Things out and find your way. Many of those for you here i must focus my attention on things by doctor my health. Each day i had to carefully monitor and manage my blood glucose level, which isnt easy since exercise, diet and many other factors have an impact. Despite the serious challenges i have many reasons to be grateful. Fatefully, i was diagnosed with a t1 d after frederick branning discovered insulin. Thankfully, i was diagnosed with the wendy after insulin pumps and continuous glucose monitors were invented. Thankfully, i have learned how to manage my diabetes without allowing it to manage me even though it is not always easy. It is only through a very strict blood Sugar Management routine and advancements in diabetes treatment and devices that i have been able to live my life to the fullest. Thirtyfive, the number of countries i visited and is still counting. 13. 1, the number of miles and a half marathon. I have completed two so far. Ten, the number of things i wish my parents knew when i was diagnosed with t1 d. I wrote this article is a published author. For plus, the number of years after college that it takes to become a doctor like my dad who i look up to. That is my dream job. One, as in type one, the number associated with my disease. I am hopeful that congresses support we will move from type one to type none. Through it bases in medicine, my life has gotten easier healthier and safer. Are using insulin pump in a continuous glucose monitor. I am well aware that these advancements to much time, research and funding to become a reality. While i have never participated in a formal clinical trial, i am very excited about a recent Research Product that i conducted. Ive always been curious as to how and why my blood sugar is so irregular when i ski. Changes in now to two and prolonged activity can be very hard on blood sugar control. After researching i realized there was an opportunity to design a study to evaluate the changes my body experiences when i ski compared to my friends without diabetes. The results, which showed that sorry. The results, which represented at the summers American DiabetesAssociation Meeting in boston showed that despite strenuous activity, altitude cause an increased demand for insulin by more than a third. Most importantly, i show that my blood sugar could be in the same range as my friends with careful monitoring and planning of my, hydrates. The use of a continuous glucose monitor was especially helpful in preventing heiko glide hypoglycemia, and producing safe blood sugars prior to scheme. My project obviously does not compare to those responsible for the significant process made for the lifechanging treatment for t1 d. Projects with artificial pancreatic pancreas technology, Technology Hotel available in the years to come, but my project rivers of western desire to make an impact. I am not someone who can just stand by when there is so much to be done to improve my quality of life and that of my friends before you today. In closing, i ask for your support and testify to cure diabetes. Thank you chairman call it, Ranking Member mccaskill and Ranking Members of the committee today. [applause]. [applause]. Madam chairman, before we go on to the next witness may i ask unanimous consent that the record of this herein reflect something that the people behind million might not have seen, which is to record testimony she virtually never looked down at her notes, which is far better than most adults. I just hope she doesnt run against me. [laughter] i would be in trouble if that happens. That really was extraordinary testimony and we thank you so much for being here today. Now, we will turn to another extraordinary young woman, kate hall. s directed afternoon. My name is kate hall and i am from maine. Thank you chairman call it, Ranking Member mccaskill and members of the committee for the honor of being here today to share my experience of living with type one diabetes. I was diagnosed with type one diabetes when i was 10 years old. At first it seemed as if i would never understand every little detail that was involved in having diabetes. I had to adjust to taking shots of insulin, checking my blood sugar several times a day, learning how to count carbs in everything i ate and learning how to deal with high and low blood sugar. However, the thing that stood out to me the most was being benched in my first soccer game after my diagnosis. That made me realize that diabetes wasnt going to ever stop me from doing the things i love most. I thought, i am not sitting out on anything ever again if i can help it. Im figuring this thing out. Type one diabetes is challenging to put it comes to what love doing most, track and field for the events i competing, the long jump in the short sprint require rigorous training. For me because i live with type one diabetes keep me because i e one diabetes keep in my blood sugar in a healthy range as much as possible is as just an important part of my training as anything else i do to prepare for competition. Managing my diabetes can be hard at times and i realize i cant figure everything out on my own. I need help from doctors, my parents, Diabetes Technology and researchers. Being a competitive track and field athlete there are many tiny details involved that people have to do to get the best result possible. Some of these include staying hydrated, eating well, sleeping well, training the right way and warming up correctly to prevent injury. But only do i have to do all of these things, but making sure my blood sugar is at a another thing to add to the list. Whenever i