[Senate Hearing 119-509]
[From the U.S. Government Publishing Office]


                                                      S. Hrg. 119-509

             A FUTURE WITHOUT TYPE 1 DIABETES: ACCEL-
              ERATING BREAKTHROUGHS AND CREATING 
              HOPE FOR FISCAL YEAR 2026
=======================================================================

                                HEARING

                               BEFORE THE

                        COMMITTEE ON APPROPRIATIONS 
                           UNITED STATES SENATE

                    ONE HUNDRED NINETEENTH CONGRESS

                             FIRST SESSION

                               __________

                            SPECIAL HEARING

                      JULY 9, 2025--WASHINGTON, DC

                               __________

         Printed for the use of the Committee on Appropriations
         
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]         

        Available via the World Wide Web: http://www.govinfo.gov
                               __________
                               
               U.S. GOVERNMENT PUBLISHING OFFICE
64-417 PDF            WASHINGTON : 2026
=======================================================================
                               
                      COMMITTEE ON APPROPRIATIONS

                     SUSAN M. COLLINS, Maine, Chair
MITCH McCONNELL, Kentucky            PATTY MURRAY, Washington, Vice 
LISA MURKOWSKI, Alaska                   Chair
LINDSEY GRAHAM, South Carolina       RICHARD J. DURBIN, Illinois
JERRY MORAN, Kansas                  JACK REED, Rhode Island
JOHN HOEVEN, North Dakota            JEANNE SHAHEEN, New Hampshire
JOHN BOOZMAN, Arkansas               JEFF MERKLEY, Oregon
SHELLEY MOORE CAPITO, West Virginia  CHRISTOPHER A. COONS, Delaware
JOHN KENNEDY, Louisiana              BRIAN SCHATZ, Hawaii
CINDY HYDE-SMITH, Mississippi        TAMMY BALDWIN, Wisconsin
BILL HAGERTY, Tennessee              CHRISTOPHER MURPHY, Connecticut
KATIE BOYD BRITT, Alabama            CHRIS VAN HOLLEN, Maryland
MARKWAYNE MULLIN, Oklahoma           MARTIN HEINRICH, New Mexico
DEB FISCHER, Nebraska                GARY C. PETERS, Michigan
MIKE ROUNDS, South Dakota            KIRSTEN E. GILLIBRAND, New York
                                     JON OSSOFF, Georgia

              Elizabeth McDonnell, Majority Staff Director
                Evan D. Schatz, Minority Staff Director
                            
                            C O N T E N T S

                              ----------                              
                                                                   Page

Opening Statement of Chair Susan M. Collins......................     1
Statement of Vice Chair Patty Murray.............................     3
Statement of Senator Jeanne Shaheen, Read by Chair Collins.......     4
Statement of Ms. Ruby Whitmore, Breakthrough T1D 2025, Children's 
  Congress Delegate, Old Town, Maine.............................     6
    Prepared Statement...........................................     7
Statement of Ms. Rachel White, Children's Congress Delegate, 
  North Hampton, New Hampshire...................................     8
    Prepared Statement...........................................     9
Statement of Ms. Katie Bone, USA Climbing Speed National 
  Champion, Bernalillo, New Mexico...............................    10
    Prepared Statement...........................................    11
Statement of Dr. Griffin P. Rodgers, M.D., M.A.C.P., Director, 
  National Institute of Diabetes and Digestive and Kidney 
  Diseases, Bethesda, Maryland...................................    12
    Prepared Statement...........................................    13
Conclusion of the Hearing........................................    37

 
                   A FUTURE WITHOUT TYPE 1 DIABETES: 
   ACCELERATING BREAKTHROUGHS AND CREATING HOPE FOR FISCAL YEAR 2026

                              ----------                              


                        WEDNESDAY, JULY 9, 2025

                                       U.S. Senate,
                               Committee on Appropriations,
                                                    Washington, DC.
    The Committee met at 10:00 a.m. in room SD-106, Dirksen 
Senate Office Building, Hon. Susan Collins, chair, presiding.
    Present: Senators Collins, Murkowski, Moran, Hoeven, 
Boozman, Capito, Hyde-Smith, Britt, Murray, Durbin, Shaheen, 
Baldwin, Van Hollen, and Ossoff.

               BREAKTHROUGH T1D 2025 CHILDREN'S CONGRESS


              opening statement of chair susan m. collins


    Chair Collins. What an obedient crowd we have here today.
    This hearing will come to order. Good morning, everyone and 
welcome to our Nation's Capitol. I am so pleased to convene 
this biennial hearing in conjunction with the Breakthrough T1D 
2025 Children's Congress. It is wonderful to host you and your 
families at the Senate Appropriations Committee.
    As the founding co-chair of the Senate Diabetes Caucus, I 
have long promoted diabetes research as one of my top 
priorities. Your advocacy for life-changing research to 
prevent, treat, and ultimately cure type 1 diabetes (T1D) 
inspires me. Looking out at this field of blue inspires me, but 
looking at your faces inspires me even more.
    Over the years, I have met so many wonderful children 
living with type 1. Individuals such as my summertime neighbor, 
Ruby Whitmore, who is going to be testifying today; Caroline 
Cardoza from Brunswick, Maine, who is 6, and joins us as a 
delegate; Aidan Sweeney, whom I first met when he was only age 
4, and now he is age 23. There is so many more, including our 
New Hampshire Delegate, Rachel White, who is also testifying 
today.
    There are adults who are living with type 1 as well, 
including Nicole Wiesendanger, a teacher of who has lived with 
diabetes for more than 37 years and happens to be married to my 
nephew. I told Nicole I would work her in.
    [Laughter.]
    Chair Collins. More than 170 delegates have traveled to 
Washington from across the United States and five other 
countries to share with Members of Congress their personal 
stories of what it is like to live with type 1 diabetes. And I 
want to tell you how much your personal stories really matter. 
They motivate and educate Senators and House Members to get 
involved and to support funding for the research that is 
necessary to deliver new treatments, more effective 
technologies, and one day, a cure.
    Let me tell you about my very first meeting with a family 
who had a son with type 1 diabetes. I was a brand new Senator, 
it was back in 1997. They came to my Portland, Maine office. 
And this little boy looked up at me and he said, ``I wish I 
could just take one day off from having diabetes, my birthday, 
or Christmas, just one day.'' But of course he could not. And 
type 1 diabetes today is a disease that one can never outgrow. 
But I am confident that that is going to change.
    Just this morning, 6-year-old Caroline Cardoza, from 
Brunswick, Maine, told me that she is a warrior for the cause 
of finding a cure for diabetes.
    So these personal stories are why I started the bipartisan 
Senate Diabetes Caucus in 1997. Since we started the caucus, 
and it has been bipartisan from the beginning, because diabetes 
does not care if you are a Republican, or a Democrat, or an 
Independent, or a Green, or what.
    We have made some real progress. It has been exciting, 
Federal funding for diabetes research has increased from $319 
million in 1997 to more than $2.3 billion. That is due to your 
advocacy, and that includes a $10 million increase enacted just 
last year. These investments are yielding results.
    One program in particular has led to technologies that will 
allow better control of diabetes. That is the Special Diabetes 
Program (SDP) at the National Institutes of Health (NIH), and 
how lucky we are to have Dr. Rodgers joining us again this 
year. This critical program provides $160 million a year for 
type 1 diabetes research, supplementing the regular 
appropriations for diabetes. In 2017, the Special Diabetes 
Program led to the development of the first ever FDA (U.S. Food 
and Drug Administration) approved artificial pancreas that can 
control blood glucose levels automatically.
    And I am curious, how many of you here today are using the 
continuous glucose monitor? All right, that is wonderful.
    [Applause.]
    Chair Collins. That shows the difference that the research 
can make. More recently, clinical trial data resulting from an 
SDB-supported Clinical Islet Transplantation Consortium, have 
contributed to the development of the first ever stem cell-
based research, and treatment for type 1 diabetes. This was 
developed through research by Dr. Doug Melton at Harvard 
University who has two children with type 1, and was determined 
to find a cure.
    So here is the exciting news which Dr. Rodgers will talk 
about further today: Of the 12 individuals enrolled in the 
clinical trial, 10 of them no longer need insulin after 1 year. 
Imagine that. So today, we can be ever more hopeful that one 
day we will live in a world where type 1 diabetes can be cured.
    Another important component of the program, which I know is 
of particular interest to the Senator from Alaska, supports 
prevention and treatment services for American Indians and 
Alaskan Natives who experience type 2 diabetes at nearly three 
times the National average. The Special Diabetes Program must 
be extended again this year; otherwise, it expires in 
September. We work together to secure the first funding 
increase for the SDP in 20 years, but we have got to extend the 
program all together.
    I have introduced legislation with the co-chair of the 
Caucus, Senator Jeanne Shaheen, to reauthorize this program 
through the end of 2027. So as you make your visits today, 
please ask Members to co-sponsor that bill so that the Special 
Diabetes Program does not expire in September.
    Let me close by saying how truly inspiring it is to look 
out and see all of the children who are here today, their 
parents and loved ones who have come to DC to share your 
personal stories, and to continue advocating for increased 
research funding so that we expedite, we speed up the search 
for a cure. Your passion and hope for a cure gives us the 
confidence that it will happen.
    Thank you so much for being here today.
    I will now turn to my friend and colleague, the Vice Chair 
of the Senate Appropriations Committee, Senator Murray, for her 
opening statement. Thank you, Senator.
    [Applause.]
    Vice Chair Murray. Thank you.
    Chair Collins. Thank you. Thank you.


                  statement of vice chair patty murray


    Vice Chair Murray. Thank you very much, Madam Chairman. And 
just a point of personal privilege before I speak about this 
topic, I do want to acknowledge the tragedy in Texas, and our 
thoughts are with the families who lost loved ones, and we 
thank all of our first responders who rushed into danger. I 
know that all of us here are ready to help Texas recover and 
rebuild. And I say that on behalf of all of us here in this 
Committee.
    With that, thank you again, Chair Collins, for again 
convening this really important, impressive hearing to talk 
about the NIH Special Diabetes Program's critical work that 
supports life-changing research for millions of people who are 
living with type 1 diabetes. And in particular to hear from all 
the kids and young adults who are living with type 1 diabetes 
who came all the way here today to talk about why this program 
matters. I know all of you have traveled from all over the 
country. I do not think anybody made it here from Washington 
State, it is a long trip but--oh, in the back, awesome, great 
to see you.
    I want you to know that your voices make a huge difference 
in making sure that Congress takes action to treat and 
eventually cure type 1 diabetes. It is important that all of us 
understand your experiences with diabetes, which is, of course, 
what this hearing is all about. And of course, it is important 
that we improve our understanding of this disease itself, which 
is what the NIH Special Diabetes Program is all about. This 
program has a great history of accomplishment. Getting new 
artificial pancreas--pancreatic devices to market, bringing us 
new medication to delay type 1 diagnosis, and improving care 
for patients with serious complications, and more breakthroughs 
that we all know are just around the corner.
    This work is life-changing which is why I do want to really 
express my concern today about the fact that the Trump 
administration is terminating or freezing more than 260 grants 
from the National Institute of Diabetes and Digestive and 
Kidney Diseases (NIDDK). The care and research that people are 
counting on is really in jeopardy and your voices are important 
today. Four of those canceled NIDDK grants are in my home State 
of Washington, including a clinical trial looking at blood 
pressure in 200 hemodialysis patients and a grant to train the 
next generation of researchers.
    I know that at Columbia University, President Trump 
terminated funding for research on how type 1 diabetes affects 
bone strength in kids. I do not think anyone here needs us to 
explain why that is so important. We need to strengthen bones 
and avoid fractures, so everyone can run, and play, and compete 
in sport, and live life to its fullest.
    So, I want to be clear here today: Trump does not get to 
decide funding for diabetes; Congress does. And I know Members 
on both sides of the aisle are committed to making sure we 
maintain strong investments in this work. But we need more than 
just talk right now. We need to stand up and reject what is 
happening right now to biomedical research at NIH. And I know 
that my colleagues understand that as well.
    So again, I really want to thank all of you for being here 
today, because when it comes to defending this research, when 
it comes to pushing back against these kinds of cuts and 
funding freezes that we are seeing, the most effective tool we 
have is our voices, like the advocates in this room. The 
strongest way all of you can push back is by speaking out, just 
like you are doing today, sharing your stories, which are so 
important, and make sure everyone knows what is at stake. And I 
know that with the incredible advocates like all of you, we are 
going to keep making progress, and we are going to keep 
investing in life-changing research and eventually cure type 1 
diabetes.
    Thank you very much, Madam Chair.
    Chair Collins. Thank you.
    [Applause.]
    Chair Collins. I mentioned that Senator Shaheen from New 
Hampshire has been my longtime co-chair of the Senate Diabetes 
Caucus. We worked together as a team with many of our 
colleagues who you see here today. She is delayed because of a 
session in the Senate Armed Services Committee. She will be 
joining us later, but she asked that I quickly read a brief 
opening statement before we turn to our witnesses.


