Reauthorizing the special Diabetes Program before it expires on september 30th and supporting more research. This is about an hour, 45 minutes. The hearing will come to order. Good morning, everybody. Its wonderful to welcome all of you here to washington, d. C. This is our 11th childrens congress. Its always a privilege to work with jdrf families whose commitment to promoting lifechanging research to prevent, treat and ultimately cure type 1 diabetes inspires me. I want to welcome not only our Ranking Member senator casey and senator scott from florida, but also we have a special guest, that is the cochair with me of the Senate Diabetes Caucus, senator Jeanne Shaheen of new hampshire. Thank you for joining us here today as well. Let me shorten my opening comments this morning because we do have votes beginning at 11 00. And i want to make sure that we have time to hear from all of our witnesses. As i said, i want to begin by welcoming the more than 160 children who have traveled to washington from all across the country to share your personal stories. Youll tell us what it is like to live with type 1 diabetes, just how serious it is, and why it is critical for congress to fund the research necessary to discover better treatments, more te Effective Technology and ultimately a cure. Your personal stories really matter. They motivate senators and members of the house to get involved in the cause. In my case, one of my very first meetings as a brandnew senator was with maine families with children with diabetes. And ill never forget this 10yearold little boy looking up at me and he told me that he wished he could take just one day off from having diabetes. His birthday or christmas. But, of course, he could not. And that really touched me and it led me to start the Bipartisan Senate diabetes caucus. So, i want to give a special welcome to two delegates from maine, Ruby Anderson from yarmouth, whos going to be testifying, and lydia bryant from ellsworth. Im very proud that youre here representing our great state. Since the last convening of the childrens congress two years ago, we have made remarkable strides with new technological discoveries that are already changing the lives of people with type 1 diabetes. We celebrated the fda approval of an artificial pancreas system for children ages 14 and older. Now the artificial pancreas is also available for kids who are age 7 to 13, opening the door for better daytoday management of diabetes. Todays Research Represents tomorrows cure. Just last month a new study, the first of its kind, illustrated the potential of an immunotherapy drug to keep the onset up to two years. What a significant breakthrough. These advances have only been possible due to our bipart commitment to funding Diabetes Research. Since i founded the Bipartisan Senate diabetes caucus, federal funding for Diabetes Research has tripled. And these results are yielding these Research Dollars are yielding results. We now spend more than 1 billion on Diabetes Research. The special diabetes frahm program in particular has contributed to phenomenal discoveries, especially advancements in technology. This Program Provides an additional 150 million each year for td1 research and another aim of this program is equally important, the special Diabetes Program also steadies diabetes in American Indians and alaskan natives who experience type 2 diabetes at nearly three times the rate of the national average. The special Diabetes Program is important both for people who have type 1 and also for native americans and alaskan natives. Over the past 22 years, the special Diabetes Program has contributed 2. 8 billion to improve the lives of People Living with diabetes. So, by the end of september, we must pass legislation to reauthorize the senate Diabetes Program. And thats what you need to tell all the members of congress. It has strong bipartisan support, 68 senators signed a letter to Senate Leadership that senator Jeanne Shaheen and i authored advocating for this program. Im pleased to report to you that just last week, the Senate Health committee on which i serve, approved a fiveyear authorization of the special Diabetes Program. Thats the longest authorization ever. So thats really good news. Finally, let me just say that i am very concerned about the spiraling cost of insulin. The cost of managing diabetes is growing at an alarming rate. Between 2012 and 2016, average insulin spending for patients with type 1 diabetes nearly doubled. And last year a father from maine testified that he turneded to drug importation from canada after the price of a 90day supply of insulin for his son with type 1 tripled to 900. So, i am going to put the rest of my statement in the record so that we can expedite the hearing. But let me just end by telling you two things. First, until last fall, i had no personal connection at all with type 1 diabetes. So i feel like im now officially part of the jdrf family. And second, it is truly inspiring to look out and see this wave of carolina blue. I did this best i could to come close to matching it. But your passion and hope for a cure are contagious. And together, i am confident that well continue the progress and achieve that goal. Thank you. Senator casey. Thaupg for holding this hearing. Were grateful to be back b with so many of the delegates of the childrens congress. I want to welcome you back to the senate. I know many of you have been here over many years now. Im pleased to welcome four delegates from pennsylvania. Adriana, joey, libby and maraid and their families. Its so important you joined us because finding a cure for type i. Diabetes requires a combined effort from all people. Our understanding has come a long way. As chairman collins mentioned, in just the past decade, more people have gained access to continuous glucose monitors and the artificial pancreas. In large part, thats due to you in this room. Young and a little bit older than young. Were grateful that youre here again to bring a sense of urgency to this issue. Froms many of the advocates who have traveled to washington before to press for funding for this program are doing so again today and were grateful. Were pleased to report as senator collins said, the extension of funding is already in the works around i was proud as a member of the Health Education labor and pensions committee, health committee, to support the fiveyear extension of the reauthorization of the program. This sets up the b possibility for the longest extension ever. We need to make sure the full Senate Passes it as senator collins said by the end of september and also that the house does the same. By securing Stable Funding for medical research, that is just one part of the agenda. We must also be sure that each individual and family can afford life saving treatment. During a hearing last year, this committee took a magnifying glass to the rising cost of insulin. In just recent, the committee concluded a threepart hearing series on the cost of prescription drugs. It will not surprise anybody in this room that the cost of insulin featured prominently during those hearings as well. Let me summarize why theres such an urgency to address the price of prescription drugs as it applies the todays hearings. Number one, the rising cost of prescription drugs is not occurring in isolation. Its part of a larger challenge that Many Americans face every day trying to make ends meet. Flat wages and high costs might be the fastest way to say it. For so many families, the cost of prescription drugs is like a bag of rocks thrown on their shoulders every day. In addition to the other bags orocks youre carrying around. High health care costs. College tuition. Child care costs and the like. So we have lots of work to do to make sure that were focused on and get results on lowering the cost of prescription drugs. We know that lessly insul lcostn is oh, maybe 100 years overdue. As well hear today the price an individual or family must pay for a vile of insulin is also impacted by Health Insurance coverage. Thats why the Affordable Care act and medicaid are critically important to shield families from very high and onerous out of pocket costs for insulin. In pennsylvania because of medicaid, insulin for most children is fully covered. That should be the case in every single state. And so today, im introducing the Affordable Health care for children with disabilities act which will encourage states to adopt policies that pennsylvania put in place over 20 years ago. Weve got a sacred responsibility to children and to young adults and to their parents who are here today as well as those across the country to do everything in our power to make sure that were doing everything we can to make life better. So thank you to chairman collins and all of our delegates. And parents and friends and advocates. Were so grateful youre with us today. Thank you. Thank you very much. Our first witness today is a familiar face to our committee, dr. Griffin rogers. Dr. Rogers assumed his position in 2007 and he has testified before us i believe six times at six different Children Congress hearings. Its always a great pleasure to hear from him and to get an update on the research thats being done. Next, we are pleased to welcome dr. Aaron kowalski. The new president and ceo and he is the first person with type i diabetes to lead this organization. He has a