by your legislation would be an important step forward in addressing the diabetes epidemic, and we applaud you for your leadership in introducing this bill. James L. Madara, MD

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