The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications

Greenlee, M. Carol; Bolen, Shari; Chong, Wai Po; Dokun, Ayotunde O.; Gonzalvo, Jasmine D.; Hawkins, Meredith; Herman, William H.; Leake, Ellen; Linder, Barbara; Conlin, Paul R.

doi:10.2337/dc22-0621

Cited by 8 publications

(4 citation statements)

References 42 publications

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“…We argue that population-wide interventions to address social and environmental determinants of health are fundamental to diabetes prevention and control in the U.S (7, 8). Other papers have described the recommendations of the two other subcommittees (9,10).…”

Section: Methodsmentioning

confidence: 99%

Rethinking diabetes in the United States

Herman

Schillinger

2023

Front. Endocrinol.

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Despite the availability of effective medical treatments, the diabetes epidemic has accelerated in the United States, efforts to translate treatments into routine clinical practice have stalled, and health inequities have persisted. The National Clinical Care Commission (NCCC) was established by the Congress to make recommendations to better leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It gathered information from both health-related and non-health-related federal agencies, held 12 public meetings, solicited public comments, met with interested parties and key informants, and performed comprehensive literature reviews. The final report of the NCCC was transmitted to the Congress in January 2022. It called for a rethinking of the problem of diabetes in the United States, including the recognition that the lack of progress is due to a failure to confront diabetes as both a complex societal problem as well as a biomedical problem. To prevent and control diabetes, public policies and programs must be aligned to address both social and environmental determinants of health and health care delivery as they impact diabetes. In this article, we discuss the findings and recommendations of the NCCC as they relate to the social and environmental factors that influence the risk of type 2 diabetes and argue that the prevention and control of type 2 diabetes in the U.S. must begin with concrete population-level interventions to address social and environmental determinants of health.

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Section: Methodsmentioning

confidence: 99%

Rethinking diabetes in the United States

Herman

Schillinger

2023

Front. Endocrinol.

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“…The Commission also developed recommendations to address 1) population-wide policies and federal programs that can affect diabetes prevention and treatment; 2) diabetes prevention in populations at high risk for developing type 2 diabetes; and 3) the treatment of diabetes and its complications. These are discussed in detail in other articles in this series (7)(8)(9)(10)(11)(12). We summarize key recommendations below.…”

Section: Foundational Recommendationsmentioning

confidence: 96%

“…This gap results in many people with diabetes developing preventable complications. The NCCC’s recommendations for diabetes treatment and complications focus on what can be done at the federal level to bridge this gap ( 11 , 12 ): At the patient level, the NCCC recommends reducing barriers and streamlining administrative processes to facilitate the delivery of diabetes self-management training, increasing patient engagement, ensuring access to affordable medications (including insulin), and regularly updating eligibility criteria for diabetes supplies, technologies, and devices. At the practice level, the NCCC recommends developing capacity to support technology-enabled interventions, increasing access to virtual care for all patients with diabetes, and enhancing programs that support team-based care.…”

Section: Recommendations For Diabetes Treatment and Complicationsmentioning

confidence: 99%

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The National Clinical Care Commission Report to Congress: Summary and Next Steps

et al. 2023

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The U.S. is experiencing an epidemic of type 2 diabetes. Socioeconomically disadvantaged and certain racial and ethnic groups experience a disproportionate burden from diabetes and are subject to disparities in treatment and outcomes. The National Clinical Care Commission (NCCC) was charged with making recommendations to leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC determined that diabetes cannot be addressed simply as a medical problem but must also be addressed as a societal problem requiring social, clinical, and public health policy solutions. As a result, the NCCC’s recommendations address policies and programs of both non–health-related and health-related federal agencies. The NCCC report, submitted to the U.S. Congress on 6 January 2022, makes 39 specific recommendations, including three foundational recommendations that non–health-related and health-related federal agencies coordinate their activities to better address diabetes, that all federal agencies and departments ensure that health equity is a guiding principle for their policies and programs that impact diabetes, and that all Americans have access to comprehensive and affordable health care. Specific recommendations are also made to improve general population-wide policies and programs that impact diabetes risk and control, to increase awareness and prevention efforts among those at high risk for type 2 diabetes, and to remove barriers to access to effective treatments for diabetes and its complications. Finally, the NCCC recommends that an Office of National Diabetes Policy be established to coordinate the activities of health-related and non–health-related federal agencies to address diabetes prevention and treatment. The NCCC urges Congress and the Secretary of Health and Human Services to implement these recommendations to protect the health and well-being of the more than 130 million Americans at risk for and living with diabetes.

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BRG1 Deficiency Promotes Cardiomyocyte Inflammation and Apoptosis by Activating the cGAS-STING Signaling in Diabetic Cardiomyopathy

Chen,

Lai,

et al. 2024

Inflammation

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Brahma-related gene 1 (BRG1) has been implicated in the repair of DNA double-strand breaks (DSBs). Downregulation of BRG1 impairs DSBs repair leading to accumulation of double-stranded DNA (dsDNA). Currently, the role of BRG1 in diabetic cardiomyopathy (DCM) has not been clarified. In this study, we aimed to explore the function and molecular by which BRG1 regulates DCM using mice and cell models. We found that BRG1 was downregulated in the cardiac tissues of DCM mice and in cardiomyocytes cultured with high glucose and palmitic acid (HG/PA), which was accompanied by accumulation of dsDNA and activation of the cyclic GMP-AMP synthase (cGAS)–stimulator of interferon genes (STING) signaling pathway. shRNA-mediated Brg1 knockdown aggravated DCM mice cardiac functions, enhanced dsDNA accumulation, cGAS-STING signaling activation, which induced inflammation and apoptosis. In addition, the results were further verified in HG/PA-treated primary neonatal rat cardiomyocytes (NRCMs). Overexpression of BRG1 in NRCMs yielded opposite results. Furthermore, a selective cGAS inhibitor RU.521 or STING inhibitor C-176 partially reversed the BRG1 knockdown-induced inflammation and apoptosis in vitro. In conclusion, our results demonstrate that BRG1 is downregulated during DCM in vivo and in vitro, resulting in cardiomyocyte inflammation and apoptosis due to dsDNA accumulation and cGAS-STING signaling activation. Therefore, targeting the BRG1-cGAS-STING pathway may represent a novel therapeutic strategy for improving cardiac function of patients with DCM.

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The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications

Cited by 8 publications

References 42 publications

Rethinking diabetes in the United States

Rethinking diabetes in the United States

The National Clinical Care Commission Report to Congress: Summary and Next Steps

BRG1 Deficiency Promotes Cardiomyocyte Inflammation and Apoptosis by Activating the cGAS-STING Signaling in Diabetic Cardiomyopathy

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