am training or competing i had to take my blood sugar several times before i read to make sure it wont go higher low even when i try my hardest to control it. I where an insulin pump. With most private Health Insurance covering cgm i am hopeful i can update my policy. This helps me focus on training and competing. Thankfully knew technology and the support of my family will allow me to pursue my passion and become a world ranked junior athlete. I was able to end my career by breaking a 39 yearold National Record at the new balance nationals last month my jump surpassed the automatic qualifying standard for the 2016 olympic trials. I finished 3rd in the 100meter event. My dream is to one day represent the United States at the olympics. Although i will be far from home one key part of my life remains unchanged the challenges of managing my type one diabetes everyday. Technology is important but we need a scientist to help us figure out better treatments and the cure for this disease which is why my family and i are grateful for the funding. Chairman, we thank you for your leadership and are counting on congress to help us figure it out. Thank you. Thank you. [applause] i just want to say personally how proud i am of you. It was thrilling to hear of your success and setting new records, and to do so while coping with a very complicated illness is even more impressive. Most impressive. Most of all, you inspire all of the children who are here today to no that they, too, can achieve there dream. So thank you for coming. Welcome. Chairman collins, Ranking Member mccaskill, members of the committee, thank you for this opportunity to speak before you. You. My name is bob amato, and i am from Johnston Rhode island. When i was 1st diagnosed with type one diabetes i was 67 years ago, approximately seven years old. Thinking at that time, people such as you guys were not able to compete. No athletics, no jim. That was difficult. I did not accept that, and i sought guidance from joslin and again guidance from my parents and i was able to prove that particular concept a fallacy, a fallacy to the point where in 2009 i was entered into the Providence College hall of fame for athletics for both my running accomplishments and accomplishments as a coach. As a coach i had the privilege of coaching to world champions, 16 division i allamericans. Teams competed and 116 new england championships. My coaching colleagues selected me to coach of the year 15 different times. That was what i would hope hope for when i was told it could not be done. I was able to find success despite the daily challenges of diabetes. Because i always used to five this is important, the term, the latest technology. The latest technology. You have the picture of that. When i 1st came down with diabetes the needles, are you ready for this one . The needles were metal. We had to sharpen the milestone. The syringes were glass. Blood 25 urine analysis, testing urine was the method of determining blood glucose. Now we are up to the insulin pump, and the technology is just fantastic about 15 years ago i began to realize that the normal low blood sugar warnings were no longer happening. All of you know that when you have aa low blood sugar you are either a little tired, shaky, or things happen that are not normal. But at this point in my diabetes career after 67 years those body signals are gone. And that provides me with some pretty big dangers. I neededdangers. I needed to find a way to manage that situation. I was fortunate that the gdr s funded Research Program using the continuous glucose monitor, the cgm which took place in boston, and i was one of the 1st to start in on that. We spent about a year with the program. It was great. I went from not realizing what was going on with regards to insulin reactions as we used to call them, low blood sugars, hypoglycemia. You guys are all familiar, to no knowing ahead of time what to do and how to correct it. It also enables me to control my diabetes better which again is very important. A new Technology Helps me with a situation that was really dangerous. As a result of the study and other studies the cgms were endorsed by leading clinics throughout the country, the inductor and society, American Diabetes association, american clinical american clinical 25 American Association of clinical endocrinologist. I dont knowi dont know what they are, great organizations, but we cannot relate to the. Almost every insurance agency, almost everyone is now on board. But there is still a tragedy, and that tragedy is medicare will not cover these things. I appealed to medicare over for solid years. The folder that i have is thicker than this. However, i received a notice that last november it was okay. The judge found in my favor. Well, i have the pleasure of coaching to world champions. The feeling i had was exactly the same when they told me we find in favor of you, but that was not all of the difficulty. Two months later they took it back and said no, and i, and i was heartbroken, but i have not given up. I have not given up. And that is what i hope you will do as you are going through school, high school later on in college and so forth. Do not quit. Now that i depend upon medicare for my diabetes, the cgms could save my life when i was wearing them numerous times. Again, i will not accept the cms decision, those are the administrators of the medicare program. The cgm can mean literally the difference between life and death. I will explain one instance. You have got to remember, we are trying to show that technology has helped me for 67 years be healthy