Strong Research background having serve d as th organizations chief mission officer. Our next witness you may recognize from broadway or his numerous roles on television and in major Motion Pictures such as the titanic or argo. It is the Award Winning actor, Victor Garber and we are so pleased to have him with us today. He has received i hope i have these statistics right. Five emmy nominations. Four tony award nominations and one Screen Actors Guild award and theres another thing that maybe i got those statistics wrong, but hes received a lot. Lets put it that way. And because he is such an extraordinary actor. And he also which is most pertinent to this hearing, type i diabetes, which he has managed for almost 60 years. Then we will hear from my constituent, Ruby Anderson, joining us today from maine. Now, i met ruby several times and it was really fun looking at the pictures of her when she was even much younger than the 9 years old that she is now and she is a great advocate for better treatments and working toward a cure or means of prevention. So i am delighted to welcome you, ruby, here today. Its great to have you. I will now turn it over to the Ranking Member to introduce our final witness from his state. Pleased to introduce Adriana Richard. She is 16 years old. A resident of milton, pennsylvania. Shes joined here by her mom, christie. She traveled pretty far to get here. North um berland county is not an easy ride. She has lived with type i diabetes since she was 5 years old and has not let the disease slow her down. Along with excelling at school work, she educates her peers and through instagram and created an Online Support group. She serves as a member of the jdrf teen task force where she mentorsd children. Shes even published a book entitled the real t 1 d. Thanks for being here and being a dedicated advocate for and bringing your testimony and example here today in helping us create a sense of urgency to get the job b done here in the senate. Thank you. Thank you. Dr. Rogers, its a pleasure to have you pack. Thank you. Chairman collins, senator casey, members of the committee, thanks for this invitation to testify and for your strong support of type i Diabetes Research at the nih ip colluding the special Diabetes Program or sdp. The sdp has enabled us to take on values and to conduct critical trials that were unlikely to have been done without our, with our regular appropriation or by the private sector. Im pleased to be testifying along with dr. Kowalski and id like to recognize Ruby Anderson, Adriana Richard and victor g garber. All of you here today and the people you represent across the country are the true heroes in advancing Diabetes Research. Nih studies would not be b possible without your p participation, passion and commitment. In two years since i last testified, major scientific advances have come from a longterm, sustained investment in the sdp. Just last month, type i diabetes trial net reported truly exciting results. For the first time ever, early preventive treatment was shown to delay clinical type i diabetes. Now in a study, people at high risk for the disease were treated with a trug targeting the immune system had a striking twoyear delay in the progression to clinical type i diabetes. Thats two years they didnt have to take insulin. Two years they didnt have to check their blood glucose. Two more years of good health towards preventing or delaying complications. Its important to note that this trial, which relied on screening thousands of people to identify those eligible to enroll, would not, i really should say could not, have been conducted outside of trial net. Looking ahead, theres a cue of other promising agents to prevent type i diabetes progression and we plan to test those with trial net. Theres also good news for people who are working every day to manage their type i diabetes. Since i last testified, several continuous glucoseapproved, inc first that doesnt require a finger stick operation, the first fully operable and the first fully implantable. Each received sdp support during their development. These approvals come on the heels of the 2016 fda approval of the first hybrid art first time pancreas. The Early Development in fact, much of the verge towards the development of artificial technologies have been spurred by sdp support and going forward, our goal is to develop multiple artificial pancreas technologies so that all people with type i diabetes can choose whats best for them. Importantly, sdp fills a critical gap by studying populations under studied by industry, suas Young Children a older adults. In addition, sdp supports niddk fund eed research of the pancre system customized to the need of pregnant women. We want to make sure people benefit from new technologies, so our research is also focusing on incorporating these devices in Clinical Care and looking for new ways to enhance their usability, but as everyone here knows, managing technology is not a cure. Were also supporting research towards a cure including understanding the auto immune attack in type i diabetes and since i last testified, theres been progress in our ability to study single cells in the pancreas. This is giving us never before seen insight to type i diabetes and how it progresses and we can now visual liz at the same time, study the individual beta cells and other cells and ill immune cells involved in this auto immune attack. Complimenting this effort is Exciting Research to develop eyelids on a chip, like the one you see before me here. These, which is this is empty, but this chip can contain beta cells and other components needed to function in the body and this tiny but mighty chip developed with dp support can allow us to test new therapies very quickly and efficiently and determine which are likely to be beneficial in Clinical Trials and were exciteded about applying other cutting Edge Technologies in other type i diabetes. For example, Artificial Intelligence and Machine Learning approaches hold great promise for Clinical Applications such as diagnosing diabetic eye disease. Research to combat these and other complications is critical to improving Peoples Health and their quality of life. As i hope my testimony is highlighted, our efforts were strengthened by the last sdp renewal, which allows scientists to pursue their longterm Research Projects without interruption. With the incredible progress already achieved through the sdp and promise for future research, were really extremely hopeful that we can reach our goal of preventing and curing this disease. Id be ploeased to answer any questions you may have. Thank you. Thank you very much for such encouraging testimony. The trials that are underway are so exciting. Our next witness is mr. Dr. Kowalski. Members of the committee, thank you all for welcome us here today. The childrens Congress Delegates sit iting here before you, these amazing kids, all have type i diabetes or t 1 d, an auto immune disease that destroys the cells that make insulin in their pancreases. I, too, live with this as does my brother, steven. These children and their parents work very hard to manage this. Its very difficult, but today, we can live healthier lives than ever before because of Research Funded by the special Diabetes Program. As a scientist by training and now as the president and ceo of jrf, i can tell you that your leadership and the strong bipartisan support for sdb has led to Numerous Research breakthroughs. Transforming lives and bringing us closer to our ultimate goal. Cures for type i diabetes. Just last month, as dr. Rodgers pointed out, a Clinical Trial showed that new artificial pancreas system supported by the sdb has helpeded people map tan more consistent and healthier blood glucose levels. Also, they approved the first pump that works interoperably. This will allow them to select component devices without having to put together a do it yourself system. This choice is is critical as with diabetes achieve Better Outcomes when they can choose the tools that are right for them. This progress builds on the success of the first artificial pancreas system which came to the market in 2017. Thanks the your leadership, senator collins, which has had a major positive impact for our community. Of course to stay healthy, we need access to these advances. And we need access to affordable insulin. Its unacceptable for anyone to ration insulin due to cost. S we need the government and the private sector to act now. I want to thank senators collins, senator casey, senator shaheen and so many others for your commitment to this issue. Its so incredibly important. As dr. Rodgers noted, last month, e had exciting news. A Clinical Trial funded published results in the new england journal of medicine that found a drug can can delay the onset of diabetes in two years in children and adults. This is so important. The delay in onset is likely to have longterm benefits that will have a tremendous impact on our community and the Overall Health care system. This progress is thanks to leadership and foresight to invest in multiyear funding in sdp research. While theres great progress, were here because theres still important work to be done. The sdp must continue to invest in immune other pi. We need to understand how to eliminate these attacks. We need to understand better what triggers type i diabetes. An environmental