Recommendations for Federal Programs to Improve Diabetes Care and Prevention

Diabetes monitoring and healthcare. Close up top down view of glucose meter, insulin pen, drug pills and syringe on blue background with copy space in the middle
More than 34 million people in the United States have diabetes, the majority with type 2 diabetes. A national report outlined strategies for better detection, prevention and care.

The National Clinical Care Commission (NCCC) has submitted a list of recommendations to Congress regarding ways to improve diabetes prevention and care in the United States. The report was recently published in the Annals of Internal Medicine.

Improvements in care for people with diabetes was also addressed by President Joe Biden’s in his State of the Union address on March 1st with a specific call for insulin to be capped at $35 per month for people with type 1 diabetes (T1D).

The NCCC was convened by the US Department of Health and Human Services to recommend federal programs that support clinicians and provide diabetes education and awareness for health care professionals and the public. The commission includes 23 members from the fields of diabetes epidemiology, public health, clinical care, patient advocacy, health policy, and regulatory matters.

The NCCC made 39 recommendations that require either administrative action by federal agencies or departments or legislative action by Congress. Some of the issues apply to all types of diabetes, and some are specific to type 1 diabetes (T1D) or type 2 diabetes (T2D).

The recommendations are grouped according to federal programs and policies, population-level interventions, T2D prevention, insurance coverage, diabetes care delivery, and research.

The NCCC recommends creating an Office of National Diabetes Policy to develop and administer a national diabetes strategy that involves transagency collaboration.

“Preventing T2D and treating all types of diabetes requires changes in social and environmental contexts,” stated the research group. “This necessitates coordinated engagement by health-related and non–health-related federal agencies whose policies and programs impact nutrition, food labeling and marketing, housing, transportation, and the ambient and built environments.”

The NCCC supports a Centers for Disease Control campaign to raise awareness of prediabetes and promote enrollment in the National Diabetes Prevention Program.  Approximately 88 million adults in the US have prediabetes, according to the NCCC. The Commission also supports the implementation of the American Medical Association’s proposed prediabetes quality measures on screening for abnormal blood glucose levels and prediabetes interventions.

Health insurers, according to the NCCC, should cover key elements of T2D prevention and treatment and assist in keeping insulin and insulin-delivery devices affordable, and provide coverage for high-value diabetes services and treatments that prevent or delay the progression of diabetes complications. The Endocrine Society, the American Diabetes Association, and others have put out position papers on affordable insulin.

Diabetes care and delivery in the US, according to the NCCC, would benefit from an adequate clinical workforce trained to meet the care needs of patients with diabetes, including the enhancement of virtual and telehealth care. Quality measures should be in place to assess potential overtreatment or inappropriate treatment which could result in severe hypoglycemia among Medicare beneficiaries with diabetes. Additionally, the Center for Medicare & Medicaid Innovation should collaborate with the Health Resources and Services Administration and the Indian Health Service to develop a technology-enabled, collaborative learning and capacity-building model to support diabetes best practices among primary care providers and care teams.

The NCCC recommends funding research at the population level, with a focus on social and environmental conditions associated with diabetes. The commission also advises that the National Institutes of Health should summarize data from the Diabetes Prevention Program study regarding the effectiveness and safety of metformin, which may then be used to support a request to the US Food and Drug Administration to review an indication for metformin in high-risk patients with prediabetes.

“The NCCC strongly encourages Congress and the HHS secretary to swiftly implement its recommendations,” the report’s authors urged. “It is imperative that a national diabetes strategy be established to coordinate and monitor transagency collaboration and progress toward achieving these goals. Doing so will substantially benefit the health and quality of life of people at risk for or living with diabetes, promote health equity, and support clinicians as they assist patients with diabetes prevention and treatment efforts.”


National Clinical Care Commission Writing Group. The National Clinical Care Commission Report: improving federal programs that impact diabetes prevention and care. Ann Intern Med. Published online February 15, 2022. doi:10.7326/M21-4175