and strong and successful. Now they have taken that technology away. I was driving on the interstate between boston and rhode island when not knowing, a reaction low blood sugar occurred. My car started to move back and forth on the highway. I did not realize that. An 18 wheeler didnt realize it, truck, truck, saw was happening, and he took and pushed my car off the road into the median. When the technicians took my blood sugar it was extremely low. That gentleman save my life. That did not have to happen. That did not have to happen. I could have been the cgm , if i had had that i would have known ahead of time, and things would have been taking care of. I couldi could have taken care of it. About a month ago i had a chance. Things have been difficult. I went up there alone. I hate to cut you off because your story is absolutely fascinating. I am worried because of the vote scheduling. If i could ask you to wrap up, that we will be great. Chairman, i would like to thank you for the opportunity of just being here and pleading for this particular situation and i hope that the vote that we will be taken from those that have been on assignment with you will continue. Continue. If anyone has any questions and i know you dont have the time, but if you have questions please be free to contact me and i would be glad to talk with you. Thank you for your compelling testimony. It is great to have you back chairman, senator, members of the committee, thank you for the invitation to testify today. A lifelonga lifelong disease that affects americans of all ages including seniors. On behalf of the National Institute of health pleased to report our Research Investment continues to improve the lives of type i diabetes. Through coordinated efforts with our Research Partners at j drf and 88 as well as a supporterthe support of the recently renewed special Statutory Funding Program for type one diabetes, we are helping children sitting here today and all people with type one diabetes live healthier lives and longer lives and im pleased to report that since i testified before you this Committee Just two years ago we have made significant scientific advances that are putting is closer to reaching our ultimate goal of preventing, treating, and ultimately curing type one diabetes and its complications. With the renewal of the program that you alluded to, we are looking forward to taking advantage of the future opportunities i would like to briefly describe for you today. Before i highlight these advances, i wanti want to acknowledge the important contribution my fellow witnesses of made and thank you for your personal testimony that you are not letting type one diabetes define you as a person. Ii am pleased to share the table with the doctors who we will share their Research Goals of preventing, treating command ultimately curing type one diabetes and would like to thank those here today representing americans of all ages with type one diabetes. Im happy to report the outlook is better than ever. People with the disease have knew and emerging technologies and treatments. And because of Research Conducted in the followup studies we know that early and intensive blood sugar control is key to reducing the risk of the devastating complications of the disease. Just this year we learned that people with diabetes who control their blood sugar levels are more likely to live longer than those are not an further emphasize the importance of early and intensive blood sure controls. As everyone here today knows controlling blood sugar is easier said than done. Challenging and burdensome and is limited by the potential for acute episodes of hypoglycemia promising approaches the artificial pancreas which is a device that can since blood sugar levels and automatically administer insulin. What this special Program Support theyre has been tremendous progress in this area. Just last year, 170 for five days and five nights by adults and adolescents led to lower blood sugar levels and reduced episodes of hypoglycemia. The study found an adolescent unsupervised overnight use of artificial pancreas for 21 nights led to improved blood sugar control during the day and night and reduce the number of episodes of nighttime hypoglycemia. Because of tremendous progress great promise in the nearterm approaching to help manage type one diabetes while improving health. However, it is not a cure. Replacing or restoring the function of the beta cells would be the biological cure in another area under vigorous investigation one strategy is via islet transplantation, collaborative islet transplant. Both safety and efficacy outcomes have improved from the year 2007 to 2010 compared to 1999 to 2006. Additional Research Progress areas have been made by an idd k and the niaid co led transplant consortium who has completed the pivotal trial and reached another endpoint in the 2nd phase three trial, and we look forward to these exciting results toward licensing pancreatic product for transplantation. A current barrier for using islet transplantation as a scarcity of donor islets for transplantation and here again and other major advance to overcome this difficulty has been recently reported by researchers in the Beta Cell Biology Consortium who have achieved the longstanding goal of type i Diabetes Researchone Diabetes Research discovering a way to create large numbers of glucose responsive insulin producing beta cells. With further research such cells could be used for transplantation to restore insulin producing capacity in patients with type one diabetes. Nih has made important strides in