hearing on diabetes research and funding. this is just under two hours. >> thank you. good afternoon. this hearing will come to order. let me thank everyone for gathering earlier than we had anticipated due to votes being scheduled on the senate floor. we wanted to make sure that our young people here today did not have to sit for a long time. while members of this committee

went to vote. hearing inng today's fonjunction with the jdr examine's conference to how diabetes affects people of all ages with a special focus on americans with type one diabetes and their families. the eighth consecutive congress that i have chaired. it has been such a privilege to the young people and families all across the country whose commitment to finding a cure is inspiring. i want to welcome our distinguished panel of witnesses and the 150 delegates to the congress who have traveled from

washington from every death traveled to washington from -- tostate in the country delegates who have traveled to washington from every state in the country. i want to give special welcome to the two delegates from maine. isabel and mark from harrington. remarkablehall, a young woman from maine who was diagnosed with type one when she was 10. broke aently 39-year-old national high school record in the long jump. she jumped an astonishing 22

feet five inches. founder of the senate diabetes caucus, i have learned about the the years difficulty and heartache this disease causes for so many american families as they await a cure. diabetes costs the state's $245 billion per year. it also accounts for one out of three medicare dollars. withal costs for americans diabetes are more than doubled those incurred by individuals

without diabetes. me toeally motivated devote so much energy and time moreis cause is meeting and more families like our delegates today whose lives have been forever changed by diabetes. why it is so important that you have traveled to washington today to tell your personal stories. you put a human face on statistics. caucus, found it the funding for diabetes research from $310han tripled million in 1997 to well over $1 billion this year. piercing some encouraging

breakthroughs and a threshold of encouraging discoveries. as glucosech monitors have helped prevent diabetes complications. closer and closer to our goal of an artificial pancreas which would revolutionize artificial care. today's function is being held in conjunction with the children's conference fact is living withthose type one diabetes are adults. i was surprised and troubled to learn that insulin dependent medicare beneficiaries are being denied coverage for continuous glucose monitors.

seeingnsequence we are situations similar to what we pumps in thelin late 1990's where individuals with type one diabetes had their coverage for their monitors on their private insurance only to lose that coverage when they thoughto medicare, even 90% of private insurers cover continuous glucose monitors, medicare does not. i have joined shahir she he -- senator and others to help cover this important device. while we are making progress, this is no time to take our foot off the accelerator.

year we were able for that legislation diabetes program for two more years through september of 2017. provides over and above the regular appropriations for diabetes research at the national institute of health. that this hearing will help generate even more support in congress to extend your support into the future. >> i have been so impressed with the changes in technology and the differences that they have made to the lives.

it never fails to inspire me the young all of people of all ages from all around the country who come to washington to share their countries with us. thank you for being here today. time, i amnterest of not going to give my formal opening statement. youou would indulge me, guys look so awesome. [applause] a hearing room that we usually use for armed services hearings and i am on the armed services committee. it is a bunch of people who are leaders and heroes, but they are kind of so i people in uniforms.

have to get a picture of this. [laughter] [applause] i am so proud of all of you are looking at all of you in blue because you are learning firsthand because you can make a difference because this is your government and your government needs to listen to you about what you are living with what your needs are and the incredible gaping hole you have in this country. to be partnered with sen. collins:'s she and i agree on this. we have to do something -- to senator collins because she and i agree on this. we have to do something. i will shout out to a million cooper who is from kansas city -- to amelia cooper.

she is from kansas city and probably a cardinals fan but she is not a typical teenager. she has visited 35 countries, is a cross-country skier, a half marathon finisher and a published author and a person living with type one diabetes. and someone from my on the mater,-- from my alma the doctor who has too many accompaniments as a pediatrician for me to begin to talk. university and school of medicine in columbia, with amazing credentials. finally i want to recognize the is from st.ur cdo louis -- so we evened out, amelia, he is a cardinals fan.

