Leveraging Federal Programs for Population-Level Diabetes Prevention and Control: Recommendations from the National Clinical Care Commission

Authors: SCHILLINGER, DEAN - University Of San Francisco; BULLOCK, ANN - Indian Health Service; POWELL, CLYDETTE - George Washington University Medical Center; Fukagawa, Naomi; GREENLEE, CAROL - Collaborator; TOWNE, JANA - Indian Health Service; GONZALVO, JASMINE - Purdue University; LOPATA, AARON - Health Resources & Services Administration; COOK IV, WILLIAM - Ascension Saint Agnes Health Center; HERMAN, WILLIAM - University Of Michigan

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/6/2022
Publication Date: 1/30/2023
Citation: Schillinger, D., Bullock, A., Powell, C., Fukagawa, N.K., Greenlee, C., Towne, J., Gonzalvo, J.D., Lopata, A.M., Cook Iv, W.J., Herman, W.H. 2023. Leveraging federal programs for population-level diabetes prevention and control: Recommendations from the National Clinical Care Commission. Diabetes Care. 46(2):e24-e38. https://doi.org/10.2337/dc22-0619.
DOI: https://doi.org/10.2337/dc22-0619

Interpretive Summary: Diabetes mellitus is one of the major non-communicable diseases affecting a significant portion of the global population. One of the duties of the National Clinical Care Commission (NCCC) was to make recommendations to improve federal education, awareness, and dissemination activities related to diabetes prevention and treatment. A myriad of factors at the individual, community and societal levels influence diabetes risk and the treatment of the disease with minimal complications. The NCCC acknowledged that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be addressed as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions to facilitate the prevention and treatment of diabetes. This paper reviews the rationale and scientific evidence base and summarizes the NCCC’s population-wide recommendations that relate to specific federal policies, programs, agencies, and departments beyond those that relate to healthcare, including USDA, HUD, FDA, FTC, Labor and EPA, among others. These population-level recommendations represent a major shift in how the federal government can address the diabetes epidemic. By recommending a health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress and the Secretary of Health and Human Services has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, and costs in the U.S. However, substantial political resolve will be needed to translate recommendations into policy; engagement by diverse members of the diabetes stakeholder community will be critical to such translation efforts.

Technical Abstract: The etiology of type 2 diabetes is rooted in a myriad of factors at the individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. These causal factors are impactful on diabetes risk and treatment not only around the time of diabetes diagnosis, but can accumulate biologically from before conception, continuing in utero and across the life course. These include inadequate nutritional quality, poor access to physical activity resources and opportunities, chronic stress from many sources (e.g., adverse childhood experiences, racism, poverty), as well as exposures to environmental toxins. The 2021 National Clinical Care Commission (NCCC) acknowledged that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be addressed as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions to facilitate the prevention and treatment of diabetes. This paper reviews the rationale and scientific evidence base and summarizes the NCCC’s population-wide recommendations that relate to specific federal policies, programs, agencies, and departments beyond those that relate to healthcare, including USDA, HUD, FDA, FTC, Labor and EPA, among others. These population-level recommendations represent a major shift in how the federal government can address the diabetes epidemic. By recommending a health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress and the Secretary of Health and Human Services has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, and costs in the U.S. However, substantial political resolve will be needed to translate recommendations into policy; engagement by diverse members of the diabetes stakeholder community will be critical to such translation efforts.