       statement of senator jeanne shaheen, read by chair collins


    Chair Collins. This is from Senator Shaheen:
          ``I want to extend a warm welcome to all of the 
        witnesses and the more than 170 advocates who have 
        traveled to Congress today to participate in this 
        year's Children's Congress. Your tireless advocacy for 
        yourself, your families, your friends, and everyone 
        living with type 1 diabetes, including my own 
        granddaughter, is truly inspiring.
          ``While I regret that I cannot be with you in person, 
        I do want to take a moment to recognize Rachel White 
        from Northampton, New Hampshire''--not far from Maine--
        she did not write that part, I added that part----
    [Laughter.]
    Chair Collins [continuing].
          ``Who you will be hearing from shortly. Rachel's 
        story is one that has deeply moved me. As a teenager, 
        she balances a demanding academic schedule, collegic 
        level athletics, and dedicated advocacy work, all the 
        while managing the daily challenges of type 1. She will 
        share what that means in her own words, but let me say 
        from my family's experience, it requires 
        extraordinary--extraordinary discipline, strength, and 
        resilience.
          ``To my colleagues, I urge you to listen closely to 
        these advocates. Their stories are powerful reminders 
        of the urgency of our work. We must do more to support 
        people living with diabetes, starting with increased 
        Federal investment in research through the NIH and the 
        Special Diabetes Program. Thanks to these programs, we 
        stand on the brink of a cure.
          ``This is the moment to deepen our commitment to 
        these advocates, not to abandon it. We must also 
        finally pass comprehensive legislation to make insulin 
        affordable for every American, namely, our Bipartisan 
        Insulin Act I have co-authored in previous Congresses 
        with Senator Collins.
          ``Thank you again for sharing your stories and for 
        being here today. I wish you all a meaningful and 
        memorable Children's Congress.''
    [Applause.]
    Chair Collins. Thank you, Senator Shaheen. Thank you.
    We will now turn to our witnesses. Our first witness I am 
proud to welcome from the Great State of Maine is Ruby 
Whitmore. Ruby is 16 years old and was diagnosed with type 1 
diabetes at age 5. I have known Ruby, literally, her entire 
life. She is a rising junior and plans to major in biochemistry 
in college with the goal of working in the emergency medical 
field of trauma surgery. Ruby, thank you so much for making the 
journey down from Maine to be with us today.
    Our next witness, as I mentioned, is going to be Rachel 
White from Northampton, New Hampshire. Rachel is also 16 years 
old and was diagnosed with type 1 at age 11. She is a 
nationally ranked tennis player who aspires to play tennis at 
the collegiate level. Rachel, thank you for being here today to 
share your story.
    After Rachel's testimony, we will hear from Katie Bone. 
Katie was diagnosed with type 1 at age 11. Today, she is a 
professional rock climber and her passion for climbing led her 
to local Ninja Warrior competitions. She made her debut on 
American Ninja Warrior TV Show, becoming the youngest champion 
in the American Ninja Warrior Women's Championship history. She 
is now working hard to qualify for the Olympics. Katie, thank 
you for being here today.
    Finally, we are delighted to welcome Dr. Griff Rodgers. Dr. 
Rodgers is the Director--this is a mouthful--of the National 
Institute of Diabetes and Digestive and Kidney Diseases, or 
NIDDK, at the National Institutes of Health. Dr. Rodgers has 
led this institute since 2007, and he is here today to talk 
about the research advances made, thanks to Federal funding for 
diabetes research and the Special Diabetes Program. Dr. 
Rodgers, I want to thank you most sincerely for coming back. 
Every single one of the Children's Congresses that I have 
chaired since you have been head of the institute, you have 
been here to update us on the developments. I thank you for 
your dedication to this cause.
    Thank you all for joining us.
    With that, we are now going to start with Ruby's testimony. 
Thank you, Ruby.
STATEMENT OF MS. RUBY WHITMORE, BREAKTHROUGH T1D 2025, 
            CHILDREN'S CONGRESS DELEGATE, OLD TOWN, 
            MAINE
    Ms. Whitmore. Good morning, Chairwoman Collins, Senator 
Shaheen, Ranking Member Murray, and Members of the Committee.
    My name is Ruby Whitmore, and I am a 16-year-old student 
from Old Town, Maine. I am honored to speak with you today, not 
just as someone living with type 1 diabetes, but as a student, 
an athlete, a volunteer, and someone who dreams of becoming a 
surgeon. Diabetes runs in my family, so it was not a total 
surprise when one summer my parents noticed the signs and took 
me straight to the doctor. I was just 5 years old. Now, more 
than 10 years later, I can say I have learned how to manage the 
disease, but it has also changed my life in ways that most 
people never see.
    Managing type 1 diabetes is not something I ever get a 
break from. Even when everything is going well, it is always 
there, like an extra layer I have to think about that others do 
not. Playing sports makes it even more complicated. I have had 
to learn through experience how to balance my blood sugar 
before a game or during a race. And there have been times when 
I have had to sit out and treat a low in the middle of practice 
or a game.
    It is frustrating sometimes because I do not want to worry 
about numbers, carbs, or whether my sensor is still reading 
correctly. But being open about those challenges has helped me 
take control of them. It has made me stronger and more 
confident in who I am. Despite the challenges, I have never let 
diabetes define what I can or cannot do. I play soccer on both 
school and travel teams. I run track. I serve as my school's 
Best Buddies Chapter President. I even had the opportunity to 
volunteer at Northern Light Eastern Maine Medical Center 
working with patients in both general care and neurosurgery.
    My goal is to become a doctor, a trauma surgeon, because I 
want to help people the way my care team, especially my 
endocrinologist, Corey Webb, helped me. He has made a lasting 
impact on my life and I hope one day I can do the same for 
someone else. I volunteer, in part, because T1D has given me 
perspective and empathy for those in need, who also face 
extraordinary challenges, often without the support and 
resources that my family and friends have provided.
    I want to take a moment to talk about my family. My dad 
also has type 1 diabetes, so I have grown up knowing what it 
looks like. This has put a great deal of stress on my mom, who 
is always there for us. She is the one not-so-quietly making 
sure I am okay, reminding me to bring sugar tablets, staying up 
when I sleep through my pump alarms, and just being there every 
day. Even though I think of myself as independent, I know I 
would not be the person I am without her support. She is the 
reason I felt safe enough to be confident in living with this 
disease.
    The burden placed on families dealing with type 1 is often 
invisible and often overlooked. I have been lucky to have 
access to the latest diabetes technology, like continuous 
glucose monitors and advanced insulin pumps which have made it 
possible for me to live a full active life. Advancements like 
these have been made possible by the Special Diabetes Program. 
I want to thank you for the recent extension of the SDP because 
it supports groundbreaking research and brings us closer to 
better treatments, and one day a cure.
    I never want a young girl to think she cannot play sports 
because of her insulin pump. I never want a family to skip 
doses or ration supplies because of cost. Everyone living with 
type 1 diabetes deserves the chance to thrive. Your support 
makes that possible.
    Thank you for your time, and thank you for investing in a 
healthier, better future for people like me.
    [Applause.]
    [The statement follows:]

                  Prepared Statement of Ruby Whitmore
    Good morning, Chairwoman Collins, Senator Shaheen, Ranking Member 
Murray, and Members of the Committee.
    My name is Ruby Whitmore, and I'm a 16-year-old student from Old 
Town, Maine. I'm honored to speak with you today not just as someone 
living with type 1 diabetes, but as a student, an athlete, a volunteer, 
and someone who dreams of becoming a trauma surgeon.
    Diabetes runs in my family, so it wasn't a total surprise when one 
summer, my parents noticed the signs and took me straight to the 
doctor. I was just 5 years old. Now, more than 10 years later, I can 
say I've learned how to manage the disease--but it's also changed my 
life in ways that most people never see.
    Managing type 1 diabetes isn't something I ever get to take a break 
from. Even when everything is going well, it's always there--like an 
extra layer I have to think about that others don't.
    Playing sports makes it even more complicated. I've had to learn 
through experience how to balance my blood sugar before a game or 
during a race, and there have been times when I've had to sit out or 
treat a low in the middle of practice.
    It's frustrating sometimes, because I don't want to worry about 
numbers, carbs, or whether my sensor is still reading correctly. But 
being open about those challenges has helped me take control of them. 
It's made me stronger, and more confident in who I am.
    Despite the challenges, I've never let diabetes define what I can 
or can't do. I play soccer on both my school and travel teams. I run 
track. I serve as my school's Best Buddies chapter president. I even 
had the opportunity to volunteer at Northern Light Eastern Maine 
Medical Center, working with patients in both general care and 
neurosurgery.
    My goal is to become a doctor, a trauma surgeon, because I want to 
help people the way my care team, especially my endocrinologist Corey 
Webb, helped me. He made a lasting impact on my life, and I hope one 
day I can do the same for someone else.
    I volunteer, in part, because T1D has given me perspective and 
empathy for those in need, who also face extraordinary challenges, 
often without the support and resources that my family and friends have 
provided.
    I want to take a moment to talk about my family. My dad also has 
type 1 diabetes, so I've grown up knowing what it looks like. This has 
put a great deal of stress on my mom, who is always there for us.
    She's the one quietly making sure I'm okay--reminding me to bring 
sugar tablets, staying up when I sleep through my pump alarms, and just 
being there, every day. Even though I think of myself as independent, I 
know I wouldn't be the person I am without her support. She's the 
reason I've felt safe enough to be confident in living with this 
disease.
    The burden placed on families dealing with type 1 is often 
invisible, and often overlooked.
    I've been lucky to have access to the latest diabetes technology, 
like continuous glucose monitors and advanced insulin pumps, which have 
made it possible for me to live a full, active life. Advancements like 
these have been made possible by the Special Diabetes Program.
    I want to thank you for the recent extension of the (SDP), because 
it supports groundbreaking research and brings us closer to better 
treatments--and one day, a cure.
    I never want a young girl to think she can't play sports because of 
her insulin pump. I never want a family to skip doses or ration 
supplies because of cost. Everyone living with type 1 diabetes deserves 
the chance to thrive.
    Your support makes that possible.
    Thank you for your time--and for investing in a healthier, better 
future for people like me.

    Chair Collins. Great job, Ruby. Thank you.
    Rachel, would you please deliver your testimony?
STATEMENT OF MS. RACHEL WHITE, CHILDREN'S CONGRESS 
            DELEGATE, NORTH HAMPTON, NEW HAMPSHIRE
    Ms. White. Good morning, Chairwoman Collins, Senator 
Shaheen, Ranking Member Murray, and Members of the Committee. 
Thank you so much for giving me the opportunity to be here 
today.
    My name is Rachel White and I am a high school student, a 
nationally ranked junior tennis player, and I live with type 1 
diabetes. My diagnosis came just before I turned 12. My mom 
noticed something was not right. I was eating and drinking 
water non-stop, but I was losing weight. I had just grown an 
inch, but I had also lost 5 pounds. I started waking up in the 
middle of the night to use the bathroom, which had never 
happened before. At the doctor's office, no one was immediately 
alarmed, but my mom insisted on blood work, and that is when 
everything changed.
    My blood sugar was over 600. My A1C was over 14. I had type 
1 diabetes. And my life, as I knew it, was suddenly and 
completely different. At 11 years old, I had to learn how to 
manage a disease that has no cure and never takes a day off. 
That was the scary part. A typical day for me now starts at 
6:30 a.m. I eat the same breakfast almost every day because it 
helps keep my blood sugar stable. I do the same for lunch and 
snacks even though it gets boring because steady blood sugars 
help me get through my intense school and tennis schedule.
    I train for tennis anywhere from 1 to 3 hours a day. It is 
a true passion of mine. My goal is to eventually play tennis at 
an elite college, but tennis with T1D is a real challenge. I 
carry juice with me at all times because I tend to have low 
blood sugars when playing. I check my blood sugars on 
changeovers, not to get an advantage over my opponent, but to 
make sure I am safe.
    Having low blood sugar can make me feel dizzy, unfocused, 
and there is a risk of passing out. While most players think 
about winning the next point, I have to think: Am I crashing? 
Do I need juice? Did I take too much insulin? Adding this extra 
challenge to an already mentally demanding sport is difficult, 
at times very frustrating. However, I choose to move forward. 
Every single day, I am making complex, high stakes decisions 
while trying to live the life of a normal teen.
    That is why I am here today to ask you to please keep 
supporting the work that makes life with T1D a little more 
livable, and one day curable. Thank you for extending the 
Special Diabetes Program through September. The research the 
SDP funds is the reason we have better devices, smarter insulin 
pumps, and more hope than ever. I hope you will extend the 
program for years to come so it can continue to deliver 
treatments and cures that will improve the lives of millions of 
Americans like my own.
    My family and I truly believe that with your support and 
improvements and technology, a cure for this disease in the 
near future is very much a possibility. I am grateful for the 
tools I have now. I recognize I am very fortunate that my 
family has been able to support me in this journey, but I dream 
of a future where I do not have to carry juice in my tennis 
bag, explain to a chair umpire that I have T1D, check my blood 
sugar in the middle of a math test, or wonder what will happen 
if my insulin does not arrive on time.
    Thank you, Senators, for taking the time to listen to my 
story and for supporting all of us living with type 1 diabetes. 
Speaking in front of you today has been an honor, and something 
I will remember for the rest of my life.
    [Applause.]
    [The statement follows:]

                   Prepared Statement of Rachel White
    Good morning, Chairwoman Collins, Senator Shaheen, Ranking Member 
Murray, and Members of the Committee.
    Thank you so much for giving me the opportunity to be here today. 
My name is Rachel White, and I'm a high school student, a nationally 
ranked junior tennis player, and I live with type 1 diabetes.
    My diagnosis came just before I turned 12. My mom noticed something 
wasn't right-I was eating and drinking water nonstop, but I was losing 
weight. I had just grown an inch, but I had also lost five pounds. I 
started waking up in the middle of the night to use the bathroom, which 
had never happened before.
    At the doctor's office, no one was immediately alarmed, but my mom 
insisted on bloodwork and that's when everything changed.
    My blood sugar was over 600. My A1C was over 14. I had type 1 
diabetes--and my life as I knew it was suddenly and completely 
different.
    At 11 years old, I had to learn how to manage a disease that has no 
cure and never takes a day off. That was the scary part!
    A typical day for me now starts at 6:30 a.m. I eat the same 
breakfast almost every day because it helps keep my blood sugar stable. 
I do the same for lunch and snacks, even though it gets boring, because 
steady blood sugars help me get through my intense school and tennis 
schedule.
    I train for tennis anywhere from one to three hours a day. It's a 
true passion of mine. My goal is to eventually play tennis at an elite 
college. But tennis with T1D is a real challenge.
    I carry juice with me at all times, because I tend to have low 
blood sugars when playing. I check my blood sugar on changeovers--not 
to get an advantage over the opponent, but to check if I'm safe. Having 
low blood sugars can make me feel dizzy, unfocused, and there is a risk 
of passing out.
    While most players think about winning the next point, I have to 
think: Am I crashing? Do I need juice? Did I take too much insulin?
    Adding this extra challenge to an already mentally demanding sport 
is difficult at times, very frustrating. However I chose to move 
forward.
    Every single day, I am making complex, high-stakes decisions--while 
trying to live the life of a normal teen. That's why I'm here today--to 
ask you to please keep supporting the work that makes life with T1D a 
little more livable, and one day, curable.
    Thank you for extending the Special Diabetes Program through 
September. The research the SDP funds is the reason we have better 
devices, smarter insulin pumps, and more hope than ever. I hope you 
will extend the program for years to come so it can continue to deliver 
treatments and cures that will improve the lives of millions of 
Americans, like my own. My family and I truly believe that with your 
support and improvements in technology, a cure for this disease in the 
near future, is very much a possibility.
    I'm grateful for the tools I have now, I recognize that I am very 
fortunate that my family has been able to support me in this journey, 
but I dream of a future where I don't have to carry juice in my tennis 
bag, explain to a chair umpire that I have T1D, check my blood sugar in 
the middle of a math test, or wonder what will happen if my insulin 
doesn't arrive on time.
    Thank you Senators for taking the time to listen to my story, and 
for supporting all of us living with type 1 diabetes. Speaking in front 
of you today has been an honor, and something that I will remember for 
the rest of my life.