research to combat diabetes complications. Three drugs with widely differing costs. The results showed in people with mild vision loss all three drugs were equally effective. This canthis can inform clinical decisions and lead to more personalized treatment for diabetic eye disease while having significant cost implications and importantly drugs were found to improve vision which could make a difference in the quality of life that people with diabetes share. The in idd k and cdc have developed a study, and this program has shown that type one diabetes in people under the age of 20 has risen by 21 percent, the incidents has risen by 21 percent during the years 2001 to 2009 suggesting there is an environmental factor or factors contributing to disease risk, and our study of the environmental determinants which is now following 6,000 children from birth until the age of 15 we hope will soon get a handle on what is a murmur these environmentalists factors are. I know that the time is limited to select me in their. Chairman, members of the committee, thank you for the opportunity to testify before you today. The nih isthe nih is grateful for your continued support of congress, public and private partners, and the unwavering efforts of the Clinical Study volunteers. We look forward to continuing our vigorous support of research to build upon our recent scientific advances toward the goal of allowing people of all ages with type i diabetes toone diabetes to live long and healthy lives free of the burden of this disease. Thank you forthank you for your attention. Thank you very much, dr. [applause] doctor habib, as i am going to call you. Chairman, Ranking Member, members of the special committee to my aunt delighted to be here in the speech i am going to give is more educational and hopefully to convince you how to invest in research more and more so that we can get children to become type none, not type one. Thank you. Focus on the poster. Type one diabetes is an autoimmune disease which means that. Systems which are there to protect us from infection, cancer, and other diseases, in fact, make mistakes and attacked other cells. And so when the immune system attacks they die. Theredie. There is no more incidents, and sugar cannot be taken to cells, the cells cannot have energies and function. So we started by looking how to get the bugs away so that they dont attacked the beta cells so that we can get insulin again, and when we did we succeeded when we tried to get the immune system before the mice developed type one diabetes, but we failed utterly tried. We had to use, the disease is diagnosed. We had to establish thetechnology with an approach that can reverse the disease. When. We looked harder we understood that the immune system attacks the blood vessels that connect the beta cells to the rest of the body so they can no longer distribute insulin or get to produce insulin in the blood vessels are represented by pipe. It is broken and leaking. In order to fix the disease the thought was in order to fix the disease and curate you cannot just eliminate bugs. You have to fix the pipes. If you eliminate the bugs you fix the pipe with stem cells and get the flowers and produce insulin and cure the disease which is the experiment we set to test ended. Next slide, please. So, what we did here is that a sick mouse in the upper panel left side and are going to treat it or give it a drug to eliminate the system that attacks the cells and gave it adult stem cells we can get from blood or bone marrow. What happens to the mouse . Surprisingly what we found, as schematic representation, we made the mouse happy. I am hoping that we can get you all back on your scooters. [applause] we took we looked at the pancreas specific islet. If you can see, there is a brown. Dot, the only leftovers beta cells. After we gave it this treatment look how the insulin became full of insulin which is what we want to do. You would not need to test insulin anymore and we have funding and research to continue. So that is the science part of it. You can remove. What i. What i want to say here is i have been doing research for 20 years and type one diabetes advocate progress. Now that wenow that we are getting closer to make the difference i find myself in trouble funding wise. Ii have to spend 70 percent of my time writing grants and so far this year i have not been successful. I would rather spend my time doing a Research Rather than writing grants and getting nothing. My advice or opinion, chairman collins, you made the statement saying we keep pushing the accelerator. Well, chairman, senators, keep pushing that accelerator. You willyou will not get a police ticket. You will get a cure for type one diabetes. Thank you very much. [applause] thank you all for your excellent testimony. Isabel, you talked about that you have worn a continuous glucose monitor since you are very young, i think age three. Does it send a signal to your parents on their phone or so other way if your blood sugar is getting too low . So it does not matter if my blood sugar is high or low or no matter what my blood sugar is saying, i have a little iphone in my bag, and by cgm reads there and then my iphone sends it all to my parents. T10 can you describe the difference for you between having a cgm and not having one . It makes a big difference in general but especially with competing. I need to know what my blood sugars are every single moment because it can go in like 10 minutes without me realizing. So usually i either one of my parents or my train will be able to see my blood sugars are the whole, im