determinant study has screened more than 425,000 to understand what fa h factors trigger the onset of type i diabetes. This sdp funded study is more than halfway through and its crucial that it be finished. I cant overstate how important this trial is is. At the same time, we need to reduce the burden from kidney and heart disease. Senators, let me tell you that this research is too important to have an expiration date. In 2017, when the sdp renewal was delayed, there were real implications. Within trial net, enrollment was postponed in a promising prevention trial. But the time the funding was in place, some of the people who would have been eligible had since developed full onset type i diabetes and were no longer eligible to participate in the trial. We cant allow this to happen again. Were so grateful for the outstanding leadership of the Senate Diabetes Caucus cochair who champion ed a letter in support of the sdp and has been signed by 68 narts. The special Diabetes Program is making real difference in every life here impacted by type i diabetes. We need congress to reenact a fiveyear renewal of the program and keep researchers working without interruption so that when these children are my age, they can say they used to have type i diabetes. Thank you. Thank you very much for your testimony. Mr. Garber, welcome and thank you so much for being here today. Chairman collins, oh, thats better. Chairman collins, Ranking Member casey and members of the committee, thank you for inviting me to testify today. Its an honor to be here with the jdrf 2019 childrens congress. I was diagnosed with type i diabetes when i was 11 years old. Nearly 60 years ago. But i remember vividly that my diagnosis was a traumatic event for my family. And especially for my mother. I have a disticket memory of her standing on the porch as hi father drove me to the doctor. The fear and desperation in her eyes remains an indelible image in my mind. When ever i meet the mother of someone with type i, i am brought back to that moment, to that confusion, panic, uncertainty, which is why im so determined to do everything i can to help find a cure for this disease. I am here today with these amazing delegates to implore you to keep supporting advances in type i research, by supporting a longterm renewal of the special Diabetes Program. Its been said before and it will be said again. After my diagnosis, i was kept in a hospital where i learned to inject oranges with insulin sirnlgs until i was brave enough to try it myself. My new and confusing diet consisted of weighing food on a small scale and deciphering carbohydrate carbohydrate ratios. I have no idea what this is which is why im still guessing today. In those days, we had to boil them and test blood sugar levels with urine in a test tube. Weve come a long way, but not far enough. As i adjusted to my new reality, i was determined that i would not be deterred from living the life i envisioned. When i was 1, i left home to pursue by showbiz dream. I was a folk sing er, dishwashe, played tiny parts on tv shows and movies. Hard enough for any teenager. But balancing blood sugars with inexplicable highs, food choices, getting proper rest was daunting. I can only say that my determination and will kept me from just giving up. Thanks in large part to the special Diabetes Program, living with type i diabetes today is vastly different than when i was a teenager. My access to amaze iing diabete Technology Like a continuous glucose monitor that can be used with different insulin pumps gives me constant information to help avoid blood sugar highs and lows and im so fortunate to be able to afford insurance that allows me to choose the best insulin pump and glucose monitor for my specific lifestyle. This should be everyones right. My anxiety level has i havent got much time. My anxiety level has decreased somewhat since those days. Living an erratic life in movies, television and theatre has become more manageable thanks to funding through the special Diabetes Program which made all these things possible. However, it is imperative that congress provides a longterm renewal of the program which will ensure the Critical Research can continue unimpeded and enable more life changing breakthroughs for the children you see here today. Finally, i would be remiss if i did not tell you how concerned i am about the skyrocketing cost of insulin. The idea that someone has to ration insulin in 2019 due to greed and avarice is unconscionable. No mother in the u. S. Should lose her son due to insulin rationing and no father should have to rely on buying insulin from canada to keep his child alive. I am lucky. Extremely lucky to have good Health Insurance, but i am paying more than i should be for the life saving drug that i would die without. Senators, this is simply unacceptable. Dealing with type i diabetes is already hard enough. Chairman collins, Ranking Member casey, senator shaheen and others of this committee, i want to thank you for addressing the insulin pricing issue. Head on. And beg you to keep up the fight to bring down these costs. As you do, please keep your commitment to the research our community desperately needed to find a cure for type i diabetes. A cure. We need you to keep the momentum going by reknewing the special Diabetes Program before it expires at the end of september and put it on b Stable Funding for years to come. If you do that, you will make it easier for all these delegates to live their dreams and enable them to thrive without the fear of type i diabetes holding them back. Thank you, chairman collins. Rank iing member casey. And members of the committee for your support and your time today. Thank you so much for your testimony. Ruby, youre up. Chairman collins, Ranking Member casey, senator, thank you for inviting me to talk to you today. My name is Ruby Anderson. I am 9 years old and just finished third grade in yarmouth elementary school. Yarmou yarmouth, maine. I was diagnosed with type i diabetes just before my 2nd birthday. I dont remember not having type i diabetes. But i am lucky because i have devices that can help me manage my type i diabetes. Ive been using a pod insulin pump since i was about 3 years old. It has no tubes b, which i like, and i dont have to take shots, but sometimes it hurts when i have to change my pod every three days. Ive been also been using a dexcon g 6 continuous monitor for over a year. I love it. Things have gotten a lot easier. Now i can just check my numbers on my phone. My mom even lets me ride my bike to school. Now because she can see my numbers on her phone where ever she is. Before the g6, i was checking my blood sugar up to ten times a day. Now i still have to brick my finger, but sometimes not for weeks. But as great as my pump and g6 are, type i diabetes is still really hard to manage. I have to count carbohydrates in everything i eat, make sure im giving myself enough insulin to keep my blood sugar from going too high. If i give myself too much, i go low. Even if i do my very best, my numbers, can be b way off and i dont feel good. My g6 and pod sometimes alarm in class, am home doing homework, playing lacrosse and swimming at the beach. It even went off once on an airplane. That was awkward. When it goes off, i have to stop and check my numbers. Ill have to eat or drink when im low or take more insulin if im high. My parent, brother and sister and friends and teachers all help me if my numbers are too high or low. I wish my diabetes would just d disappear and senators b, i dont want my brothers and sisters to get type i diabetes. We need more verge and better devices. We need to figure out what causes it so we can stop it and all the kids here at childrens congress, we need you to continue to support us. When i grow up, i want to be a scientist. Partly because type i Diabetes Research is so important and if they havent found a cure by then, i will. When we have a cure, im going to have a party and invite everybody in the whole entire world. Senator collins, you will be first on my list. Thank you. Thank you for listening and for all you do for kids like me. Thank you so much. Dr. Rodgers, sign her up right now. And im coming to that party. Adriana, welcome, were delighted to have you here. Chairman collins, Ranking Member casey, senator, thank you for asking me to speak here today. I am 16 years old and from a small town in central pennsylvania called milton. Im a proud member of the team task force. Last year, we raised over 10,000 with our walking teamment i wrote a a book, the real tdn and started an Instagram Account to share my story because im one of many living with diabetes every day. Im not the only one living through this. I go to diabetes camp every summ summer. Its my favorite time of the year because im not judged and i can be myself. Im here to share my voice because ive been motivated by what ive experience. I was diagnosed when i was 5. I remember my parents were scared for me m i am the oldest of four kids and the only one with diabetes. In elementary school, i was sometimes teased for being different or for always being with the nurse. School was already stressful and having diabetes only makes it more difficult. Ive gone through some hard times. A few years ago i was having bad lows which means my blood sugar was getting dangerously low, but i didnt know it. I felt fine. I