    Chair Collins. Thank you very much. Great job.
    Katie.
STATEMENT OF MS. KATIE BONE, USA CLIMBING SPEED 
            NATIONAL CHAMPION, BERNALILLO, NEW MEXICO
    Ms. Bone. Good morning, Chairwoman Collins, Senator 
Shaheen, Ranking Member Murray, and Members of the Committee. 
Thank you for the opportunity to share my story.
    When I was diagnosed with T1D at age 11, my very first 
question to the doctor was not, ``Why me?''; it was, ``Can I 
still climb?'' Climbing has always been my passion and I 
decided right away that T1D was not going to stop me from 
achieving my goals. That mindset has helped shaped everything I 
have done then--since then, from earning a spot on the youth 
and elite U.S. climbing teams, to becoming the youngest 
champion in American Ninja Warrior Women's Championship.
    I have learned how to compete at the highest level while 
managing my diabetes around the clock. But T1D is relentless 
and carries an enormous toll on my body and my mental health. 
It is not something I can pause or ignore; it is often the 
simplest things that are not visible to the outside world that 
are the most difficult.
    Sleep is a constant struggle. I consistently wake up to 
alarms, or unexpected highs and lows. And when you are not 
sleeping well, you are not recovering well, and that directly 
affects my ability to train, perform, and stay healthy.
    I compete in China, Europe, and all over the world, and 
every time I go, I have to figure out how to manage my blood 
sugars, with unfamiliar food, different time zones, and new 
schedules, I have had to carry my own food across continents. 
And as a female athlete hormone cycles throw in another 
unpredictable layer. There are weeks when I figured out no 
longer works, and I have to readjust all over again.
    People see me win a national title, or run up the wall on 
TV, but they do not see the 100-plus decisions I make every 
day. They do not see me stopping in the middle of training to 
treat a low, or the days I feel completely wiped out from a 
night of bad blood sugars. They do not see the toll it takes, 
because a lot of us with T1D carry it well, we have to. These 
challenges are very real, but I am still inspired by the 
progress that has been made, and hopeful about the potential 
cures to come.
    Today, I wear a continuous glucose monitoring on my own--on 
my arm. It gives me a blood sugar reading every 5 minutes, and 
lets me see trends in real time on my phone. That technology 
means I do not have to stop climbing or competing just to poke 
my finger. I also use an insulin pump to stay in range during 
training, competitions, and even during overnight filming for 
American Ninja Warrior.
    The development of this technology did not happen by 
accident. It is a direct result of policymakers like you, who 
have funded the Special Diabetes Program. In fact a new study 
finds that that the SDP has led to at least $50 billion in 
Federal health care savings. That is more than 10-fold return 
on your investment.
    That is why I am here to strongly urge Congress to renew 
the SDP. The program funds the science that makes T1D more 
manageable, and it brings us closer to cures.
    For millions of Americans with type 1 diabetes, the SDP 
means hope. It means the development of cell therapies that can 
replace insulin-producing beta cells. It means disease-
modifying therapies aimed at preventing, slowing, halting, or 
even reversing T1D progression.
    This week at Breakthrough T1D's Children's Congress, I have 
had the opportunity to meet so many young people, like Rachel 
and Ruby, who are also leading amazing lives because of 
research breakthroughs. We all imagine what our lives will be 
like when we have cures. I know we will get there, thanks to 
you.
    Thank you again for hearing my story and for being our 
champions. Thank you.
    [Applause.]
    [The statement follows:]

                    Prepared Statement of Katie Bone
    Good morning, Chairwoman Collins, Senator Shaheen, Ranking Member 
Murray, and Members of the Committee. Thank you for the opportunity to 
share my story.
    When I was diagnosed with T1D at age 11, my very first question to 
my doctor wasn't ``Why me?''--it was, ``Can I still climb?''
    Climbing has always been my passion. And I decided right away that 
T1D was not going to stop me from achieving my goals.
    That mindset has helped shape everything I've done since then. From 
earning a spot on the youth and Elite U.S. climbing teams, to becoming 
the youngest champion in American Ninja Warrior's Women's Championship. 
I've learned how to compete at the highest level, while managing my 
diabetes around the clock.
    But T1D is relentless and carries an enormous toll on my body and 
my mental health. It isn't something I can pause or ignore. It's often 
the simplest things, that aren't visible to the outside world, that are 
most difficult.
    Sleep is a constant struggle. I consistently wake up to alarms or 
unexpected highs and lows. And when you're not sleeping well, you're 
not recovering well, and that directly affects my ability to train, 
perform, and stay healthy.
    I've competed in China, Europe, and all over the world, and every 
time I go, I have to figure out how to manage my blood sugars with 
unfamiliar food, different time zones, and new schedules. I've had to 
carry my own food across continents.
    And as a female athlete, hormone cycles throw in another 
unpredictable layer. There are weeks when everything I've figured out 
no longer works, and I have to readjust all over again.
    People see me win a national title or run up the wall on TV, but 
they don't see the 100+ decisions I make every day. They don't see me 
stopping in the middle of training to treat a low, or the days I feel 
completely wiped out from a night of bad blood sugars. They don't see 
the toll it takes, because a lot of us with T1D carry it well. We have 
to.
    These challenges are very real, but I am still inspired by the 
progress that has been made and hopeful about the potential cures to 
come.
    Today, I wear a continuous glucose monitor on my arm. It gives me a 
blood sugar reading every five minutes and lets me see trends in real 
time on my phone. That technology means I don't have to stop climbing 
or competing just to poke my finger. I also use an insulin pump to stay 
in range during training, competitions, and even during overnight 
filming for American Ninja Warrior.
    The development of this technology did not happen by accident. It 
is a direct result of policymakers like you, who have funded the 
Special Diabetes Program. In fact, a new study finds that the SDP has 
led to at least $50 billion in Federal healthcare savings--that's more 
than a 10-fold return on your Invesment. That's why I'm here to 
strongly urge Congress to renew the SDP. The program funds the science 
that makes T1D more manageable, and it brings us closer to cures.
    For millions of Americans with type 1 diabetes, the SDP means hope. 
It means the development of cell therapies that can replace insulin-
producing beta cells. It means disease-modifying therapies aimed at 
preventing, slowing, halting, or even reversing T1D progression.
    This week at Breakthrough T1D's Children's Congress, I've had the 
opportunity to meet so many young people, like Rachel and Ruby, who are 
also leading amazing lives because of research breakthroughs. We all 
imagine what our lives will be like when we have cures. I know we'll 
get there thanks to you. Thank you again for hearing my story, and for 
being our champions.

    Chair Collins. Thank you so much, Katie, for your 
testimony.
    Dr. Rodgers, thank you for being here.
STATEMENT OF DR. GRIFFIN P. RODGERS, M.D., M.A.C.P., 
            DIRECTOR, NATIONAL INSTITUTE OF DIABETES 
            AND DIGESTIVE AND KIDNEY DISEASES, 
            BETHESDA, MARYLAND
    Dr. Rodgers. Thank you so much. Chair Collins, Vice Chair 
Murray, Senator Shaheen, and Members of the Committee, thank 
you for the invitation today to testify and for your long-
standing support for type 1 diabetes research.
    Research supported by the Special Diabetes Program, or SDP, 
has dramatically improved the health and quality of life of 
people with type 1 diabetes. This progress would not be 
possible without the support of my fellow witnesses as well as 
the people here today, those you represent across the country. 
All of you are true champions in advancing diabetes research. 
Thank you.
    The long-standing Federal investment in diabetes research 
through the SDP has enabled us to take on challenges, drive 
innovation, and address research gaps beyond what we could do 
with support, with NIH's regular appropriations. We have been 
able to enroll more patients in longer trials to maximize our 
research investments. This approach has yielded incredible 
progress.
    For example, SDP supported research has culminated in the 
first ever FDA approved preventive therapy for type 1 diabetes, 
the first ever FDA approved cellular therapy for type 1 
diabetes, and multiple new FDA authorized artificial pancreas 
devices that have become the standard of care for many people 
living with type 1 diabetes, and including the children who you 
pulled in the room today.
    These therapies were just far off goals when I first 
testified about SDP supported research in 2007. Today, they are 
realities that directly benefit people with or at risk for type 
1 diabetes. These advances were made possible, thanks to your 
long-term investment in research, our close partnership with 
organizations like Breakthrough T1D, and the dedication of our 
clinical study volunteers and their families.
    While we celebrate this progress, we are also vigorously 
building on it. A major current research goal and a high 
priority for people affected by the disease is to find a 
biological cure for type 1 diabetes. This involves 
understanding how insulin producing beta cells are lost and how 
they can be replaced and protected, including through 
transplantation. Additionally, scientists must work to develop 
novel ways to protect transplanted cells from the attack by the 
body's immune system.
    NIDDK's ongoing research complements industry's clinical 
trials, testing cell replacement strategy in people. Some of 
these trials use techniques that have their roots in SDP-
supported research, including cell products and so-called 
encapsulation technologies that protect transplanted cells from 
ejection. We are confident that these complementary efforts 
will one day culminate in approaches to replace lost beta 
cells, cure type 1 diabetes, and eliminate the burden that 
comes with the disease management.
    I am also pleased to report that SDP-supported research 
provides benefit beyond type 1 diabetes, for example, the 
artificial pancreas device developed with SDP support for the 
management of type 1 diabetes was recently approved for adults 
with type 2 diabetes, recent SDP extension enabled the launch 
of our expansion of ambitious studies related to diabetes 
complications, such as heart disease, and diabetic foot ulcers.
    Understanding these complications is not only important for 
people living with type 1 diabetes, but additionally benefits 
those with type 2 diabetes. Conversely, we are using our 
knowledge from treating type 2 diabetes and applying it to type 
1 diabetes. For example, SGLT2 inhibitor medications are 
improved to manage blood glucose levels in type 2 diabetes and 
have heart and kidney protective effects. Determining if these 
medications are safe and effective for people with type 1 
diabetes could provide much needed tool for preventing multiple 
complications.
    While we celebrate these and other incredible successes 
made possible by SDP, we will continue to pursue cutting-edge 
research such as applying artificial intelligence and machine 
learning technologies to type 1 diabetes research in new and 
exciting ways. With continued research, we know we can achieve 
our ultimate goal, preventing and curing type 1 diabetes.
    Thank you. And I am happy to answer questions when the time 
is appropriate. Thank you very much.
    [Applause.]
    [The statement follows:]