activelouis has a very chamfer. -- chapter. this is something we all the to stay focused on and thank you madam chairman for calling this important hearing and the chairman's commitment to this for many years is unmatched and i am proud to be ranking on her committee and i'm proud of the work she has done in this area. collins: i want to echo what you said. this is a great hearing -- not to say we don't have wonderful hearings on the time. we will now turn directly to our panel of witnesses. it is my great pleasure to introduce isabel from maine. she was diagnosed with type one diabetes at the age of two.

an extraordinarily active girl who enjoys reading, arts and crafts, playing soccer and softball with camping, fishing and music. has alreadyskill been introduced. third, we will hear from kate quite ate has become start in the state of maine. recentlyioned she broke a 39-year-old national high school long jump record with an astonishing jump of 22 feet five inches. [applause] donnelly, i had to have her show me how long that was.

she was diagnosed with type one diabetes at age 10 but she has been yet another shining example of someone for has not let this lifelong disease stop any of her goals or ambitions. frome next going to hear bob amato. i will now turn it over to senator whitehouse. sen. whitehouse: it is a pleasure to be here. this is the most inappropriate aging committee hearing i have ever seen. [laughter] it is lovely to see the this sea of blue faces. i want to recognize, as senator

mccaskill did, the leadership that senator -- chairman collins has shown for a long time. she has led a letter to the appropriations committee to support diabetes research. we are all happy to be senator colin's wingmen on this issue. i get the pleasure of introducing a panelist today. island justrhode like some of the other witnesses . bob was diagnosed with type one day beauties at a very young age but she has been living with the disease for 67 years. even back then, bob refuse to

accept that it meant he could not lead an active life. runner andn active eventually a track coach. bob was admitted into the providence college athletic hall of fame in 2009 and was one of the most successful coaches, finishing with a career record of 162 wins , 14 losses and one time. i'm very pleased that bob could be here today to share the successes and the challenges that he has experienced living with type one diabetes. we look forward to hearing about your experiences. >> i have a question -- would the former track coach like to offer a track scholarship to the young girl sitting next to him? >> i believe he is too late.

that occurred to me when i was sitting them next to each other. [laughter] >> we will hear from the director of the national institute of diabetes and digestive and kidney diseases at the national institute of health. it is a great honor to welcome you back. she testified at our previous hearing and it is so interesting to hear your update on that research and the technology. thank you for joining us again this year. from thewe will hear mccaskill hasator already introduced him. i do want to beg knowledge senator shaheen who has joined

us. withas a granddaughter type one and i believe that her granddaughter and daughter are going to be with us today, too. welcome. we will start with our first witness and that is going to be isabel. isabel, please begin your testimony and thank you so much for coming from maine to be with us today. thank you chairman collins and senator mccaskill for inviting me to testify today. i am 10 years old and live in maine. i was diagnosed with type one was two or t1d when i years old. my diagnosis was the start of a very different childhood.

my mom and dad began a routine fingerprints -- finger pricks and insulin shots everyday. myof today i have pricked finger over 28,000 times, and changed my sensor over 400 times. can you imagine having to stick a needle into your skin 30,000 times in just eight years? my family says that i am a happy child, but it is hard when you have to deal with diabetes everyday. it is something you can never stop thinking about. i constantly have to put my life on pause to test my blood sugar. when i'm swimming or in the softball game.

sometimes i even have to come out of the game to recover from low blood sugar. when i feel my team needs me the most it is so frustrating. they don't always feel my low blood sugar. 26 andbeen as low as didn't know it until my parents had me checked. jdrf children's congress delegate because i need your help. my family and i have spent the last eight years fighting and we need your help to continue fighting with the special program. my family and i work hard to raise funds for research and to teach my community about the

disease. the topteam has been fundraising team in five of the last seven years. organize a, i helped concert where i played my guitar to increase my community's understanding of the impact of diabetes. the money we have raised as gone toward research into new treatments for type one diabetes, and hopefully we will one day find a cure. from this comes technology that has made it easier to live with diabetes. one technology that i used to track and manage my blood sugar is a glucose monitor or a gm> .- or a cgm

before i had one, it was hard for my parents to know if my blood sugar was high or low so they pricked my finger constantly throughout the day. cgma three-year-old, this has made a huge difference. although this device has helped me to stay healthy, there is much more to be done and a cure is still needed. when i grow up i want to be a this a realitye it is important that congress research.rting t1d thank you. [applause] collins: thank you very much. that was perfect. you did a great job. amelia?