competing. I can make the adjustment before goes loved someone have muscle cramps and it makes a huge difference. Its been tough not having it recently. Hopefully it works out. Thank you. Dr. Rodgers, medicare officials at cms consult with you before they made the decision to not have coverage for cgm, for Medicare Beneficiaries . Chairman, im unaware of any cms officials contacting us on that. Theres an agreement with, the former commissioner of the fda made it really is agencies we should Work Together on this entire scheme. Very recently we held that diabetes interagency coordinating committee, and we presented information about Glucose Monitoring, particularly in older adults and the proposals that came out of that meeting were presented to a group of experts and the uniform agreed that this is really a high area for research priority. I think this is very important to move forward with. Thank you. I think its absolutely incredible that medicare officials did not consult with you, the foremost expert that we have at nih overseeing this research, nor did they consult with the fda, which approved the device before deciding that it was just a precautionary or safety device and, therefore, was considered nonmedical. Mr. Amato, it sounds like it certainly was medical for you and literally a lifesaver. Would you agree . Yes, senator mccaskill, senator collins, im sorry. I absolutely agree with that. And i saw those two terms, precautionary and medically necessary, over and over again. Its still not believed to be medical necessary, at least in a data that has been sent to me. Well keep our fingers crossed. As i mentioned in my opening statement, senator shaheen and i have a bill to mandate coverage and we will cant speak for my colleagues but im pretty sure well all be pushing very hard on that. And, finally, amelia, you said in your testimony that there were 10 things that you wished your parents had no when you are diagnosed. Im almost out of time but could you tell me the top thing that you wish your parents had known . I think that the top thing i wished they had known is that when i ago though i get upset or angry or something, but then every time i get angry or upset or something that automatically jump to the conclusion that i was little. Last night after while a guy kind of annoying. [laughter] thank you very much. Senator mccaskill. You need attention of you can just be angry. Having children i certainly understand that. Let me start with dr. Zaghouani. In your testimony you talk about the need to involve pharmaceutical companies in clinical type i Diabetes Research. Is there anyway at the federal level, anything we could do to encourage that kind of collaboration . I think you can. The pharmaceutical companies, when they do a clinical trial. When they succeed they make money, but i understand 10 years ago, i understand merck spent 400 million to genetic one drug. I dont know if thats true now. Theres a lot of risk. I think the government can help create an incentive for them. I think that will push us forward towards the cure. Dr. Rodgers, we know that research of dollars are scarce. Nih has been living under a dark cloud now for several years because of our cutting back on funding to in n. H. Age. Its my understanding that theres an effort to humiliate that somewha some issue. We stood up and get back to the type of increases that he think we need to be embracing. To stay in a composition in terms of medical research around the world. But does nih and niddkd, how do you decide what Research Study that you find . Are you giving priority to clinical studies that have a better chance of translational impact, both in terms of quality of life for people like the young people in front of me, and for the federal government saving money, fo for example, me all you have to do is turn on cable tv. Not for type one but for type two. Additional question that Glucose Monitoring is one of the drivers of our debt at this point. Because of the cost of monitoring and all of the ads for buying monitoring machines that is all being paid for by the federal government. The receiver important point. The prevalence, the burden of the disease, the number of people affected, the scientific opportunity we may have all factor into the types of trials that we conduct. For example, the special diabetes Statutory Fund has allowed us, for example, to work with our sister organization, the National Eye Institute to conduct the study of three commonly used drugs for the treatment of one of the major complications, diabetic eye disease. For example, this network of these particular treatments that he mentioned it during my testimony, one cost about 2000 per injection. One cost 1200 per injection, and one cost 70 per injection. All of the results were quite substantial in terms of the improvement but all three of these drugs have nearly the equivalent attacks. Obviously, because of the financial aspects of this this isnt a particular study quite likely that private sector Pharmaceutical Company would be likely to find but it is the kind of thing related to the question that you asked. So all in on the 70 bucks, right speak was like a caveat does for people to mild disease. One other example because of the special Diabetes Program we are able to now fund a trial called retention of penn state we will disease, renal loss using a fairly safe and quite effective drug thats not only frequently used drug for the treatment of gout because there is fairly indication this may prevent the progression of kidney damage. Will if we are able to show in this trial that its