        Prepared Statement of Griffin P. Rodgers, M.D., M.A.C.P.
    Chair Collins, Vice Chair Murray, and Members of the Committee, as 
Director of the National Institute of Diabetes and Digestive and Kidney 
Diseases (NIDDK), I thank you for your invitation to testify at this 
hearing on type 1 diabetes. On behalf of NIDDK and the other Institutes 
and Centers of the National Institutes of Health (NIH) within the U.S. 
Department of Health and Human Services (HHS), I am honored to be here 
today to update you on recent scientific advances and future research 
opportunities in type 1 diabetes and its complications, including 
research supported by the Special Statutory Funding Program for Type 1 
Diabetes Research (Special Diabetes Program).
    Diabetes takes an enormous personal and economic toll on our 
country, but we are making great strides in reducing that burden 
through biomedical research. NIDDK supports the majority of diabetes 
research at NIH, which includes studies on both prevention and 
treatment of type 1 diabetes, type 2 diabetes, gestational diabetes, 
and diabetes complications. Funding from the Special Diabetes Program 
is part of the NIH investment in diabetes research, and it enables the 
agency to expand type 1 diabetes research beyond what is possible with 
our regular appropriations and to conduct clinical trials that follow 
more patients for longer periods of time than would otherwise be 
feasible. NIH's efforts have been complemented by our research 
partners--the U.S. Food and Drug Administration (FDA); the Centers for 
Disease Control and Prevention (CDC); academic institutions; and 
charitable, professional, and patient advocacy groups such as 
Breakthrough T1D (formerly JDRF), the Endocrine Society, the American 
Diabetes Association (ADA), and the Leona M. and Harry B. Helmsley 
Charitable Trust.
    Through the invaluable support of Congress, the tireless work of 
our researchers, and the dedication of our clinical research 
volunteers, we have made significant progress toward our goals of 
understanding, preventing, treating, and ultimately curing type 1 
diabetes-with more progress on the horizon.
           improving the lives of people with type 1 diabetes
    Type 1 diabetes is an autoimmune disease, where the immune system 
attacks and destroys the insulin-producing beta cells in the pancreas. 
People with type 1 diabetes (or their caregivers) must monitor their 
blood glucose (sugar) levels, administering insulin as needed depending 
on their food intake, physical activity levels, and other factors. This 
is an enormous burden, and despite constant vigilance, keeping blood 
glucose levels consistently in a healthy range can be a challenge. For 
over 25 years, NIDDK has deployed Special Diabetes Program funds toward 
research with high potential to improve the health of people with and 
at risk for type 1 diabetes, both in the short and long term.
    One important way that we gauge our success is to determine whether 
our research findings are directly reaching and benefiting people with 
type 1 diabetes. I am pleased to report that NIH-supported research 
advances have dramatically improved the health and quality of life of 
people with and at risk of the disease, as well as their families. For 
example, Special Diabetes Program-supported research has culminated in 
the first ever FDA-approved preventive therapy for type 1 diabetes; the 
first ever FDA-approved cellular therapy for type 1 diabetes; and 
multiple new FDA-authorized artificial pancreas devices for children 
and adults that have become the standard of care for many people with 
type 1 diabetes.
    While we are heartened by this progress, we also recognize there is 
more to achieve. The SEARCH for Diabetes in Youth study, supported by 
CDC and NIDDK, has reported that type 1 diabetes incidence is 
increasing in youth under age 20 in the United States.\1\ It is 
imperative that we combat this increase by identifying the factors 
driving it and developing new prevention approaches for this younger 
population. Additionally, while the artificial pancreas has reduced the 
burden of managing disease, people with type 1 diabetes and their 
families want that burden reduced further--they want a cure. NIDDK 
remains committed to supporting critical research areas to achieve our 
longer-term goals, which include helping to identify potential cures.
---------------------------------------------------------------------------
    \1\ https://pubmed.ncbi.nlm.nih.gov/36868256
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            improving glucose management and quality of life
    For people with type 1 diabetes, keeping blood glucose levels 
within a healthy range is a key step to maintaining good health and 
preventing or delaying the development of long-term complications of 
the eyes, kidneys, nerves, heart, and other organs. NIDDK, with Special 
Diabetes Program funds, has prioritized the development of new tools 
and technologies to help people control their blood glucose levels with 
less burden.
    The Special Diabetes Program has contributed to this area by 
supporting the development of glucose management technologies, 
including artificial pancreas systems that automate insulin delivery in 
response to blood glucose levels. I am pleased to report that NIDDK and 
Special Diabetes Program-supported research contributed to the 
development or testing of most of the currently available commercial 
artificial pancreas devices. One of these devices was also recently FDA 
cleared for adults with type 2 diabetes who are taking insulin,\2\ 
demonstrating the far-reaching benefit that Special Diabetes Program-
supported research is having on daily management of disease for all 
individuals with diabetes.
---------------------------------------------------------------------------
    \2\ www.fda.gov/news-events/press-announcements/fda-roundup-
february-28-2025
---------------------------------------------------------------------------
    We are extremely pleased that the research investment supported by 
the Special Diabetes Program has made such a significant and positive 
impact on the lives of people with the disease and their families. 
While we celebrate this progress, we are also looking ahead to 
developing the next generation of artificial pancreas systems. New 
technologies can enable the development of devices that are less 
invasive and burdensome, while improving durability, adaptability, 
reliability, and accuracy. We also have opportunities to augment these 
devices with artificial intelligence (AI)/machine learning (ML) tools, 
to optimize their function for individual users.
                      restoring beta cell function
    Technologies for managing type 1 diabetes are important tools for 
alleviating the burden of this disease, but they are not a cure. 
Finding a biological cure for type 1 diabetes that restores the body's 
ability to produce insulin and regulate blood glucose levels is another 
major, long-term goal of NIDDK- and Special Diabetes Program-funded 
research. I am pleased to report that decades of NIH- and Special 
Diabetes Program-supported research, including research conducted by 
the Clinical Islet Transplantation Consortium, an effort co-led by 
NIDDK and the National Institute of Allergy and Infectious Diseases 
(NIAID), paved the way for the June 2023 FDA approval of a cellular 
therapy--islet transplantation--for adults with type 1 diabetes whose 
disease cannot be managed using current therapies. This landmark 
achievement represents the first ever FDA-approved cell therapy for 
treating type 1 diabetes.\3\
---------------------------------------------------------------------------
    \3\ www.fda.gov/news-events/press-announcements/fda-approves-first-
cellular-therapy-treat-patients-type-1-diabetes
---------------------------------------------------------------------------
    While this therapy represents a major step forward in providing a 
cure for those with type 1 diabetes, islet transplant recipients must 
take long-term immunosuppressive medicines to prevent the body from 
attacking the transplanted islets. These medicines may cause serious 
side effects. Additionally, there is a shortage of cadaveric islets 
available for transplantation. These limitations underscore the need 
for additional research to develop more broadly available cell 
replacement therapies. Researchers are currently looking for ways to 
prevent islet transplant rejection without the need for long-term 
immunosuppression, such as by encapsulating islets with a material that 
protects them from immune system attack.\4\ Scientists are also using 
knowledge from the study of other diseases and applying it to type 1 
diabetes. Based on the success of CAR-T therapy for cancer treatment, 
scientists in the Special Diabetes Program-supported Human Islet 
Research Network (HIRN) engineered immune cells that protect 
transplanted islets from immune system rejection without tamping down 
the protective parts of the immune system in a mouse model.\5\ This 
finding represents an exciting approach to advance islet 
transplantation, and it could prove useful for other organ 
transplantations, expanding the impact of the Special Diabetes Program.
---------------------------------------------------------------------------
    \4\ https://pubmed.ncbi.nlm.nih.gov/37106151; https://
pubmed.ncbi.nlm.nih.gov/37543091; https://pubmed.ncbi.nlm.nih.gov/
35559682
    \5\ https://pubmed.ncbi.nlm.nih.gov/39636990
---------------------------------------------------------------------------
    In parallel with research to protect transplanted cells from immune 
attack, scientists are also vigorously studying ways to generate and 
preserve sufficient numbers of islets for transplantation. This 
research has already yielded success-cell products and encapsulation 
technologies developed in part with Special Diabetes Program support 
are now being tested in industry clinical trials. HIRN researchers are 
investigating how beta cells develop and mature with the goal of one 
day allowing for the production of new beta cells. HIRN researchers 
reported a groundbreaking discovery that pancreatic alpha cell 
dysfunction precedes beta cell loss in people who have a single type 1 
diabetes autoantibody (a protein made by the immune system that signals 
an early stage of type 1 diabetes). This finding is paradigm changing 
and defines a new, distinct, early stage of type 1 diabetes. Additional 
studies of this early stage could pave the way for developing clinical 
interventions to protect or replenish beta cells.\6\
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    \6\ https://pubmed.ncbi.nlm.nih.gov/35642629
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    Additionally, HIRN has developed new models of type 1 diabetes, 
including sophisticated mouse models that mimic key features of human 
disease and three-dimensional laboratory models of human pancreatic 
islets, that will enable novel studies of pathophysiology and serve as 
platforms for pre-clinical testing of new therapies. Continued research 
through HIRN and other efforts holds promise to yield knowledge 
necessary to further develop cell replacement therapy as a type 1 
diabetes cure.
         preventing type 1 diabetes initiation and progression
    Preventing type 1 diabetes has been a long-standing goal of NIH-
supported research. Toward this goal, research supported by the Special 
Diabetes Program culminated in the 2022 FDA approval of teplizumab as 
the first therapy that can delay the onset of stage 3 type 1 diabetes 
in people ages 8 and older with stage 2 T1D. Key research underlying 
this approval stemmed from a clinical trial conducted by the NIDDK- and 
Special Diabetes Program-supported Type 1 Diabetes TrialNet, which is a 
large, collaborative, international consortium designed to perform 
clinical trials of therapies to delay or prevent type 1 diabetes 
progression. TrialNet continues to be a unique and critical network for 
testing novel type 1 diabetes preventive therapies.
    While we are excited about teplizumab's success, we also recognize 
that more research is needed to make type 1 diabetes prevention a 
reality for more people at risk of developing the disease. As such, 
TrialNet research continues to shed important light on possible 
prevention therapies, such as findings from clinical trials that the 
drug abatacept has beneficial effects on insulin-producing beta cell 
function but did not delay type 1 diabetes diagnosis, and that the drug 
hydroxychloroquine did not slow type 1 diabetes progression.\7\ 
TrialNet has one ongoing prevention trial testing a low dose of the 
immunotherapy drug anti-thymocyte globulin which showed promise in new 
onset diseases. The Network is also considering testing combinations of 
drugs with complementary mechanisms of action toward a longer-term goal 
of permanent prevention.
---------------------------------------------------------------------------
    \7\ https://pubmed.ncbi.nlm.nih.gov/36920087/; https://
pubmed.ncbi.nlm.nih.gov/37708415/
---------------------------------------------------------------------------
              understanding the causes of type 1 diabetes
    Understanding the causes of type 1 diabetes could also help 
identify and advance new prevention strategies. We know that a person's 
risk for developing type 1 diabetes is dependent on both genetic and 
environmental factors. While research efforts have helped to uncover a 
large part of the genetic contribution to disease, less is known about 
environmental contributors to disease.
    To identify these environmental components, NIDDK, through the 
Special Diabetes Program, supports an ambitious, long-term clinical 
research study called TEDDY (The Environmental Determinants of Diabetes 
in the Young). TEDDY has screened over 425,000 newborns, enrolling 
8,000 who were at high genetic risk of type 1 diabetes. These children 
are followed until the age of 15 years old, and they and their families 
have donated over 6 million biological study samples to date.
    We have reached a milestone in this study: the youngest TEDDY 
participant turns 15 this year, marking the end of the participant 
follow-up phase of the study. I am pleased to report that with this 
major accomplishment--made possible by decades of dedication by TEDDY 
researchers and families--final data analyses can begin. In the 
meantime, TEDDY researchers have already been analyzing vast amounts of 
data and generating a wealth of knowledge. They are looking at genes, 
proteins, and metabolites and are also studying the children's 
microbiomes, viromes, and environmental exposures to understand how 
these evolve during childhood and how they might influence disease. 
From this wealth of information, new insights are emerging. For 
example, analyses of thousands of blood samples from TEDDY children 
have identified proteins that can predict early stages of the disease, 
which could lead to improved methods to detect islet autoimmunity 
before clinical disease onset toward determining who is likely to 
progress to type 1 diabetes.\8\ Continued analyses of TEDDY data and 
samples--by both TEDDY researchers and the broad scientific community-
are expected to continue to yield critical insights that can help us 
develop new strategies to prevent type 1 diabetes.
---------------------------------------------------------------------------
    \8\ https://pubmed.ncbi.nlm.nih.gov/37390828
---------------------------------------------------------------------------
    Other Special Diabetes Program-supported efforts are complementing 
TEDDY's research to understand factors associated with type 1 diabetes 
onset. For example, the Type 1 Diabetes in Acute Pancreatitis 
Consortium is studying type 1 diabetes and other forms of diabetes that 
occur during or after one or more episodes of acute pancreatitis 
(sudden inflammation of the pancreas) toward developing new prevention 
and treatment approaches.
             preventing and treating diabetic complications
    People with type 1 diabetes are living longer than ever thanks to 
new therapies, devices, and other improvements in treatment. Therefore, 
it is imperative to find ways to prevent and treat the diabetes 
complications that can arise throughout the lifespan. Special Diabetes 
Program-supported research has already led to tremendous progress, such 
as research by the National Eye Institute's DRCR Retina Network that 
have transformed the treatment of diabetic retinopathy and diabetic 
macular edema worldwide, changing clinical practice guidelines for 
diabetic eye care.
    Through Special Diabetes Program support, NIDDK recently began 
innovative consortia focused on combating type 1 diabetes complications 
to improve health outcomes, such as research to understand the 
neurocognitive impact of type 1 diabetes in children to mitigate the 
risk of developing neurocognitive complications in later life; identify 
mechanisms that promote the development of cardiovascular disease (CVD) 
in people with type 1 diabetes to develop CVD prevention and treatment 
strategies; identify factors that restore awareness of hypoglycemia in 
adults with type 1 diabetes and impaired awareness of hypoglycemia; and 
address diabetic foot ulcer healing to prevent amputations. Research is 
also investigating expanding treatments for people with type 1 
diabetes. For example, sodium-glucose cotransporter-2 (SGLT2) inhibitor 
medications, which are approved to help manage blood glucose levels in 
type 2 diabetes, have heart-protective effects and may also protect 
against kidney disease. Determining if these treatments are safe and 
effective for people with type 1 diabetes could provide a much-needed 
tool for preventing multiple important complications.
           emerging opportunities in type 1 diabetes research
    The scientific achievements that I described today are just a few 
examples of recent progress in understanding and combatting type 1 
diabetes and its complications. Our efforts were significantly 
strengthened by the renewal of the Special Diabetes Program through the 
end of Fiscal Year 2025, which enables NIH to continue many of these 
successful, long-running programs. Sustained, long-term funding of the 
Program has allowed NIH to launch new clinical trials and support novel 
research areas. Maximizing the value of the Special Diabetes Program 
and responsibly administering its funds is one of NIDDK's highest 
priorities.
    Throughout the years of SDP support, NIDDK has solicited input from 
scientific experts, patients, and other interested parties about future 
research directions in type 1 diabetes and its complications. The most 
recent workshop for gathering input was held in November 2024 under the 
auspices of the statutorily required Diabetes Mellitus Interagency 
Coordinating Committee. Numerous opportunities were identified to build 
upon the significant progress to date that could lead to new prevention 
and treatment strategies for people with and at-risk for type 1 
diabetes, such as understanding heterogeneity of type 1 diabetes toward 
developing more precision medicine approaches; applying AI/ML to type 1 
diabetes research, including better prediction models to inform 
prevention and management; developing cell replacement therapies toward 
curing the disease; and combating debilitating diabetes complications. 
NIDDK's support of type 1 diabetes research will continue to be guided 
by strategic planning efforts and input from scientific conferences and 
workshops. This input will continue to ensure that NIDDK-supported type 
1 diabetes research benefits all Americans who are living with or at 
risk of developing type 1 diabetes.
                           concluding remarks
    I appreciate this chance to share these exciting scientific 
advances, ongoing efforts, and emerging opportunities in type 1 
diabetes research. We are extremely grateful for the continued support 
of Congress, which provided the recent historic increase in Special 
Diabetes Program funds, that has allowed NIH to vigorously support 
research to combat type 1 diabetes and its complications. We look 
forward to continuing our strong partnerships with patient advocacy 
groups, professional organizations, research institutions, and our 
sister Federal agencies to advance our research objectives. We also 
thank our dedicated clinical study participants, without whom the 
clinical research I described today would not be possible. The Special 
Diabetes Program has catalyzed remarkable progress in type 1 diabetes 
research and has ushered in a new era where individuals with type 1 
diabetes have significantly improved health, longevity, and quality of 
life.
    Thank you, Chair Collins, Vice Chair Murray, and Members of the 
Committee. I will be pleased to answer any questions you have.