amelia: thank you senator collins and members of the committee for inviting me to testify today. i was diagnosed with t1d three years ago at age 12. as you all know the teenage years can be a little rough with pressure to fit in and find your way. at a time when many of my peers are worried about hair and clothes and social schedule, i must focus on my health. each day i have to carefully monitor might look -- blood glucose level. these serious challenges , i have many reasons to be grateful. thankfully, i was diagnosed after frederick banting discovered insulin.

thankfully, i was diagnosed with t1d after insulin's monitors -- insulin monitors were invented. thankfully i have been able to manage my diabetes without it managing me. it is only through a strict blood sugar management routine and advancements in diabetes treatments and devices that i have been able to live my life to the fullest. -- the number of countries i have visited and still counting. 13.1 -- the number of miles in a half marathon. i have completed two so far. 10 -- the number of things i wish my parents knew when i was diagnosed with t1d. i wrote this article on the blog diatribe. four -- the number of years it takes after college to become a doctor.

that is my dream job. type one, the number of my disease. i hope with congress's support we will move from type one to type none. through advances in medicine, my life has gotten easier, healthier and safer. i am well aware that these advancements took 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 project that i conducted. i have always been curious as to how and why my blood sugar is in regular when i ski. changes in altitude and prolonged activity can be hard on blood sugar control. after researching, i learned there was the opportunity to design a study to evaluate the changes in my buddy when i ski

-- my body when i ski as opposed to my friends. results, which were presented at this summer's diabetes association meeting in boston showed that despite strenuous activity, altitude cause an increased demand in insulin by more than one third. myt importantly, i shall do blood sugar could be in the same range as my friends with careful monitoring and planning of my carbohydrates and insulin requirements. the use of a glucose monitor was the session -- especially writing aior to chairlift -- to riding a chairlift or skiing. projects on beta cell encapsulation and other

technology, treatments that i hope to have available in the years to come. justnot someone who can stand by when there is so much to be done to improve my quality of life before you today. in closing, i ask for your support in this fight to cure diabetes. thank you for your time today. [applause] may i askhairman, that this hearing record something that others may not have seen which is that throughout her testimony she all is never looked at her notes which is far better -- >> i just hope she doesn't run

against me. i'm in trouble. [laughter] that really was extraordinary testimony and we thank you for being here today. now, we will turn to another extraordinary young woman -- kate hall. >> my name is kate hall and i am from maine. andk you chairman collins other members of the committee. diagnosed with type one diabetes when i was 10 years old and. at first it seemed i would never understand all of the details. i had to adjust to taking shots of insulin. everything had to do with what i lowand having high and blood sugars correctly. realize that diabetes

was not ever going to stop me from doing the things that i loved most. i thought, i am not sitting out on anything ever again as long as i can help it. challengingbetes is , particularly with track and field. the events i compete in require rigorous daily training. for me, keeping my blood sugar in a healthy range as much as possible is just an important part of my training as anything else i do. managing my diabetes can be hard at times, and i realize i cannot figure out everything on my own. i need help from doctors, parents and researchers. athlete,ompetitive there are many tiny details that people have to do to get the best results possible. some include staying hydrated, eating well, sleeping well, and