also had bad highs. One especially bad time, i had dka and was hospitalized. I felt really sick and was in a lot of pain. Its very serious as it can lead to a coma or worse. I was constantly battling diabetes and manage my life with no braegs. I was physically and emotionally exhausted and suffering from burnout. Thankfully, i have been able to manage it better over the last year. Since i got my dexcom, it catches my highs and lows before they get bad and i can check on my phone. It also alerts my parents which is a huge leaf because i miss it on the phone when im asleep. Before, i had to check my levels before going to bed and hope i didnt go too low during night. Now i feel much better in the morning. My life is easier with this technology, which is thanks in part from the special Diabetes Program. I want emp here to ask you to support this. It needs to be renewed. So close to finding cures and if you stop research now, theres no way well find it. Until then, we need sdp for research. To help scientists and engineers to invent things that have change my life. After childrens congress, i will be b take iing my drivers test to get my license. Im excited and my parents are, too. Know iing my cgm will help me manage my blood sugar levels. Senators, people with type i diabetes can do anything we set our minds to. We just have extra responsibilities. The Research Funded by the sdp helps people like me, all of us here today and all those responsibilities ultimately give us a cure and im grateful as a resident of pennsylvania, the price is zero dollars. Thank you senator casey for your interest in expand iing this program broadly so kids with diabetes in other states may also benefit. Thank you all for listening to my story and thank you for your support of people with type i diabetes. Thank you. Thank you very much, adriana. Ruby, you have such a joyful, positive attitude and you participate in everything. You dont let your diabetes stop you at all. Could you tell us what advice that you would give to another child whos just learned they have type i. I would say to be brave and not let diabetes get in your way. I think thats great advice. It really is. Dr. Rodgers, i was struck as you went through how the technology has changed and the many advances that have been made possible by this special Diabetes Program and in the more than 20 years that ive headed the caucus and worked as an advocate for type i diabetes, i have noticed a tremendous change in the technology. I think about how bulky and big the initial pumps were and where we are now with the artificial pancreas and the close loop with the continuous glucose monitor and it truly is amazing. But id like you to focus more on the prevention side. Im really exciteded about the trial net results you described. Could you tell us what most excites you when you look at prevention and cures . Turn that on. The special, the longterm support of this special Diabetes Program has really allows us to invest in the Critical Infrastructure necessary for trial net to do its and set up these prevention trials. Conducting prevention trials requires identifying and especially rolling people at risk for type i diabetes who have not yet developed clinical disease and so finding these people are crucial and it requires screening a lot of people. So far, weve screened over 200,000 people at risk including 15,000 annually now. And as dr. Kowalski said, if you can find them, theres a window of opportunity before they actually develop the clinical disease that you can use for testing them in crucial trials. If you miss that window, then they would have to go into a different trial. But as a result of that exciting work that was just reported last month, the next trial is obvious. You want to see whether these particular drugs might have a benefit if you give it a second time. But we have really a whole host of trdrugs that are in a cue th are just assi programsing as th one that with the infrastructure thats been created by the special diabetes and program and trial net, theyre ready to go. But of course, we wouldnt want to start a trial unless we have the funding to know that we can complete it. But thanks for your strong support. Thank you. Thats very encouraging. Mr. Garber, you have emerged as a voice in the Diabetes Community for those who have really been affected by the skyrocketin skyrocketing cost of insulin and we talked a little l bit about this this morning, but its ironic that you are from the very birthplace of the insulin in london, ontario. And insulin was first discovered in 1921 and has been used in various forms to treat diabetes for nearly a century and thats why im personally so outraged by the tripling of price. It just doesnt make sense to me. As a canadian now living in new york state, what is your reaction to the extraordinary lengths that some families are having to go to to get the insulin their children need . Part of, i wasnt really as conscious of it until like a year ago when i started hearing. I mean i knew it was difficult situation, but when i realized what the, i was on insurance. So i was always, i was paying you know, seemeded an okay amount of money. But the woman whose son was rationing insulin, thats what really sent me over the edge. I couldnt believe it and part of it was because i wasnt really Pay Attention and i thought this is unimaginable. This is unconscionable and so i just got, i just have been and everywhere i go now, people are just saying what is happening . And i dont really understand how pharmaceuticals, i dont understand, i think there are too many middlemen that are, that are benefitting and meanwhile, these children are dying. I dont, i dont get it. I just dont get it and yet you know in other states, theres no cost. For insulin, so what does that tell you . Its unconscionable and i want you to know that our committee devoted an entire hearing to the cost of insulin and we passed a bill senator casey and i are both on the Senate Health committee and we passed a bill that has several measures in it to deal with the risings of prescription drugs, but the insulin example is the worst because not as if a whole lot of rnd went into the initial investment. Right. Yeah, its you ed to you it wasr a penny in london, ontario, so no oney ied and that just has to come back. Thank you. Senator casey. Thank you, chairman collins. I want to start by commending the work of the delegates and in particular, commend and salute the testimony by ruby and adriana. Im trying to think at age of 9 or 16, if i could do what youve done today. And i am certain the answer is no. And i just am grateful that youre willing to do this, but also i want you to know not only in the work youre doing as advocates on this issue, but more broadly, you both have a very Bright Future and we may put you in charge of some other projects before you leave washington. I want to note for the record, as you know when we have a hearing like this, senators will be back and forth and in and out. So i hope when someones here and then leaves, you dont attribute that to lack of interest. Senator jones for example just indicated to me as he left, hes got to go to a classified hearing in the Armed Services committee. Hes hoping to be b back and b i think thats true of a number of senators, so were grateful that people can see that back and forth when theyre balancing hearings and different issues. I wanted to start though with adriana. Not only because shes from pennsylvania, but that sure helps to have the first question. But its pretty clear to all of us as is true of every one of your fellow delegates, that you have now allow ee ee eed not diabetes to control your life and have communicated over and over again by your example and testimony and otherwise that thats the case. You mentioned your testimony that you published a book on what its like to live with t 1 d and youve given that title. Youve also used instagram and other platforms and methods to make sure that youre helping to reduce the stigma. In fact, i just left the hallway that you and i were in, you were doing a Television Interview and you sounded really good on television. Youve used every possible resource, every possible opportunity to get the message out. Youve also taken on the roles as a mentor as part of the jdrf team tas a k force as i mentioned. So i guess wup of the questions i have is what questions do you get when youre interacting with young people or with adults . Are there common questions . Concerns . Or is there a message you want to reiterate today that comes from those questions . Yeah. So the question i probably get asked most, mostly all the time, is whats on my arm because of my ctm or whats on my hip because of my pump. I could be in the store just Walking Around and a little girl or little boy woul point at it and i just make it a point to go up and just talk to them and explain to them what it is and yeah, the other one would probably be that diabetes is from eating too much sugar. I get that all the time, which is not true at all. Diabetes is an auto immune disease. Its not caused by eating too much sugar or being overweight. Its important to repeat those messages. Especially in washington. Were grateful youre willing to do it. I wanted to turn to dr. Rodgers. Im sure that i share and i think i peek for a lot of people when i say thank you for your leadership