    Chair Collins. Thank you, Doctor. Thank you.
    Ruby, I want to direct my first question to you. First of 
all, I was truly moved by your tribute to your mother, and I 
know what an important role that she has played in helping to 
keep you healthy. Your family, unlike some others, has had a 
lot of experience with type 1 diabetes, including your dad, but 
a lot of your friends, your coaches, your teachers have had no 
experience with it. Could you talk to us a bit about how you 
educate your coaches, your teachers, your friends about your 
special needs?
    Ms. Whitmore. That is a really good question. Well, the 
first thing I think of, my soccer coach for school is actually 
type 1 diabetic.
    Chair Collins. Really?
    Ms. Whitmore. So he always has stuff. But my other coaches, 
they are all very understanding, and I just tell them, I say, 
``I am diabetic, and I need--sometimes I need to take a 
break.'' And they just tell me, they are like, that is fine, 
just tell us. And I have a couple of my other coaches keep 
stuff in their bags now just because I have told them.
    I think really you just have to tell people about it 
because they are not going to know if you do not--if you do not 
tell them. That is not something somebody ever, like, ever 
thinks of. You do not see somebody sitting on the sideline and 
think: Oh, they are diabetic, that must be why they are out--
you just need to--I think you just need to inform people. And 
yeah, my friends are really good about it, too, just telling 
people. Yeah.
    Chair Collins. Dr. Rodgers, I was thinking of Ruby's family 
and others where there are maybe more than one member of the 
family with type 1 diabetes, you mentioned that one of the 
breakthroughs that we have had is the medication that can delay 
the onset for someone who is at risk. Could you explain that a 
bit more to us?
    Dr. Rodgers. With the support that we have received from 
SDP actually we have developed a reclassification, if you 
would, of type 1 diabetes realizing that it exists in people 
who are at genetic high risk some triggering event leads to 
their immune system, to attack the beta cells, ultimately with 
the production of antibodies, but still at a level with normal 
blood sugars. But then that is ultimately followed by a period 
of the blood sugar being abnormal and then ultimately to 
clinical type 1 diabetes.
    What the funds have been able--allow us to do is actually 
to look for therapies that could prevent the onset of clinical 
type 1 diabetes by treating them in earlier stages. Initially, 
when the blood sugar is not completely abnormal, but still 
high, and then an earlier stage when only there is a presence 
of these antibodies.
    And in fact a number of years ago, following the work that 
was done in a consortium that we developed called TrialNet, a 
drug, teplizumab, was actually developed with this intended 
purpose. And it has shown for the first time that one can delay 
the onset of type 1 diabetes for at least 3 years in 
individuals who receive this therapy. Three years may not seem 
like a lot, but imagine not having to inject insulin and manage 
the disease and the other issues.
    And we have on the drawing board a number--in a pipeline, 
in this TrialNet, other medicines that we hope that might have 
that same effect either alone or in combination, but teplizumab 
is the first FDA-approved therapy for that treatment.
    Chair Collins. We have a lot of Members here today. So 
rather than going on to the next question, I am going to yield 
to Senator Murray.
    Vice Chair Murray. Thank you very much. And thank you, 
really impressive to hear all of your stories.
    Doctor, let me just follow up quickly on that because I 
heard Rachel say that as most people who are diagnosed--are 
feeling severe symptoms before they are diagnosed, you are 
talking about early diagnosis. How are we educating doctors to 
look for that early? How are we making sure families get that 
information that they need to be tested? And how are we making 
sure that people can afford that?
    Dr. Rodgers. Well, in terms of the education of individuals 
with type 1 diabetes or those at risk, a number of groups 
including the NIH, NIDDK, Breakthrough T1D has done a yeoman's 
job of public education in this field of professional 
societies, the American Diabetes Association, the Endocrine 
Society, and many others understand the work that we are doing 
and make sure that their physicians, who are specialists in 
this area, are well aware of it. Both once it gets FDA 
approval, but even to enter patients into clinical trials to 
make sure that other advances become available.
    And you know, patients typically present--they may present 
with something called diabetic ketoacidosis which is really a 
very troubling condition. So if you know that you are at high 
risk and you enter in one of these particular trials, and you 
are able to get an early indication that this may be the path, 
entering someone in such a preventive trial could very likely 
prevent them from developing rather very serious.
    Vice Chair Murray. Yeah. I think one of the things is to 
make sure all parents, and doctors, and physicians, and people 
who see young kids are giving them the information they need to 
get in early. So I appreciate that.
    Dr. Rodgers. Yes, ma'am.
    Vice Chair Murray. Rachel--I mean, all of you are really 
impressive and I really am impressed that you are athletes. I 
do have a niece who is type 1 diabetic and she was told by a 
coach in high school that she could not play because she was 
diabetic. I am certain other young people have heard the same 
thing. What do you--what is your advice to young people today 
to get past anybody who says you cannot participate because of 
that? You seem to have accomplished that so well.
    Ms. White. Yeah, I mean it is definitely way harder. There 
is many more factors you have to think about when you are being 
an athlete. And for me, I tend to go low because I am always 
running around on the court. Tennis is very physical, and it is 
only you. So I would give advice to younger people that you can 
do anything you want, and not to let diabetes stop you from 
going to play soccer, or going to play tennis, or doing really 
anything you want, because it is--diabetes definitely makes 
things more challenging, but there is nothing you cannot do.
    Vice Chair Murray. Yeah. And you talk about invisible 
challenges, I think Ruby. What are those invisible challenges, 
so we all know?
    Ms. Whitmore. I think that--I mean the invisible 
challenges, especially with such a busy schedule, like I know 
Rachel has too, your free time is just taken up by wondering if 
you have to change your site, or running out of insulin and 
changing your site the 5 minutes you are home between school 
and practice. And just thinking about--just thinking about 
everything all the time, especially now. I mean, a lot of you 
guys are probably driving now, too, just thinking about your 
blood sugar before you get on the road and thinking about 
what--how much time you are going to have before your practice, 
or school, if you are low and cannot drive. So I just think 
that is a really big, big thing.
    Vice Chair Murray. Things other people do not see, I 
appreciate that.
    Ms. Whitmore. Yeah or things other people do not have to 
think about. Yeah.
    Vice Chair Murray. Yeah. Katie, impressive, the youngest 
American Ninja Warrior, all of you guys can be Ninja Warriors. 
You are looking at one right now. It is great to hear your 
story and to see the challenges that you have overcome as well. 
How would you describe the advances in science and medicine 
that made the most difference for you to be able to accomplish 
that?
    Ms. Bone. I wear an insulin pump, and a CGM, and it has 
been----
    Vice Chair Murray. CGM. Explain to us what----
    Ms. Bone. I am sorry. A continuous glucose monitor, and it 
has been life-changing for me. I am able to go to the gym and I 
do not have to poke every 10 minutes when I feel a little bit 
weird. In climbing competitions, we have to be in isolation 
because we cannot see the climbs beforehand, and we are not 
allowed to have phones. So I have to lock my phone, and go get 
somebody if I want to look at it, which is hard.
    But it has made it so much easier that I do not have to 
spend the 10 minutes poking my finger to check my blood sugar, 
and I can focus on warming up and competing because as it is, 
that takes a lot of mental energy and so does diabetes. So it 
is kind of eased that for me and made it so I can go out there 
with knowing my glucose and having a little bit ease of mind 
with that as well.
    Vice Chair Murray. Okay, very good. And thank you to all of 
you for--all of you as well to be here today to talk about 
this, and make the public more aware of all the things you can 
accomplish, and all the work we still have to do to make sure 
we continue the research. So thank you very much.
    Chair Collins. Senator Hyde-Smith.
    Senator Hyde-Smith. Thank you, Madam Chairman and Ranking 
Member Murray. And I tell you, Ruby, Rachel, Katie, you all 
have been so impressive today, and you have really made an 
impact on me. All of you sitting here, these faces and the 
challenges that you live with. You are really, really 
incredible human beings and I know you will continue to be 
incredible human beings.
    I wanted to recognize my Breakthrough T1 delegates from 
Mississippi, T1D delegates. Where is Linley and KJ from 
Mississippi? Are they in here? Okay. And we have a meeting 
later with them. Maybe I am not seeing them, but we do have a 
meeting later with them.
    But I just so, so appreciate your attitude and your 
courage. And moms and dads, buddy hats are off. You are 
superstars, no doubt, in what you do every day.
    I wanted to address this to Rachel and Ruby. As we move 
closer to finding a cure to type 1 diabetes, which is the goal, 
you know, April the 15th, President Trump signed an executive 
order addressing insulin and making it more affordable, and 
just so significant on all the research that he is supporting 
there. But what do you each look forward to the most when that 
day finally arrives? When we are looking at these TV screens, 
and it says we have a cure for type 1 diabetes. What do you 
look forward to the most?
    Ms. White. Personally for me it is--for me tennis is a huge 
part of my life. So that would be the best part for me because 
it is always hard having to check your blood sugar and making 
sure you are having enough juice in your tennis bag, or if you 
are going up from excitement before a match, or if you are 
nervous or anything. And just being able to not have that 
anymore, it would be just such a relief for--and also not just 
for me, for people who cannot afford insulin who--some people 
who pass away from not being able to afford insulin, and that 
is very sad.
    And I think that once there is a cure, it will save so many 
people's lives, and just make the lives of millions of people 
way more easy.
    Senator Hyde-Smith. And Ruby, when you see that broadcast, 
that news flash, what do you think would be your celebratory 
moment?
    Ms. Whitmore. Oh. That is a good question. I think it would 
just be not having to worry about it anymore, just being free 
of it. I feel like it would feel like--I do not know--just 
taking off a burden that has been--that is in my life, and so 
many other people's lives. And I recognize that I am very lucky 
to be able to be here, but also be here as a healthy diabetic 
who can afford insulin, and who can--who has supplies, and who 
has resources, and has a support system, but as Rachel said, 
many people do not. And I just hope that they would be able to 
get the cure as well.
    Senator Hyde-Smith. Great answers from both of you. Dr. 
Rodgers, I am going to turn to you now. How can we improve the 
early detection of the disease to ensure those who are eligible 
for the drug can receive treatment to delay its onset? How are 
we addressing that and identifying those folks?
    Dr. Rodgers. Thank you, Senator. We are involved in a 
number of studies, of course, people who have a first-degree 
relative with type 1 diabetes, of course, as you have heard 
some of the panelists are themselves at risk. But there is a 
large number of individuals, for example, who do not have any 
family members who develop these symptoms that you heard and 
unfortunately sometimes end up in the emergency room with 
diabetic ketoacidosis, and that is their first sign.
    So just continuing to educate the professional staff, or 
people in the allied health fields about these critical 
complications or signs and symptoms early on. We have developed 
with the SDP support a fairly large network called TrialNet in 
which we are able to screen, not only individuals who are at 
high risk, but other patients who may have related autoimmune 
conditions who may also come in contact. And having them in 
these studies sometimes gives us a very early indication that 
they are at risk.
    But we really do have to continue our efforts, and I have 
to say our partner in Breakthrough T1D have really made this 
awareness campaign one of their vital challenges, and I think 
they have been equal to the challenge. They have been letting 
people be quite aware, because there are things to do in terms 
of prevention today.
    Senator Hyde-Smith. Wow. What a great breakthrough. And I 
just want to thank you for all you have done.
    Dr. Rodgers. Thank you.
    Senator Hyde-Smith. And my time is out, but I tell you, I 
want to be your cheerleader. I want to be your supporter, and 
everybody in this room that is dealing with this. You have 
Members of Congress that are in it with you. We do not know the 
anxiety that comes with this every day like you do, but we know 
what our job is, and our job is to find a cure, and we are not 
going to forget that. Thank you.
    Dr. Rodgers. Thank you.
    [Applause.]
    Chair Collins. I am now delighted to welcome the co-chair 
for many, many years, of the diabetes caucus in the Senate, 
Senator Shaheen.
    Senator Shaheen. Thank you, Chair Collins. And I appreciate 
your letting me sneak in since I am in the middle of a Defense 
bill markup, but I really wanted to be here to thank all of you 
who are members of the Children's Congress for being here 
today, for your advocacy every day, and for your willingness to 
speak up about the need, as Senator Hyde-Smith said, to find a 
cure. And none of us forget that at any time.
    I have very much appreciated all of the work that the 
Diabetes Caucus has done over the years and the leadership from 
Senator Collins to provide additional funding and to improve 
treatments, and clearly, we have more work to do.
    Thank you to Dr. Rodgers and to all of the panelists for 
being here, and for your testimony this morning.
    I would like to begin with Rachel since she is from New 
Hampshire, and ask: What advice you would give to someone who 
has just been diagnosed with type 1?
    Ms. White. Yeah. I still remember the day I was diagnosed. 
I was 11, and I got taken out of school, and luckily I was not 
hospitalized, which was honestly kind of surprising because my 
blood sugar was very high. And I would just tell people who are 
diagnosed that I know it is very scary when you are first 
getting all this information about--there is so many different 
factors, pricking your finger and giving yourself insulin, and 
counting carbs. It can be very scary, but it definitely gets 
better the longer you go.
    And I remember the first week was--I can barely remember 