safe than a generic drug can effectively prevent the disease and type i diabetes it would likely save tremendous amounts that it may have application in the broader setting type two diabetes or the complications are quite similar. Thank you very much. Thank you, madam chair. Senator tillis. Thank you, madam chair. Thank you all for being here and for your testimony and for your advocacy on the hill. I had an opportunity today to meet with some north carolinians. I dont know, i see rachel confront and trinity down there ken turner. I know the others are in the room. I think a map of all north carolinians we appreciate you all wearing our teal blue today. [laughter] but i want, mr. Amato, you mentioned something that as i was speaking with my guess in my office, we look at the need to provide coverage for cgm i think we have to take a look at benefits in economic terms think far outweigh the cost. Because when you look at your situation, the stella, mother of stella, young girl, for your old was among us today we take issues relating a story about an accident that occurred and her car was damaged as a result of someone who is obviously in circumstances similar to what she described. As we go forward and build support for coverage for cgm we really need to articulate about the hidden cost that probably are not being taken into account. That in my mind far outweigh the cost of providing the device. Not the least the greatest benefit obviously is a rachels mother dutifully tracked her while shes going on the ball and kate, similar to you. But also because i think it makes great fiscal sense. I look forward to moving forward and supporting efforts to do that. Kate, i also want to pick on you for there. I hear, you were down in north carolina. Something in the air down there. You ought to consider coming back. Can you tell me again about some of your experiences where in realtime the device has had an impact on you personal . When i first got it a couple years ago, i noticed a huge difference. It would help me control my blood sugars. Not only that, especially when competing it really, really, really helped me to cgm. It tells me when its going high or low, and i can keep it with me all the time. Instead of having to check my blood sugar every half hour i can look at the end of where its heading and grab something to eat real quick or get insulin. I dont get any muscle cramps and helps me immediately. Its a very, very helpful. Thank you. Dr. Rodgers, i know with the younger generation, isabelle was very matteroffactly talk about integration with the iphone, the ability to broadcast her levels realtime to her parents. But what sorts of challenges do we have with seniors also taking advantage of this . What kind of adoption rates do we see among seniors versus the more youthful population where we have present today . The adoption of these new technologies, certainly that seniors are embracing, perhaps not at the level that we see it in younger generations. I would say with a cgm in particular there is a fair amount of data to recognize that hypoglycemia, very low blood sugar levels, among people 65 or older with type i diabetes is a previously substantial unrecognized problem in terms of how often it occurs. It seems to be a major contributor to emergency room visits, for example. When you mentioned the hidden cost when comparing costs, imagine what the cost is having to return to emergency room repeatedly versus the cost of that type of care. Having said that though, this is one of these areas again for the special Diabetes Program we recognize that we have to bring new talent into this field. Medal in making these technologies more miniaturized and easier to use, but we also been bringing in people with knowledge of behavioral science because its one thing to have the technology to get the people to use it may provide its own challenges. And take it is being used more effectively, for example, taken with older individuals who may be suffering with the visual problems, with hearing loss, et cetera. These are issues were working on. My time is that the one thing, madam chair, id like to spend time on or if the information is available, get access to it but everything to build our case are providing coverage for cgm, that a look at the fully burdened cost of not doing it is quickly important. When you think about seniors care, particularly, my mother is 82, she lives alone. She doesnt have diabetes but i do know of many seniors that are living independently and the likelihood they can continue to live independently it happened have diabetes could be not only a marketing they themselves could see but a Family Member that may not be resident but be in a position to provide care. When you take a look at possibly the level of additional cost by not being able to live independently or the mideast agreement of the complications that could result by not having active monitoring, i think you can really see the basis for building a compelling case for coverage. Thank you. Thank you. Senator donnelly. [applause] thank you, madam chair. And thank you to all of you for being here. Id like to mention my hoosiers who are here with me from indiana. Question, aidan, to kate, you will find on your way back from iowa to maine that you try to india along the way. [laughter] i had a homecooked meal ready for you when you come back to indiana. Charlie kimball who came in third in the india 500, lost by maybe a car length. Charlie kimball as a type one diabetic who drove that race car for 500 miles, 100 degrees weather and did an extraordinary job. One of the thing