and niddk. The work being done pi researchers across the country to find a cure is very promising. In your testimony, discuss that these researchers keep moving closer to that elusive cure. Some of the work thats happen at Research Institutions in pennsylvania and i know other places is inspiring and promising. Could you highlight some of that new and Promising Research . Ill ask you to start with pennsylvania and go beyond there if we have some time. Sure. Researchers at the university of pennsylvania for example are part of the sdp supported human eye let Research Network or hern for short. Including something called a human pancreas analysis program. Theyre developing some very novel techniques understand the single cells inside of the pancreas and how they change with perspective progression of the disease. As you understand this at a single cell level, you can begin to think about new targets or either delaying the progression or potential ll lcuring disease the people at university of pennsylvania are really doing an outstanding job. In pittsburgh, university of pittsburgh, actually serves as one of these trial net sites that i talk about in my testimony. They are lining up the patients, getting them in the cure for new preventative strategies and were really excited about the trial net and the participation of people in pittsburgh. Thank you very much. Senator brawn, welcome. Thank you, madame chair. This is important to me. Ive learned a lot about auto immune diseases oaf the years. Chrons, collitis. If we find the secret to what causes type i diabetes, i think were going to unravel a host of other diseases and find the cure. Thats why i think its so important you keep doing what youre doing and that we stay on point here. At my own business, i try to address health care and the cost of it. I referred to where we shouldnt be rationing medicines that are so important. We shouldnt be grappling with a cost of insurance thats overwhelming. Took on the Insurance Companies nearly 11 years ago myself and it was a wrestling match you wouldnt believe but there are ways to address it and what we want to do is keep the best of our Health Care System that gives Us Technology and breakthroughs but somehow drive the cost down. It would take a whole other time period, but you can do that through being engaged in your own well being, emphasizing wellness over reimmediamediatio finding transparency and getting Competition Among the providers so we can keep the best of what we got and not contend with some of the things that are the worst about our current system. The other thing would be current budget wroes here. We should never have to consider whether we have money to fund along with many other things that center around disease, z disaster. Some of things we should never be wored about, how do we pay for that. To me, its an important part of what the federal government should do. Were in the context of running trillion dollar deficits and one thing as a main street entrepreneur, i hope to weigh in on how we get this place in Better Health so we can always be there for good causes like this. The question i want to drill in on when it comes to the particular disease of type i diabetes, what ive learned is theres generally a genetic predisposition to almost all of these auto immune diseases in an environmental trigger that might be part of it. Can you explain to us and i like the fact that youre geing down to single cell analysis. It seeps like that might get us on the right trial. When it comes to type i diabetes, is it more of f a gentlemetic preedition position environmental trigger or the mysterious combination of both . Excellent question, senator. Type i diabetes is a disease thats largely genetic. Ain fact, type i diabetes we knw more about the genetics of type i diabetes. 90 of the attributable gentlemgenetic risk is already known. First degree relatives is about 15 fold increased risk of developing the disease and why we screen these, their relatives of people with type i diabetes in order to put them in these prevention trials once they develop it. Now youre right. Just because you have the genes and the genetic risk doesnt mean youre going to absolutely develop the disease. Theres something in the environment that triggers that risk and makes that risk a reality. And thats the reason that we have an ongoing study called teddy. In government, everything is an acronym. It stands for the environmental determinants of die weeabetes i youth. In this study, we had to screen about 425,000 individuals in order to get 6,000 individuals who were going to be following through birth to the age of 2015. Were collecting blood samples, urn samples, saliva. Stool samples. Were getting medical records on them. Were understanding about outbreaks. In their schools and other environments and from that, and all these samples that were collecting, were doing these studies calls onic technology and using big data to analyze what it is in the environment thats actually triggering that. If we knew, it would turn out its a virus, for example, its likely that we could make v vaccines to prevent people from developing the immune or if its something in the diet for example, one can suggest a dietary restrictions. So i would say the type i diabetes is the best example of this combination of genetic risk with environmental factors and we will understand that by 2025. What those, its b probably not just one factor. Probably multiple factors. Thank you. And ive got to go to an environment and Public Works Committee meeting where were talking about roads and bridges, but thank you for the attendance. Since ive been here six months, this is the best showing of any committee. Its important to keep up the passion so that we get the message and again, i think you lead in the auto immune category and if we find the trigger, the cure, thest going to you know benefit a lot of other ailments as well. Thank you so much. Thank you. Senator scinema. Thank you, chairman collins and Ranking Member casey for hosting this important hearing. I also want to give a shoutout to our childrens Congress Delegates, especially to grant and rachel from flag staff. Are they here . Hi. I saw rachel. The grant here . Oh my gosh. You can do that all day. Hi, grant. So grant age 5 was diagnosed a few days before his 2nd birthday. He was cently recognized for raising almost 50,000 for jdrf and would like to be a firefighter when he grows up, but hes already a hero to so many of us in arizona. Rachel, age 1, is m16 is managig multiple connick conditions, she likes to hike, lift weights and swim. I could take some swimming tips for you. Youre an inspiration to me. Theyre two young arizonaians in today representing 750,000 living with diabetes. I am grateful for their advocacy and look forward to working with them to make sure they get the health care they need. I would also like to thank our witnesses for their testimony and now jump into a few questions. My first question is for dr. Kow kowalski. In 2019, the Arizona HealthServices Published its first ever die bees action plan. It noted not all program covered selfing management education. Im proud to cosponsor legislation introduced by senator shaheen and chairman collins which would expand access to programs from medicare beneficiaries. As Innovative Technologies and new smart insulins become available, education will be b crucial to helping patients make informed choices about their care and learn about Financial Assistance programs if needed. So doctor, what barriers prevent patients from accessing diabetes Management Resources and what more can be done to make sure this education is available to all . Thank you, senator, an excellent question because diabetes is a unique disease in theat youre dosing a very dangerous drug every day on your own and only see the doctor every three to six months, so youre doing this and it does require significant education. There are barriers, costs can be a barrier. Weve heard about the cost of insulin, but its really Insurance Coverage for diabetes treatments across the board, whether its pumps or sensors or education and doctors visits is a barrier for many families. Then theres simply not enough diabetes educators and endocrineologists who specialize in type i diabetes out there in a state like anthorizona where s may have to drive long distances, take off from work. A significant burden on families. So every family in this room knows that education plays an incredibly Important Role when youre make iing a decision wit drug that if given too much can cause high poe glioseem area and be very dangerous. Thanks. Next question is for dr. Rodgers. Your testimony placed a high priority on research and the impact of new technologies in special populations such as children, older adults and pregnant women. I agree. And also believe that means increasing our investment in the special Diabetes Programs. Since the program was created in 1997, diabetes rates among native populations have dropped by 54 . And tribes have the resources to more effectively manage diabetes related complications such as kidney and heart disease. For example, the navajo nations special diabetes runs a Sports Center as a Community Resource to education members on diabetes management and offer free health assessments. Can you share with the committee any specific insights from recent