because it was just--I ate so much food, and yeah, but it 
definitely--I have been a diabetic for 4 years now, so I would 
say I am definitely more educated. And I am here today, so it 
is proof you can really do anything, even with this disease.
    Senator Shaheen. Would either of the other witnesses like 
to comment on that question? Ruby?
    Ms. Whitmore. No, I think Rachel covered it. I think that 
is, yeah.
    Senator Shaheen. Great.
    Ms. Whitmore. That is pretty much what I was going to say. 
Yeah.
    Senator Shaheen. Katie, anything to add?
    Ms. Bone. She did a great job explaining it. But it is 
terrifying at first, and it is incredibly scary. And even for 
me, 8-and-a-half years later, it is still hard, but I had to 
figure out how to make it work, because I wanted so much with 
my life, and I still do. And I would not necessarily change 
what happened to me because it has given me so many incredible 
opportunities, one of them being here.
    And a newly diagnosed person also has so many incredible 
opportunities and a bright future if they want that. So yeah, 
it is just not giving up, and figuring out how to do it, 
because it is hard, but you are still here and you can make an 
incredible life out of it.
    Senator Shaheen. Thank you. Thank you to each of you.
    Excuse me. Dr. Rodgers, I am concerned that this 
administration has terminated or frozen more than 260 NIDDK 
grants in 29 States that total more than $120 million. In 
addition to these cuts, the proposed NIH budget would slash NIH 
funding and potentially gut NIDDK by combining it with other 
institutes. So can you speak to how important it is that we 
continue to fund diabetes research, including ongoing trials 
and prevention initiatives, and why that should be prioritized 
and protected from reductions?
    Dr. Rodgers. Well, Senator, we really--at some of the major 
accomplishments that we have discussed today, is one very good 
example why your continued support for ongoing research in 
diabetes, particular type 1 diabetes, is so important. We are 
really on the cusp of some major breakthroughs, especially 
related to cellular therapies and finding a biological cure. We 
have studies that that I have told this Committee about before, 
a TEDDY study, The Environmental or Determinants of Diabetes of 
Youth: What is it that triggers the autoimmune disease? We 
required studying some 425,000 at-risk kids to enroll 6,000 
from the age of birth to 15 years. And I am happy to report 
that the very last patient turns 15 this year.
    And so we are already on the cusp of understanding what 
some of these triggers are. And that is the kind of work that 
we have to roll up our sleeves and really continue, because 
that is where the cures will manifest themselves. And so I 
could not give you a better explanation of why this support has 
been so important and ongoing support will be especially 
important.
    Senator Shaheen. Well, that is an excellent explanation. 
Thank you very much for the great work that NIDDK continues to 
do. And thank you to all of the delegates from the Children's 
Congress for being here.
    Dr. Rodgers. Thank you, Senator.
    Chair Collins. Thank you, Senator Shaheen.
    [Applause.]
    Chair Collins. Senator Murkowski.
    Senator Murkowski. Thank you, Senator Collins, and thank 
you, Senator Shaheen, for your leadership on this very 
important issue.
    And to the delegates that are here at Children's Caucus, 
thank you. Thank you for not only being here, but your advocacy 
on behalf of so many, and to the witnesses that have shared 
your stories with us here in the Senate, know how important it 
is to have your voices, your fears and your determination 
shared here. It encourages us, it motivates us to do more for 
you and with you. So thank you. Thank you for that.
    Dr. Rodgers, I wanted to ask you, you just mentioned the 
environmental contributors to type 1 diabetes. We know that 
American Indians, Alaskan Natives are more likely to be 
diagnosed with diabetes, one and a half times more. Senator 
Collins has mentioned the Special Diabetes programs for 
Indians. It is really quite remarkable the gains that we have 
seen with that focus. And it is so hard because when you come 
from an area where, in your tribal communities, that the 
prevalence of diabetes may exceed 50 percent. I mean, that is 
really alarming. And these disparities have existed and 
persisted for generations.
    But what we have been able to see with the Special Diabetes 
Program is really helping to reverse these trends, it has not 
only helped reduce diabetes-related complications, but led to a 
remarkable 54 percent reduction in new diabetes diagnoses among 
American Indian and Alaskan Native youth, which is 
extraordinary. It has also contributed to a 50 percent 
reduction in end-stage renal disease among Native people with 
diabetes.
    So can you--you mentioned the TEDDY study and the fact that 
it is almost completed after 15 years. That is significant. Are 
there other strategies or other efforts that are underway to 
include diversity of races and ethnicities where we know that 
there is greater prevalence of diabetes?
    Dr. Rodgers. Sure. Thanks for that question, Senator, and 
you are absolutely right, the Special Diabetes Program aimed at 
American Indians, or SDPI, has been a sort of a program that is 
run in conjunction and in parallel with this SDP program. There 
the aim is the implementation of the provision of care for 
individuals with diabetes.
    Now, what we have learned, and in large part due to the 
SDP, in conjunction with the Centers for Disease Control, NIDDK 
has a program called the SEARCH program in which we are looking 
for diabetes in youth and adolescents including type 1 
diabetes. But something very remarkable you mentioned the high 
prevalence of diabetes among American Indians and Alaskan 
Natives, but there has been an increasing incidence of type 2 
diabetes in youth and adolescents that has been uncovered by 
that SDP-supported SEARCH Study.
    And I have to say that type 2 diabetes is even more 
aggressive, I have to say, than type 1 diabetes in youth. 
Therapies that we have for adults with type 2 do not work 
particularly well in youth and adolescents with type 2 
diabetes, and the aggressiveness of the disease in terms of the 
time of diagnosis to the time of complication is much more 
accelerated. And so these, what we are learning now from the 
SDP program we think we can potentially apply to type 2 
diabetes in youth as well.
    One final thing I will say. I do not want to dominate all 
of your time, but we really are very pleased with the success 
and the implementation of these artificial pancreas 
technologies. But there are certain areas that industry is a 
little bit reluctant to do trials to determine the success of 
that. And that is where we come in with SDP support.
    So for example, women who are pregnant, there have not been 
that many studies to determine the efficacy of artificial 
pancreas technology. Individuals who come from low-income or 
low-educational attainment, this is somewhere that we are 
stepping in. And it turns out that in the preliminary study, 
just minor modifications to this technology allows it to be 
utilized for a greater percentage of the population, including 
individuals, and Alaskan Natives, and American Indians. So that 
is just one example, or two examples of where we are moving in 
this area.
    Senator Murkowski. Promising. We need to do more. There is 
too many that are counting on all of us to, again, find this 
cure.
    Dr. Rodgers. Thank you.
    Senator Murkowski. Thank you very much. And thank you to 
our witnesses.
    Chair Collins. Thank you, Senator Murkowski.
    Senator Durbin, you have been very patient. Thank you.
    Senator Durbin. As the designated male Senator, I noticed 
at one point it was 7 to 1, 8 to 1, and I saw Senator Collins 
smiling, it is exactly the way you like it.
    [Laughter.]
    Senator Durbin. It is an honor to be here and to 
participate in this. And I would like to mention a few things. 
About 10 years ago, I went out to NIH and I met with Dr. 
Francis Collins, who I consider to be an American hero for all 
his leadership at that agency. And I said: What can I do to 
help? And he said: What we can do is make sure that every year 
we have a steady increase in research funds for so many 
different diseases. If you can give me 5 percent real growth 
every single year, we will light up the scoreboard with all 
sorts of things that are going to make life better for young 
people who are here and for other people.
    So I came back here to the Senate Appropriations Committee, 
which I have served on for a few years, and I enlisted the help 
of a number of people--my friend Patty Murray who was here 
earlier, as well as Roy Blunt who was a Republican Senator from 
Missouri who chaired the Committee, Senator Collins who was 
part of it, Lamar Alexander, Republican from Tennessee--and we 
managed to, over the span of 10 years, increase NIH funding 
from $30 billion to $48 billion, just steady increases, $18 
billion over 10 years, and good things started being reported. 
Now, that is the good news.
    Now, the bad news: President Trump's budget for this next 
year eliminates all of the increase that we put in. It goes 
back to $30 billion where we were 10 years ago. And that means 
we are walking away from research opportunities that can lead 
to cures and can lead to an improvement in lives across the 
United States and around the world.
    And here is the good news. You are looking at the first 
line of defense to make sure that does not happen. People who 
are gathered here, the Senators, have the ultimate decision as 
to how much money is going into medical research for diabetes 
and for other purposes. So we need you to help us by 
encouraging our colleagues to join us in this struggle to stop 
the President's budget and to put in place a real investment 
that will make a difference.
    The second point that I want to make is one that is 
somewhat personal. The chief--one of the justices on the 
Supreme Court is Sonia Sotomayor, some of you have heard of 
her, T1D, type 1 diabetes since age 7. She is a fan of 
baseball, Yankees fan. She said to me, I would like to go to a 
game in Wrigley Field and watch the Cubs play the Yankees. So I 
took her and a couple friends to the game several years ago, 
and she was testing herself during the whole game, but it did 
not stop her one second.
    The point I want to make is the highest level in the U.S. 
of courts and justice is the Supreme Court, and there is a 
woman in that position, who since age 7, has been dealing with 
type 1 diabetes. She is a great asset to our country as you 
will all be.
    The last point I want to make, that I think is very 
important, is that we have had an impact already, decisions 
been made in terms of funding agencies. And Dr. Rodgers, can 
you tell me how many NIDDK employees have left because they 
were fired, placed on administrative leave, or accepted a 
buyout, since the beginning of this year?
    Dr. Rodgers. Thank you, Senator, for the question, and 
thanks for what you said, prior to that direct question about 
the role of the Senate in terms of the budget. We appreciate 
those increases. And as my boss, Dr. Bhattacharya, mentioned at 
this hearing, the President's budget does recognize a cut, but 
this is really the beginning, as he said, of a close 
negotiation and discussion with the members on the final 
budget.
    With respect to the number of workforce the reductions 
were--some of the reductions were intended to centralize some 
of NIH's administrative function. I cannot give you a precise 
number because you know retirements continue. But we are doing 
the best with the numbers that we have to try to make sure we 
are as efficient as possible getting funding out to our 
investigators, and making sure that the success that we have 
made so far, do not take a back step.
    Senator Durbin. Can you tell me how many NIDDK grants have 
been suspended or terminated this year?
    Dr. Rodgers. Well, in terms of overall terminations, I 
really again cannot comment on the specifics of that, because 
as you are aware, some of these terminations are currently 
involved in appeals and litigation. I would have to get back 
with you on that. But I think, you know, the--and in fact some 
of these efforts are government-wide. So they are well beyond 
what NIH can control.
    Senator Durbin. Doctor, I do not want to put you on the 
spot. You are a friend, and an ally, and we work together over 
many years, so I am going to stop this line of questioning, but 
to the audience I want to make it clear. There have been 
dramatic cuts made in grants, some related to type 1 diabetes, 
and there have been termination of people working in this 
agency who have critical expertise for the future.
    If we are going to stop this, we have got to stand 
together, both political parties, and say that is the end of 
it. Research is part of making America great. Thank you very 
much.
    [Applause.]
    Chair Collins. Thank you. Senator Britt.
    Senator Britt. Thank you, Chair Collins, for hosting and 
holding this important hearing. And thank you to all of you for 
being here, being a part of it, lifting your voice, telling 
your story, and working to make a change.
    Ruby, Rachel, Katie, incredible, absolutely incredible. And 
to all of you, I know each of you have a story that in telling 
it will inspire others, will change lives, and will push 
research and development forward. I think we have two 
Alabamians here, do we potentially? Matthew? Awesome. Okay. 
Look, when I was reading about you, your quote, ``Live fully, 
and never let diabetes define you. You are so much stronger 
than it is.'' Thank you. Thank you. Thank you.
    [Applause.]
    Senator Britt. Thank you. And is Meg here by chance? Oh. I 
heard you just got your back handspring; amazing. How old are 
you? Nine? That is incredible. I am not sure that I could do 
one at 9. I mean, amazing. Thank you so much for being here, 
for lifting your voice, for making sure that all of those with 
T1D in Alabama are heard, and seen, and across the Nation. You, 
too, inspire me, and all others, and I really appreciate you 
being here.
    I want to thank the researchers. Dr. Rodgers, you have done 
an incredible job. When you were in front of this Committee 
back in 2023, we had a really good exchange. You shared with me 
that Alabama has one of the highest rates of gestational 
diabetes in the country. We also went on to discuss the fact 
that when a woman does have gestational diabetes that it 
increases the likelihood that she will ultimately have diabetes 
and that the infant will as well.
    My question to you is, you know, what are we doing? How is 
NIDDK supporting research on how best to manage diabetes during 
pregnancy and to ensure that the health of mothers and children 
are at the forefront of this research?
    Dr. Rodgers. Thank you, Senator Britt. As you or some may 
be aware, current practice in obstetrics and gynecology is to 
do a oral glucose tolerance test, usually in the third 
trimester of pregnancy, to determine whether a woman has 
diabetes, gestational diabetes. And we know as you have just 
indicated that having diabetes and gestational diabetes puts 
that mother, as well as the child that she is carrying, at risk 
of subsequently developing diabetes in the future. Treatment at 
that level may be too late because the period of time of which 