madam chair on to let you know, a young man from my hometown, he is that type one since he was very young. At about two years ago i told him, i said we will cure type i diabetes. Is a huge cubs fan and i said we will cure type i diabetes before the cubs win the world series last night his father said he had to do a lot better than that for us. So to all of you, dr. Rodgers and dr. Zaghouani, i will call you dr. Z is thats okay. And we put those cells back into the body to make it work . [inaudible] sorry. No. There is no transportation of cells. They have their own seeds. They rejuvenate again. So you bring the islet cells that are already in your body . Guess. How do we keep those cells are being attacked by the immune system . So you have juvenile cases and one of them develop disease, and the other one doesnt. The reason, apply for one, not the other. In order for this disease to happen you have the own environmental factors to be there. Is like an ocean of thousands of events that happened in have to come together for the hurricane to agree. Same thing with the islet. So once you fix them in the same person, unless you have those all even, all factors happen again, you dont need to do anything for the immune system. Is something this is my opinion. How would you give it rejuvenated again . There are seeds. So once you fix the blood vessels, i think you eliminate the immune system that attack. The seats are the stem cells are the ones that we give. The ones we give our [inaudible] those will grow and mature. And if we do that, that would enable all of these youngsters to go to type none . Thats what i hope. How long do you think until it will be on mark . Youth speakers are not looking for a guarantee, just a neighborhood spill my answer is the more money you put, the faster it goes. [laughter] [cheers and applause] so than how much will it cost to get it done next week . [laughter] we are incredibly grateful for the effort and we will make sure that the funding is there for you to keep this moving along. Dr. Rodgers, i want to note that behind your whole bunch of your team from the nih and i would like them to stand up. Theyve done such an extraordinary job doing the research over the years. [applause] dr. Rodgers, what sorry. Dr. Rodgers, which the most pressing thing you need from congress right now . Obviously funds. What kinds of funds do you need to get this to the place where we dont have another Child Congress or the Child Congress two years ago is a celebration of having found a cure . Well, i think dr. Z mentioned certainly we have a lot of very good investigators with a lot of very good ideas, and that unfortunately at the present level of funding, we are only able to entertain and success of a maybe one in five of perhaps one in six of those. We think theres certainly around for other outstanding ideas because obviously in this particular case we want to be thinking about a multipronged approach. We want to be able to develop new sources of cells to implant. We want at the same time, because we know so much about the genetics and or susceptible of developing this, we want to continue to determine what that environmental factors is that increase the incidents by 21 in a short period of time. We know the genes havent changed, it must be something in the environment. If we can find what it is, if its an infectious agent we can develop a vaccine. That could do to protect against developing the disease or can actually cause the disease but if its something in the diet, dietary modification could be an effect. For people who have existing disease we want, in early stages of our immunity we want to selectively tried to turn and reverse that, that autoimmune disease. And use fairly selective manner in which heard from doctor z. Not completely wiping out the immune system because its there for a reason to selectively point at the cells that are attacking those cells that this is what we are learning especially with the addition of the special Diabetes Program. For people that have existing disease for longer periods of time with wanting to live and work comfortable life so different prevent them from developing the complications. Mr. Demarco, youre an inspiration to all of us. And two young kids, we hope to beat this thing. So when your mr. Amatos age, this is just a memory from long, long ago. Thank you, madam chair. [applause] thank you. Its a great pleasure to call upon senator shaheen, the cochair of the diabetes caucus. Thank you very much, chair collins, both for your leadership as chair of the diabetes caucus and for the work that you are doing on committee. And thank you for letting me squad after this evening. Because im not normally a member of this committee, i very much appreciate being able to get it and i want to thank all of you delegates who are part of the childrens congress, because youre absolutely the best advocate for helping all of us to want to see a cure for diabetes and want to see the best new treatments available. I want to recognize that archibald and her family from exeter New Hampshire with you as part of the congress and also senator collins was kind enough to recognize my daughter and granddaughter stephanie and ellie who been very much part of the childrens congress in the past doing it today with the Diabetes Service dog, coach. Into all of you to testify, and they very much for your work and for your willingness to share your stories today. You know, mr. Amato, i cant agree more with what senator collins and senator tillis said about the importance, not just of making sure that medicare funds