research that would be of interest to our tribal partners and are there barriers to including others in verge an clinical studies. Thank you. As you mentioned, the special Diabetes Program and as chairman collins mentioned, has a, the Additional SpecialDiabetes Program in indians or sdpi and of course working in consultation with the Indian Health service and the tribal leadership consult, theyve coordinated the provision of care in many sites which actually explains the drop in some of the complications that weve seen, but none the less, native americans have the highest risk for type ii diabetes of other, any populations, actually. In the country. Prz weve been working closely with with the sdp program that we have in conjunction with our sister organization, the cdc, that do a study called search in which were looking at the onset of diabetes in individuals up until the age of 19 and were seeing a growth in type ii diabetes in native american population. Having this early information provides us to get them involved more in preventive trials and in treatment trials because i can tell you that type ii diabetes in children is extremely severe disease as well. Also indicated one other thing, a follow up to senator brawn comment that were seeing an increase in the incidents of type i diabetes across all groups over the last ten years. But particularly in certain underrepresented groups previously. Particularly nonhispanic whites, sorry, hispanic population. And in them, the genes are different, which means that its not the standard genes that i talked about in terms of genetic risk, which means theres something in the environment thats even triggering the auto immune disease at a greater frequency. Thats something we have to understand. How these sub populations are reacting to the environmental changes and hopefully with continuing support of the sdp, we can understand the disease as it affects different groups. Thank you. Senator scott, were delighted to have you here today. Thank you. To the panel, thank you all for being here this morning. To the kids, god bless you. Certainly encourage iing and exciting to see so many advocates participating in this country. I will say that your advocacy the is powerful. I am a advocate for yall because of a friend of mine who was diagnosed around 9 years old. A guy named billy siegel, who today is 53 years old, married, his son is looking at going to the medical university at South Carolina in part because of his fathers challenges with type i diabetes so your future is incredibly bright. One of the things i love about the hearing today is that we are witnessing around the country hopefully folks are watching powerful advocacy come to life. And there are three advocates from South Carolina who are here today that id like to highlight and one of the things ive learned by reading through so many of the bios is that yall are not just advocates for type i diabetes. Youre advocates for type ii diabetes. Also advocates in many different ways and the three different individuals that i will talk about are classic examples or whats possible. Hannah from lake wylie, South Carolina. Shes 17 years old. Is she here with us . There she is. How you doing . There she is. Hannah was diagnosed at 8 years old. She now enjoys participating in Cross Country and track and field, not only from an athle c athletics perspective but also a type i diabetes advocate perspective. Through participating in sports, she has been able to spread awareness about tid to her peers as well as prevention. We also have with us katie, she is 14 years old. She was diagnosed at 5. She lives in charleston, South Carolina, my hometown. Is she here . Thank you. God bless you. She is a talented musician. This is pretty impressive. Is this accurate, katie let me know if im embellishing at all, okay . Because politicians do that sometimes. Not me of course, but you are good at many instruments, including the piano, organ, cello, cello, yeah, shes pretty good. Guitar. And percussion. I will have you know that when i was in the third grade i played the cello, and they came and took it back. Im not sure what that says about me, but its nothing positive. She and her entire family advocate for type i diabetes funding with other jdrv advocates. William who is 14 from somerville, South Carolina. William, whats up . How are you doing man . Good. Go green waves. All right, all right. For those of you not from South Carolina, green waves is a wonderful high school to attend in South Carolina. William was diagnosed at 3 years old. William is an honor student, honor student . You make really good grades . William is an honor student. He is also a very good tennis player. Accurate . Awesome, awesome. These kids are so humble. We could use some of that in congress, thank you very much. When william isnt on the tennis court or in the classroom, you can find him enjoying the outdoors, particularly the water or on the golf course. William is also an active advocate for diabetes. Hes involved in a number of events, one of the things i am so excited about when i listen to the stories and i hear the and read about the involvement is if we can have more folks like you all helping us understand and appreciate the Significant Impact that funding can have on combatting the disease, i think we can make not steps forward but leaps forward. So let me use the balance of my time dr. Rodgers to ask you a question about the advancements thats happened oefver the last four or five years, and with the proper funding, what could their lives be like in 20 years . Well, the advances that have happened in the last four years have really been extraordinary following the first fda approval for an artificial pancreas, there are at least four that were currently studying, four Important International studies using various combinations of these technologies including one technology that not only develops or delivers insulin, but also glucanon in a manner analogous to what the pancreas does. For example, the ability to have interchangeable parts, interopera blt that dr. Kowalski mentioned. Using these technologies now, we really want to push the limit to put these in real life situations over extended periods of time over broader age groups is what were currently testing, and so hopefully the results of that result the results of those Research Efforts will be useful for kids here so that they will been able along with their Health Care Provider to pick the best instrument and Ap Technology that will be useful for them. Again, thats just technology. We really are sort of looking at cures. So other things that have happened in the last few years is actually thinking about a way to get the cells that make the insulin from an individual and get them back in terms of transplantation by using the persons own cells, encapsulating them in a device that would be impermeable to the immune attack that occurs as a way to correct them. And of course, in the prevention arena, youve heard about what weve mentioned, theres one treatment, there are several others just lined up that we think, you know, within the next several years might be more readily available. But ultimately, we want to find a cure, and that cure can be directed at whatever that trigger is that turns on the immune system in each individual. That wed like to learn in order to prevent that from happening. I think that thats a real possibility for the kids who are assembled before you today, and im very excited about that possibility. Thank you very much, mr. G garber. Thank you for your willingness to be an advocate, and we do miss you on the legends of tomorrow. Thank you very much. Thank you all for being here. I have to tell you, this is well, im going to say the best looking, the most enthusiastic, the most passionate, infectious in a good kind of a way group that weve had before us, and i know that whatever youall do, from what youve learned here through your advocacy, your passion, your commitment, your willingness to stand up, youre going to be great at whatever your future is. And ive got to give a shoutout to a couple nevadans. Where are you charlie bell, ashley bellows. Lets see you there. There you are down here, go nevada, and theyre great advocates for what theyre doing here for jdrf and for all the other things in their life and every parent here, any parent watching out there, be very, very proud of these young kids. And so what i want to say is that special Diabetes Program, of course combined with the hard work of jdrf has really paved the way for e Innovative Research on type i diabetes leading to progress towards a career. This progress is particularly meaningful to nevada because diabetes is an increasingly common condition that affects nevadan at higher rates than the national average. Excuse me, i have allergies today. Roughly 12 of adults living in nevada have one of the two types of diabetes. Excuse me. Last week i visited the renreno indian colony. We discussed the higher rates of diabetes among tribal members. The diabetes has a heavy impact on patients at this clinic. Its a stark reminder of why we must continue to invest in critical programs to ensure the patients have access to the best care possible. So to the doctors here today, i want to talk a little bit about the artificial pancreas, where thats at, how its going to help kids in the future. All