dysglycemia or high levels of glucose have occurred may be 
present a month, 2 months, 3 months earlier. We started a study 
called, GO MOMs (Glycemic Observation and Metabolic Outcomes in 
Mothers and Offspring). Of course, everything in Government has 
to have an acronym, and that is an acronym that stands for 
determining the glucose levels and gestational diabetes. And we 
are putting on these continuous glucose monitors in the first 
trimester----
    Senator Britt. Okay.
    Dr. Rodgers [continuing]. To determine exactly when that 
dysglycemia. I am pleased to report that the very last patient 
since I spoke with before you in 2023 has just completed--just 
delivered this month that child and very similar to the TEDDY 
Study we hope to have the results of that analysis, looking at 
these complex pictures that occur on the CGM within the next 6 
months to a year. That will inform us when one potentially 
should be intervening, and then one can then to determine 
whether that earlier intervention has a positive benefit both 
in terms of the mother and with longer follow-up of the infant.
    Senator Britt. Thank you so much. In my remaining minute, I 
was heartened to read the new potential cures for type 1 
diabetes that were published in the New England Journal of 
Medicine a few weeks ago. And I am sure everyone in here shares 
that enthusiasm. You know, as a policymaker, I want to make 
sure that potential cures for T1D do not take us down the same 
road as insulin. So if you look back at insulin when it came to 
the market in 1923, but over 100 years later, it is still 
unaffordable for so many. And so how do we make sure that we 
balance creating an innovation--an innovative place in research 
and development where people were rewarded for that, but not at 
the expense of being able to get these incredibly important 
drugs or treatment to people nationwide?
    Dr. Rodgers. Sure. Well, you know, NIH, obviously, does not 
have a particular role to play in pricing of insulin or other 
drugs for that matter, but our role is ultimately in developing 
cures. Of course, people with type 1 diabetes, and a 
substantial number of people even with type 2 require insulin 
to live. And our goal is really to focus on developing a cure 
so that insulin--their own cells are producing the insulin as 
the example. And we have developed a series of other drugs 
early on that have gone to industry that can stimulate the 
insulin production even in the remaining cells. That is where 
we stand.
    Senator Britt. Okay.
    Dr. Rodgers. Our goal is to better understand and to 
develop treatments, preventions, and curative strategies.
    Senator Britt. Thank you. And Chair Collins, just one last 
thing. I want you all to hear this from all of us. This is an 
issue. There are many issues that you see in the news that, 
unfortunately, divide us along party lines, but this is not one 
of them. And Democrat, Republican, we all stand united in 
making sure that we have the research and the treatment and the 
availability of these things for each and every one of you.
    And if you will, as a parent myself, I have a 15- and a 16-
year-old. I have a dear friend who has more than one child with 
T1D, and watching what all she does to make sure that her child 
is successful, and that they have what they need, and that they 
are ready, it is a constant process. And so will all of you, 
incredible delegates, join me in giving a huge round of 
applause to your parents who work day and night and making 
sure.
    [Applause.]
    Chair Collins. Thank you. Senator Baldwin.
    Senator Baldwin. Thank you, Madame Chair. And I want to 
thank you and Senator Shaheen for your long-term advocacy with 
the Diabetes Caucus.
    To our witnesses, thank you so much for being here to share 
your stories. And it is not often that the Appropriation 
Committee has a standing room-only audience. I will say hi to 
the people in the overflow area. Also, I know that we have so 
many here, and I just really appreciate the way you advocate 
for the Special Diabetes Program, and the critical research on 
type 1 diabetes supported by the NIDDK.
    We have made tremendous progress on a new--on new and 
better treatments for type 1 diabetes and every day we are 
closer to a cure. And that is because advocates like all of you 
here today who have pushed the Congress to increase funding for 
this research. And I was glad that Senator Durbin was here 
earlier to talk about the history of our efforts in Congress to 
increase funding for the NIH, but also to outline the threats 
that are faced right now.
    And I want to be very serious about those threats. Every 
month of this year, NIH is spending less on biomedical research 
than it did last year. And at the end of March, NIH had spent 
$1.7 billion less than through the same period last year. In 
mid-May, it was $3 billion less than the same period last year. 
And now, by the end of June, NIH has awarded nearly $6 billion 
less in grant funding.
    NIH has said that its plan is to award 40 percent fewer 
grants this year than last year, which lines up with less and 
less funding going out the door each month. Our witnesses here 
today have taken on tremendous challenges in their lives. So I 
have no doubt that you can handle a tough question.
    So I am going to start, just ask you, Katie. Thank you 
again for being here. What would you like Congress to know as 
NIH plans to reduce the number of research--new research grants 
it awards this year by 40 percent? What do you think cutting 
research would mean for children with type 1 diabetes?
    Ms. Bone. That it will be longer until we have a cure and 
easier ways to manage this. The technology we have now has made 
it where I can sleep through the night, but it is still hard. 
And if there--when there is a cure, one day that means I will 
get to sleep through the night and not have to worry about it. 
That means I can go to training and not feel really terrible 
because of this. And I can go to competitions and not work 
harder than I have ever worked in my life for years to not 
perform because of this, because that has happened many times.
    And to get to show up and be fully me, and get to show 
everybody all of the hard work that I have done. So it means 
getting to live an even fuller life than I am now, and getting 
to achieve the goals that I have. And that is my every day 
being a little less hard.
    Senator Baldwin. Thank you. Dr. Rodgers, at a hearing last 
month with Dr. Bhattacharya, I pointed out a major change the 
administration has made to the way NIH is now proposing to fund 
grants by forward funding half of them in the first year. This 
scheme would dramatically reduce the number of grants NIH is 
able to fund by the thousands across the Institute. NIH can do 
this unilaterally, effectively making billions more in cuts to 
research unless Congress steps in.
    It is why I have been raising the alarm now for months 
about delayed NIH funding, as I just described, because NIH is 
either going to not spend funds that Congress has appropriated, 
or rush funding out the door through this new and haphazard 
scheme of forward funding that will result in devastating cuts 
to research funding this year and next year.
    So Dr. Rodgers, how will diabetes research be affected if 
NIDDK awards 40 percent fewer grants this year than last year? 
And what will that mean for patients with type 1 diabetes who 
are anxiously waiting for a cure?
    Dr. Rodgers. Well, Senator, thank you for your question. We 
are doing our best to spend all of the money that Congress has 
provided to us. And I would note that the budget for the 
Special Diabetes Program is extended in the President's budget.
    Dr. Bhattacharya, I have to say, is committed to ensuring 
that the U.S. remains the global leader in research. And as he 
pointed out when he testified to this Committee really the 
efforts that are underway in terms of the discussions that are 
ongoing with Congress to try to make adjustments and come up 
with final decisions is something that is going to take, you 
know, ongoing effort. And I really applaud him for what he is 
doing.
    Obviously, you know, more funds allows for us to do more, 
which is why the Special Diabetes Program has been so 
effective, as apart from our normal appropriations. But we, you 
know, are committed to do with what we have, in as most 
efficient way as possible moving forward.
    Senator Baldwin. Thank you, Madam Chair.
    Chair Collins. Thank you. Senator Moran.
    Senator Moran. Chairman Collins, thank you very much for 
this hearing. Generally in the Senate, I feel like I am at 
least the same age as my colleagues, I do not feel old. In 
today's hearing I feel significantly older than the audience. 
But I am delighted that you are all here. And your presence 
makes a difference. It highlights--it highlights for us, on a 
regular basis, the importance of medical research and it is 
always useful for us to see the individual lives that are 
impacted.
    Things can be about numbers, and they can be about dollars, 
but in order to get our attention and get the necessary action 
on our part, it is useful to see that humans; our friends, our 
neighbors, our constituents, our family members are impacted. 
So I appreciate all of you being here today and making the case 
for--in sufficient resources necessary.
    And while Senator Collins has not yet introduced her bill, 
she has announced her--the intended introduction. And Senator 
Collins, I will not say that I am going to co-sponsor the bill 
until I meet with my juvenile diabetes kids from Kansas, so I 
can tell them first, but trusting your judgment, and your 
capabilities, and your expertise, and knowledge that you and 
Senator Shaheen, your dedication, there is a likely supporter 
from Kansas for the passage of this legislation, And so again, 
delighted to have you, and thank you.
    [Applause.]
    Senator Moran. There are many things about working in the 
United States Senate, being a member of Congress that bring 
challenges to them, this is one of them. But this is the 
circumstance in which most of us, if not all of us, get 
significant reward when we see the opportunities we have to 
make a difference in people's lives. And I have said numerous 
times when we have debated and discussed funding and support 
for NIH, the business that we are in, and this is the same 
business we are in this morning, is to provide hope.
    Hope that there is a brighter future. Hope that there is 
fewer people affected by diabetes, hopeful that the cures and 
treatments are more effective, and that we can rid ourselves, 
our families, and our children from juvenile diabetes. So I am 
really pleased to be here and lend my support to this effort.
    Dr. Rodgers, you have been an expert, provided your 
expertise. I thank you for your public service and commitment 
to finding cures, and treatments. And tell me, if you would, 
you have been here since 2007, what is the most impactful 
advances in understanding and treating type 1 diabetes that you 
have had in your tenure? But more importantly, tell me what the 
future looks like.
    Dr. Rodgers. Well, thank you Senator Moran for that 
question. I think I would just highlight a few, some of which I 
mentioned in my opening statement. The idea now in this period 
of time that we actually have a drug available that is FDA 
approved that can prevent by at least 3 years and a substantial 
number of individuals the development of clinical type 1 
diabetes, I think is a very important advance. One that we hope 
to replicate because we have, you know, on the drawing board or 
in the pipeline a series of other drugs that be used either 
alone or in combination that might yield equivalent or perhaps 
even better results.
    Having cellular therapies now to be a biological cure is 
something that I am very excited about and that that 
possibility to report to you perhaps in the 2 years from now, 
or maybe 4 years from now, of that success is very important to 
me.
    This TEDDY Study that you know involve following these 
8,000 kids, we have five million samples that the kids and 
their parents have generously provided to us. It has already 
giving us you know ideas. We know, for example, even before we 
do the final analysis, we have been able to detect proteins in 
the serum of kids who are at high risk that may determine or 
predict several months in advance the likelihood that a kid 
will develop clinical. So to get these kids into preventive 
studies is very important.
    And sort of moving forward, thinking about using your 
stem--pluripotent stem cells to get them encapsulated, we are 
working with chemical engineers to develop a way to expand and 
to get these cells so that the antibodies do not get in to 
attack it as it did in the first place, but to get the insulin 
out. That is really extremely exciting.
    We are taking a page from the oncology and the immunologist 
field. They are using something that you may have heard of, CAR 
T-cells and applying that technology as a way to prevent the 
ongoing autoimmune disease, potentially, in individuals with 
type 1 diabetes from attacking either their existing cells, or 
potentially transplanted cells.
    That is something that I really hope--look forward to 
reporting to you in the upcoming meetings. But I am very 
excited about these results. And I have to say, again, with a 
lot of thanks and appreciation for the Special Diabetes Program 
because this would not be possible at all without your ongoing 
support.
    Senator Moran. Thank you. I usually hear CAR T-cells in 
regard to cancer research, and cures, and it is nice to know 
that the potential opportunity that exists here because we have 
seen such significant outcomes, improvement in outcomes in 
cancer.
    Dr. Rodgers. Thank you.
    Senator Moran. Doctor, thank you.
    Chair Collins. Thank you very much, Senator Moran.
    Senator Van Hollen.
    Senator Van Hollen. Thank you, Chair Collins, and it is 
great to see all of you. Thank you for convening this hearing. 
Great to see the Children's Congress delegates filling this 
room. Dr. Rodgers, thank you also for your leadership.
    And I received letters from two Marylanders who are part of 
the Children's Congress. One is from Garrett Cohn, who I look 
forward to meeting later today, who said, and I am quoting, ``I 
was diagnosed with T1D when I was two. I rely on an insulin 
pump and continuous glucose monitor to keep my blood sugar in 
range. I must monitor them all the time.''
    Then I also received a letter from Andrew Manatos who said, 
``The day after my seventh birthday I found out I had type 1 
diabetes. Having type 1 diabetes is not easy. I have many 
sleepless nights. I have to miss class, sports and even have to 
go to the hospital if my blood sugar goes too low or high. But 
even with type 1 diabetes, I do not slow down.''
    That was the overall message, that as long as we make sure 
that all of you have what you need, you do not have to slow 
down either. And I want to thank Ruby, and Rachel, and Katie, 
for your testimony. I have just one question. And I do not know 
which one of you is in the best position to answer it. But 
based on what Andrew Manatos said, you know, the challenges he 
faces with, whether it is sports activities, or other school-
related activities, and having to balance that with dealing 
with type 1 diabetes. How do you go about juggling that? And 
would you be able to do what you do without the advances that 
we have made so far?
    Ms. Bone. I mean, it is incredibly hard every single day to 