right thank you for your question. The artificial pancreas, just to extend the previous comments, really, i think its going to have a great benefit. As it constantly monitors glucose from minute to minute and changes that occur with exercise and diet, it can appropriately adjust the insulin infusions, and there are multiple artificial pancreas technologies that are becoming available. Were supporting some of the pivotal trials in some of those, but were also with sdp support supporting advances for even the next generation of artificial pancreas, and i think that that will make the people who sit in front of you, make their lives much simpler. But we have to understand that there could be technology thats available, but if people dont use it or are unable to use it, then that can create barriers, and so at least from the standpoint of usability, were putting a tremendous amount of investment into studies to understand how to make these more usable ultimately for patients. Well, i want to tell you, i just came from a wonderful event called girls who code, and it is about the future of not just girls who code, but Innovation Technology and the next gen taking on careers in s. T. E. M. So artificial pancreas research, studies, analytics, everything you do, how can we be sure to help you continue to invest . I have the people pipeline to do the kinds of research that you need. How is the s. T. E. M. Education for these kids here going to help them and all of us . It absolutely will help. I have to say that i personally spent a fair amount of time going to high schools and to colleges talking about the importance of s. T. E. M. Education, and, for example, just take the artificial pancre pancreas. You would think that b obvious obviously you need a bioengineer to try and devise the microcircuitry and other things. It also takes computer engineers. It takes people with strong m h mathematic information and education. It also takes chemists and people skilled in bio skuy chem to devise smart insulin and smart gluk gone. People who are thinking about something that i mentioned, Artificial Intelligence and deep Machine Learning, its with these advances that people who participate in just their usual care we can learn from the groups almost instantaneously, and in information can actually be fed back to youve the loss of people using the current technologies. So we can take your passion, your imagination, your intelligence and if we put you into these careers where you can use them, you can create a future of possibly no more diabetes . Exactly. Yeah, thank you, i appreciate it. Thank you. Thank you very much, senator rosen. Dr. Kowalski, in your testimony you discussed not only the impact on families but also the great cost saving potential of the research that has resulted from the special diabetes progr program. Thats why i think this investment is one that really pays dividends both in improving the health care and health of all these young people, but also the impact on the federal government. For example, the adoption of the Artificial Pancreas Technology in adults could save medicare a billion dollars over 25 years. You mentioned that another sdp funded trial related to the slowing of the progression of early Kidney Disease in people with type i could save literally billions of dollars in the medicare program. What Additional Research and development has similar cost savings potential . Well, we thank you, senator collins, because this is such an important benefit of this funding is the economic benefit, of course, to the families its huge, but to our economy, reducing the high Blood Pressure of diabetes reduces the risk of diabetes complications, and we fear these combinations such as Kidney Disease as you point out, we can reduce significant burden to medicare due to end stage renal failure. I must say to senator rosens question about artificial pancreas systems, my brother and i have been on a hybrid closed loop for three years each, thank you again for your leadership. Its really transforming lives here. My brother used to have severe hypoglycemia challenges. Each hospital visit due to a severe episode on average is about 20,000, so these technologies, you have the longterm complications of diabetes, but the shortterm complications like severe hi hypoglycemia or as adriana pointed out, diabetic ketos a doe sis is very costly to the government, to employers, to Insurance Companies, so this is tangible real benefit on a personal level but also on an economic level. Thats a great example. It is also why im always puzzled if an Insurance Company denies coverage for a device that is going to help keep people healthy. That just doesnt make sense to me not only from a compassion standpoint or a health care standpoint but economically it doesnt make sense for the very statistics that you mentioned. Ruby, i want to go back to you. In a recent article that was in the Portland Press herald, your mom said we make diabetes related decisions probably every 15 to 30 minutes all day every day and through the night. It is relentless, but you dont let that get you down. Huhuh. You are a very active fourth grader. Im told you play a variety of sports. You enjoy art. You love playing with friends and exploring, and that is so encouraging to everyone so how have you been able to remain so active while also making sure that you take care of your health . I make sure that i bring, like, stuff for when i go low, and i always pack an extra like pump, and i just sometimes i just ignore diabetes. I think thats true of a lot of the children here. You just live a normal life and you get some help from your teachers and school nurse, too, dont you . Yes. Yeah, that must help out also. Adriana, i was struck you mentioned in your testimony that when you go home youre taking your drivers test. And first of all, i want to wish you the best of luck. I failed the first time, so if at first you dont succeed, try again. How has Diabetes Technology allowed you and your parents to feel comfortable with this upcoming change and responsibility . Definitely. So i have the dex com so my parents can watch my blood sugars wherever im at, and i know that its going to help me feel more safe and them help help them make me feel have them be like more okay with it. So if i was low, they can just give me a call, and my it can also hook up to like anything blue tooth, so as long as i like when im in my car, my like alerts will go through the car, so theyre really loud, which will definitely help. Thats great. I think thats a great example of the difference that technology can make, and as ive said, for someone thats worked on this issue for decades, the advances in technology are so exciting, and ive seen that with other maine families that ive worked with. Senator casey. Thanks very much. I want to do start by highlighting the legislation i mentioned earlier. For those of you who dont know about the pennsylvania example i cited, this bill that ooive introduced, will be introducing today, will be an expansion of medicaid where the federal government would initially pay 90 of the federal match. Some will say, oh, well, we shouldnt do that. Some will say we cant do that. Well have the usual arguments, but weve expanded medicaid once, and a lot of people got health care, and we should do it again for children who have disabilities, and in this case would help children with type i diabetes. The way it works in pennsylvania is children are benefitted by a special pathway. In this case, these are children who meet the supplemental security income, ssi disability criteria, so they meet the criteria in that program for al disability. However, their household income, the household they live in, exceeds the ssi limits that would make them eligible for medicaid. So that would we would change that. We would treat the child with a disability as a household, simple as that. Right now 70,000 children in pennsylvania benefit. I think this should be a national program, not just in pennsylvania or a few states. So were going to be continuing to work on that, and well talk more about it in addition to, of course, pushing the number one priority for today, which is the reauthorization of the senate program. But i wanted to end my questions with adriana where i started. Adriana, youve become a role model and ruby has as well, and i know there are other role models in this room today for so many people in your community and for young people especially, but i want to ask you who is the most Important Role model for you after your diagnosis . Right after i was diagnosed it was probably my nana because she has type ii. She was always there, she knew what was happening. How to calm me down, tell me everything would be okay. She was definitely probably my closest person after i was diagnosed. Were happy to hear that, and im sure you serve in that role for a lot of people today, so thank you. And i know in the interest of time ill cut my questions short and move forward. Thank you very much for all of the work that youve done senator casey. I also want to salute senator Jeanne Shaheen for all of her work. Shes unable to come back. She has a granddaughter with type i, and she and i have worked as a Bipartisan Team because diabetes does not discriminate. It does not care if youre a republican or a democrat or an independent or green or whatever, and thats why this should continue to be a bipartisan cause, and it always has been. Ive always had a democrat as my cochair of the diabetes caucus since i founded it back in 1997 and im pleased to have senator casey as a strong member of it as well. I want to thank each of our witnesses for being here today. It is thrilling to have Victor Garber here and to put to tell us what its like to grow older with type i diabetes, and his example is really encouraging to all of us. The work thats being done at nih and dr. Rodgers long standing commitment in working so closely with us on the special Diabetes Program has been wonderful. Dr. Kowalski, i think its wonderful that jdrf now has a president and ceo who understands firsthand the challenges of type i diabetes. Youve had excellent leaders in the past as well, but were delighted to work with you. And of course most of all, i want to thank all of the delegates who are here today but especially ruby and adriana who are so articulate and, youre right, senator casey, i cant imagine at their ages being able it to come before a Senate Committee and testify and help us better understand. I also want to do a shoutout to some families in maine who have really educated me on this issue. I believe that i first met ruby and her mom through the sweeney family, and i have watched their son aiden grow up from age 4 to now. Hes 17. He testified at age 4 before one of the childrens congress, and they are great advocates. The sere family who have a summer cottage very close to mine have three members of their family with type i diabetes, and now as i mentioned, my new niece nicole also is a tremendous advocate for people with type i. So i mention these families and theres so many more because i want all of the delegates who are here from across the nation to know what a difference your advocacy makes. You are the reason that we could get more than 60 members of the senate to sign the letter on the special Diabetes Program. You are the reason that we were successful in getting an extension in committee for five years. You are the reason that we have been able to invest billions of dollars in research that has made such a difference in your lives and will continue to make a difference in the lives of others, but we could not do it without you, and im inspired by that sea of blue that is out there. So when you go forth today and you visit your members of congress, tell them what its like to have diabetes but also give them a little nudge to help us on the research and on renewing the special Diabetes Program because believe me, its really hard for them to say no to you, and im sure that you will all make a huge difference. You touch me every time that you are here, and you help me redouble my own commitment to finding more effective treatments, a cause of diabetes so that we can prevent it, and the many causes most likely, and ultimately a cure. And that day we will have the big party that ruby has mentioned, but again, be encouraged because the difference between 1997 and 2019 is absolutely enormous, so we are making good progress. I want to thank all of you for being here today, and i want to also thank my staff which worked extremely hard on this hearing and also the people at jdrf who were wonderful in cooperating with us and bringing all these children from all over america to washington. So i know that this sea of blue is going to take over the halls of Congress Today and that will bring us closer to the dream that we all share, and that is an end to diabetes. Committee members will have until friday, july 19th to submit additional questions for the record. There may be a few, and well pass them on your way, but, again, i thank you, and i now yield to senator casey. Thank you, chairman collins for both convening this hearing and for your great advocacy on this issue for so many years. We want to thank our witnesses, both doctors, mr. Garber we want to thank you in particular for bringing your personal story and in particular the story about your mom and to refer back to the two words you used, the fear and desperation that you saw that day is something that we all need to be reminded of. And i think because of the advancements, because of the work that you and others have done, a lot of moms may not have that same fear and desperation. Were grateful for that inspiration. To ruby and adriana, youve got a Bright Future. And as i said before were going to put you in charge of some other projects while youre here. Weve got to get things moving in the senate so well give you that assignment later. I want to thank the delegates from jdrf, i didnt do this earlier. This is my failing because my colleagues were doing it when they introduced members from their states, so i want to ask joey, libby, and marid to put your hands up if i can if i can see them. Right over there. Great. Thank you. Thanks for doing that. I should have done that earlier. But we know that for our witnesses, especially the younger witnesses, its challenging to testify before congress, and were grateful that you did this and youre certainly equal to any of the witnesses weve invited to testify on any hearing. I also know that youll have a successful day ahead of you as senator collins said. Its much more compelling and persuasive when you appear at the doorway of a member of congress than when one of our one of us is appearing as a colleague, and youll be able to make the case about the importance, the urgent portion importance of reauthorizing the special Diabetes Program and also making sure that we make the case to get it through both chambers and get it signed into law. We look forward to working with you on that reauthorization, continuing the support that we will provide on investing in research and addressing the rising cost of insulin and were grateful for your presence today. Thank you very much. Thank you. [ applause ] senator blumenthal has just arrived. We obviously were about to adjourn the hearing, and were halfway through the vote, so if you could ask one question quickly, that would be great. You know, i will skip my questions. Ill submit them for the record. I just want to thank you madame chairwoman and rapginking membe casey for having this hearing. Thank you to everyone who is attending this absolutely packed room, which is very inspiring. Believe me, very inspiring. I was here earlier, and ive had various other Committee Meetings including Armed Services, but i just want to state my unequivocal support for this measure and also for efforts to reduce the costs of insulin. This astronomically rising cost of a life or death medicine is reprehensib reprehensible. It is a disgrace for this country that we cannot act more quickly and effectively and in the presence of so many young people who are so inspiring to us, i think you have given us the impetus to try to do more and do it better, so i thank you all for being here today, and i particularly want to thank members of the connecticut delegation, logan murwin and emma delvecchio, and all of the advocates and activists who are here today. When people say to me or ask me what can we do to improve the state of our democracy, they should come and see this kind of showing this morning. Thank you very much. Thank you very much, senator. Thank you. [ applause ] thank you. So i know the delegates are getting tired and the vote is on. The photographer has asked that we come down and get a couple of photos with the sea of blue, and so were going to do that, but this hearing is now adjourned. Thank you so much. [ applause ] later today President Trump holds a Campaign Rally with voters and supporters in fayetteville, north carolina. The president is visiting the tar heel state on the eve of a special election for the ninth Congressional District and will campaign for republican dan bishop. That district is yet to be decided. You can see President Trumps comments live today at 7 00 p. M. Eastern on cspan2, and if the senate is still in session, well bring you live coverage on cspan3. Tomorrow testimony from housing and urban Development Secretary ben carson and treasury secretary Steve Mnuchin on Housing Finance reform. Theyll be speaking before the Senate Banking committee. That gets underway live tuesday at 10 00 a. M. Eastern on cspan3. And following that, the House Judiciary Committee meets to consider several gun prevention bills including measures that aim to ban high capacity magazines while urging states to create a process that stops high risk individuals from buying firearms. That starts live tuesday at 2 00 p. M. Eastern, also on cspan3. Wednesday is the 18th anniversary of the 9 11 terrorist attacks. Watch our live coverage at 8 30 a. M. Eastern on cspan3 from the 9 11 Memorial Plaza in new york city. The moment of silence, the reading of the names, and the ringing of the bell at 9 00 a. M. Eastern on cspan from the pentagon, a wreath laying ceremony at the 9 11 memorial, live coverage of the 18th anniversary of the 9 11 terrorist attacks on cspan, cspan3, and online at cspan. Org or listen live on the free cspan radio app. Up next, a discussion on the Current Congress and its efficiency as a law making body. We hear remarks from congressional observers and think tank analysts who looked at their research in the congress and what influences its worked held by the american Political Science association. This is about