get up and deal with it. And without the advances that we have 
had, it would be significantly harder. It would be doable. And 
everyone here could still be successful, but it would be a lot 
harder, and it would be a lot more mentally taxing. As it is 
diabetes is mentally very, very hard every single day. And 
personally for me, I have had a lot of anxiety and depression 
due to it. But being able to see my blood sugar in real time 
and just easily give myself a little bit of insulin has made 
that a lot easier for me.
    Senator Van Hollen. Thank you. And I think the personal 
stories all of you bring to this are really essential to giving 
us an understanding of why all this is so important.
    Dr. Rodgers, I heard your earlier testimony about how you 
believe that we have made a lot of progress, but we are also on 
the cusp, as you were just saying, of additional progress. And 
of course, we all hope to find a cure. But I assume that if you 
saw a significant cut in your resources, it would make it 
harder to achieve these new breakthroughs; is that not the 
case?
    Dr. Rodgers. Well, Senator, of course, the more you have--I 
frequently tell my staff, every other year we have an 
initiative, or every year we have an initiative meeting for 2 
years from now. And I tell them that no matter what our budget 
is, it is better to have good ideas and no money than to have 
money without any good ideas. And so we are always in a 
position in which we have to prioritize what we do to ensure 
that we continue to be successful.
    We may have to cut back, we may have to slow down, or maybe 
not start something new, but we have to make sure that the 
progress that has achieved does not fall behind. And I remain 
committed, I think it is when you have--you enroll people in 
clinical studies, that you have to see it through completion 
particularly if they look very promising, and so that is 
obviously a priority that I have.
    Senator Moran. Understood. And look, obviously you need 
good ideas but you need the resources to match the good ideas, 
or good ideas just sit on the table, right?
    Dr. Rodgers. That is correct.
    Senator Van Hollen. And I want to make sure that they are 
not good ideas out there that could lead to a cure that we are 
not providing the resources to pursue. So I want to thank you 
for the work you do. I want to thank all the delegates here.
    And I will say, Senator Collins, I was proud to co-sponsor 
your earlier reauthorization and look forward to co-sponsoring 
the next reauthorization. Thank you all very much.
    Chair Collins. Thank you. Thank you. Appreciate that.
    [Applause.]
    Chair Collins. Thank you, Senator.
    Senator Ossoff.
    Senator Ossoff. Thank you, Madam Chair. Thank you for uh, 
convening this hearing. It is powerful to be in the presence of 
so many young people. Thank you for being here with us, and for 
holding elected officials accountable through your presence and 
your example. And thank you to our witnesses as well.
    Dr. Rodgers, NIH collaborates with CDC on the Special 
Diabetes Program, correct?
    Dr. Rodgers. That is correct, Senator.
    Senator Ossoff. And have you had positive working 
relationships with many of your colleagues at the CDC?
    Dr. Rodgers. Very positive relationship. I mentioned one 
earlier on, the search for diabetes in the youth which has been 
funded through this Special Diabetes Program, and it is not 
only detecting that there has been, over time, an increase in 
the incidence of type 1 diabetes but also in type 2 diabetes. 
What I was taught when I was in medical school, we called it 
Adult Onset, but we are seeing this now in kids 10, 12, 14, and 
that would not be possible without the collaboration that is 
longstanding now with the Centers for Disease Control.
    Senator Ossoff. And appreciate your work at NIH. And the 
CDC does vital work for the nation, yeah?
    Dr. Rodgers. Correct.
    Senator Ossoff. And I know, Dr. Rodgers, you do not produce 
the budget request, so this is not directed at you personally. 
But I want to raise, once again, for the Committee and the 
public my bitter opposition to the Trump administration's 
proposal to cut the CDC budget by more than half in fiscal year 
'26, which will have a devastating impact on epidemiological 
defense and health research to defend the American public from 
deadly diseases.
    And I would note, Madame Chair, that the administration's 
budget request proposes to eliminate entirely the CDC's 
Diabetes Division responsible for data collection and research, 
and to eliminate entirely the CDC's Division of Nutrition, 
Physical Activity, and Obesity. And I will fight this effort to 
destroy the CDC with everything I have as a member of the 
United States Senate. And if we, on a bipartisan basis in the 
Senate, do not defeat this effort to gut the CDC, the American 
people will pay for it in lives, in suffering for decades to 
come.
    And I want to thank you again, Dr. Rodgers, for your work 
at the NIH, and respectfully request your assurance that any 
information that the Committee may need in order to better 
understand your activities, and also your collaboration with 
the CDC, and the vital role that the CDC plays in defending the 
Nation, you will provide to the best of your ability to this 
Committee. Do I have that assurance?
    Dr. Rodgers. You have it, Senator.
    Senator Ossoff. Thank you, Dr. Rodgers. I want to ask you 
also about ensuring that diverse communities across the United 
States have access to information and treatment. I note with 
concern that the--of course diabetes impacts every community in 
the United States. And in Georgia the Hispanic community, 
Hispanics in Georgia are about one and a half times more likely 
to be diagnosed with diabetes.
    There was a project at the University of Georgia, an NIH 
grant had been awarded to help develop new tools, with language 
access, bilingual and multilingual tools to help improve the 
Hispanic community's access to information about diabetes, 
about staying on top of insulin, and blood sugar levels, and 
treatment as well as to be able to diagnose diabetes earlier.
    Can you speak broadly, please, Dr. Rodgers, to the 
importance of ensuring that diagnostic tools and treatment 
information are widely accessible to diverse communities across 
the United States?
    Dr. Rodgers. Well, I would say that it goes without saying 
that the current Director has mentioned that at his hearing, 
that we want to make sure that advances and medical treatments 
serve all communities.
    Senator Ossoff. Thank you, Dr. Rodgers. And I will be 
following up with the Director's office about this canceled 
grant to the University of Georgia. Again, I know that is not 
your decision and your prerogative, but appreciate your work on 
behalf of the American people and your presence here at the 
hearing today.
    Dr. Rodgers. Thank you.
    Senator Ossoff. Thank you. Thank you, Madam Chair.
    Chair Collins. Thank you.
    [Applause.]
    Chair Collins. I am delighted to call on my friend and 
colleague, Senator Hoeven.
    I would note that there is a roll call vote on, so I 
believe that Senator Hoeven will be our last questioner, and 
then we will wrap up this great hearing. Thank you.
    Senator Hoeven. Thank you, Madam Chair. And I noticed that 
you are perfectly color-coordinated with our Children's 
Congress.
    Chair Collins. That is on purpose.
    Senator Hoeven. I knew it. I knew it.
    [Laughter.]
    [Applause.]
    Senator Hoeven. It is not only why you are a good Chairman, 
but it truly reflects the empathy that you have, and for--I 
know how much you care.
    Chair Collins. Thank you.
    Senator Hoeven. And how hard you work to be a strong 
advocate for all of these young people and many others. I do 
want to acknowledge right off the bat that Nina Kritzberger 
from Hillsboro, North Dakota, I think is here somewhere. Nina, 
are you here? I know I am going to meet with you later.
    But I think she is here, with all of you and I want to 
thank you all for coming, and let you know there is somebody 
here from my state, and I look forward to meeting with her 
later on today. But it is truly inspirational to see all of 
you, and you make a difference. You make a difference. Good for 
you.
    Ruby, I would like to start with you speaking out. Just 
tell me, what are some of the biggest challenges that you face 
that you wish more people, and particularly we as lawmakers, 
understood when it comes to type 1 diabetes?
    Ms. Whitmore. I think just how hard it is to have to think 
about it all the time. I know this has been said a couple 
times, but you do not get a break from it, ever. And as Katie 
said, even when you are sleeping, you do not get a break from 
it. It might go away for a couple hours when you are asleep, 
but then as soon as you--as soon as it beeps, it wakes you back 
up and you are--it starts all over again. I just want people to 
know that it affects so many people, not just the people here, 
but their families, and the millions of other people who also 
have type 1 diabetes.
    Senator Hoeven. I understand. Rachel, your story helps, you 
know, you have got demanding academic schedule, participating 
in athletics, all those kind of things. So tell us what--tell 
us about your support systems, both at home and in school, and 
I think that is something that is informative not only for us 
as policymakers but for others in the room. What are the--what 
are the support systems both home and school that have really 
help you accomplish all the things that you are doing?
    Ms. White. Yeah, I am very grateful to have my mom and dad 
right back here, and they are very helpful. Especially with 
changing my pods, and my continuous glucose monitors. I have it 
right here on my arm, and they are very helpful with helping me 
managing it, and reminding me if I am going low or going high. 
And especially I am a high-level tennis player, and especially 
during a tennis match when I cannot always be looking at my 
number when I am in the middle of a match, and my mom 
especially she helps me by making sure I know when to have 
juice if I am going low, or giving me insulin. And I am very 
grateful to have them. And they are awesome parents.
    Senator Hoeven. My daughter played tennis, and she did not 
have diabetes, but she played tennis and her mom was her 
biggest supporter and advocate and she always--when in those 
tough matches she would always say, ``Bear down. Bear down.'' 
And I do not know that my daughter liked it, but I think it 
worked. Does your mom have a certain saying or anything to 
encourage you?
    Ms. White. I do not know if she have a certain saying, but 
she is definitely always in my corner cheering.
    Senator Hoeven. Right.
    Ms. White. Even in the not so great moments, or when I am 
not playing my best, she is always in my corner, always 
cheering me on, and always supporting me.
    Senator Hoeven. Yeah. Yeah. That is awesome. That is 
awesome. And then, you know, speaking of the athletics, 
obviously Katie, I mean, amazing, you know, what you can do. I 
always kind of wanted to be a Ninja Warrior, but fell woefully 
short. So I really admire you. You know, what would you say 
to--obviously you show that--you have shown and are showing 
that anybody can accomplish whatever they truly set their mind 
to do. What would you--how would you advise people to be 
successful? To have the kind of determination and grit it takes 
to accomplish whatever they want? I mean what would be the 
advice that you would give them?
    Ms. Bone. Never give up. If it is something that you really 
want to do, like it is not necessarily going to be easy, but it 
is going to be worth it. My sports as it is, like outside of 
diabetes, getting to the point that I have gotten is--has been 
very hard. You know, I would be up at 5:00 a.m., and I would go 
to strength and conditioning. I would go to school, and then I 
would be at the gym for six hours, and get home, and still have 
to do school, and try and recover and go to bed. And then on 
top of that, I still have diabetes.
    So it has taken so much work in years to get to the point 
that I am at. And for diabetes everybody here--and I have 
gotten a lot of comments about this, that I make it look easy, 
and it is not. So it is okay to struggle, and it is okay to 
feel the emotions, and to feel not okay. But that it is worth 
it. And getting to your goals and what you have always dreamed 
of doing is worth it.
    And for me, I have wanted to go to the Olympics since I was 
3 years old. And that is something that I have never stopped 
reaching for, even though there has been more bumps in the road 
than anybody will ever know.
    Senator Hoeven. So I think you summed it up so well. And I 
think for anyone listening, the work ethic, and what goes into 
achieving what goes into winning. I love football and the 
Chicago Bears were a long time ago really good. And they had a 
coach by the name of Mike Ditka, and he said, ``There is a lot 
more to winning than just wanting to.'' You have summed up 
perfectly all the hard work. The hard work it takes.
    Ms. Bone. For sure. People see the trophies, and the goals, 
and the records, but they do not see the amount of tears----
    Senator Hoeven. Bingo.
    Ms. Bone [continuing]. And hard work that it takes to get 
to that point, and what I have had to do to get to that point, 
so yeah, to never give up, because if it is what you want, it 
is it is very worth it.
    Senator Hoeven. Right on. I do not think anybody could have 
said it better, or demonstrate it better. Thanks so much. 
Thanks to all of you. Thanks for being here.
    [Applause.]
    Chair Collins. Thank you. Thank you, Senator.
    I want to end this hearing on a very hopeful note. And 
really, Katie summed it up best when she said, ``Never give 
up.'' I want to assure you that we are your champions, and we 
will never give up until there us a cure.
    [Applause.]
    Chair Collins. And in the decades that I have personally 
worked on this issue, from when I first founded the Senate 
Diabetes Caucus way back in 1997, I cannot tell you the 
progress that has been made. I think of those old heavy pumps 
that used to be lugged around, and now we have the continuous 
glucose monitor. That was because of the Federal investments in 
research.
    We have heard Dr. Rodgers talk about the exciting new 
medication that can delay the onset, for as much as 3 years, of 
type 1 diabetes for those who are prone to it. We know that 
there is research underway, even as we meet here, that is the 
pathway, one of the pathways to ultimately discovering a cure.
    And I want to thank all of you for being here today, 
particularly our witnesses who did such a fabulous job; Ruby, 
Rachel, Katie, Dr. Rodgers, thank you so much for being here, 
and for doing a wonderful job.
    [Applause.]
    Chair Collins. So our hearing record will remain open until 
July 16th for any additional questions or materials that may be 
submitted.
    Let me just have my final statement be a thank you to all 
the delegates who are here. See the difference you made? I have 
already got more co-sponsors for a bill that I just put in with 
Senator Shaheen yesterday. So keep up the good work.
    [Applause.]

                       CONCLUSION OF THE HEARING

    Chair Collins. Thank you so much. This hearing is now 
adjourned.
    [Whereupon, at 11:51 a.m., Wednesday, July 9, the hearing 
was concluded, and the committee was recessed, to reconvene 
subject to the call of the Chair.]

                                  [all]