warming up correctly to avoid injury. making sure my blood sugar is a good level is another thing to add to the list. whenever competing i have to take my blood sugar several times before i run to make sure it does not go high or low. doit is, i need to quickly what i need to to make sure it doesn't affect me. mying competition, i check blood sugar every half hour to an sure it will not -- to ensure it will not affect my performances. if it is high or low, i occasionally get muscle cramps. they are very painful and prevent me from competing the rest of the day or the rest of the week. it ishis happens, extremely frustrating to think my diabetes is preventing me from doing what i love the most even when i try hard to control it. i was using a glucose monitor

until we changed health insurance companies. with most private insurers covering cgm's these days, i hope they will update their policies. it helps me focus on training and competing. new technology, diabetes management devices, and the support of my family and healthier team allow me to pursue my passions and become a world-ranked junior athlete. i broke a 39-year-old national high school record with a jump of 22 feet eight inches. it also broke the u.s. junior record and surpassed the automatic qualifying standards for the 2016 olympic trials. i finished third and the 100 meter event with a time of 11.3 seconds. my dream is to one day represent the united states at the olympics.

though i will be home and working with a new team of coaches, one key part of my life from its unchanged. the challenge of managing it every single day. technology is important. those of us with type one diabetes need more. that is why my family and i are grateful for the funding provided for type one diabetes research. we thank youins, for your leadership. we are all counting on congress to help us figure it out. >> just want to say personally how proud i am of you. it was just thrilling to hear of your success and setting new records and to do so while coping with a complicated

illness is even more impressive. but most of all, you really inspire all of the children who are here today to note that they, too, can achieve their dreams, so thank you for coming. kate: thank you. chairman collins: mr. amato, welcome. mr. amato: members of the committee, thank you very much for this opportunity to speak before you. my name is bob amato and i'm from johnston, rhode island. when i was first diagnosed with type one diabetes, 67 years ago, i was approximately seven years old. thinking at that time, people, such as you guys, were not able to compete.

no athletics, no gym, that was difficult. i did not accept that and i sought guidance from joslin clinic and again some guidance from my parents and i was able to prove that particular concept of fallacy. a fallacy to the point where in 2009, i was entered into the providence college for athletics for both my running accomplishments and the and accomplishments as a coach. as a coach, i had the privilege of coaching to world champions. [laughter]

16 division i all-americans. our teams competed in 60 new england championships. my coaching colleagues selected me to the coach of the year 15 different times. that is what i would hope for when i was told it couldn't be done. i was able to find success despite the daily challenges of diabetes. because i always used -- now, this is important, the term -- the latest technology. the latest technology. you've got to picture that when i first came down with diabetes, the needles, get ready for this one, the needles were metal. we had to sharpen them on the

stone. the syringes were glass. testing urine was a method of determining blood glucose. now we are up to the influence -- 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 a low blood sugar, you are either a little bit tired, a little bit shaky, or things happen that are not normal. at this point in my diabetes career, after 67 years, those body signals are gone.

that provides me with some pretty big dangers. i needed to find a way to manage that situation. i was fortunate that the jdrf funded research programs using the continuous glucose cgm's. it took place in boston and i was one of the first to start on that and we spent about a year with that program. it was great. i went in not realizing what was going on with regards to insulin reactions, as we used to call them, hypoglycemia, low blood

sugar, you all are familiar with that, to now knowing ahead of time what to do and how to correct it. it also enabled me to control my diabetes better. which is very important. a new technology helped me with a situation that was really dangerous. as a result of the jdf study and other studies, the cgm's were endorsed by leading clinics throughout the country. the indoctrine in society, the american diabetes association, the american clinical -- american association of clinical endochronologists. i do not know what they are.

they are great organizations, i know, but we cannot relate to them. what i can say is that 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 a period of four solid years. the folder that i have is thicker than this. however, however, i received notice that last november, it was ok. the judge found in my favor. well, i had the pleasure, again,

as i said, two world champions, the feeling i had at those two . world champion successes was exactly the same when they told me we find in favor of you. that was not all the difficulty. two months later, they took it back. they said no. and i was heartbroken. i have not given up. i have not given up. and that is what i hope you guys will do as you are going through school, high school with a in college and so forth. do not quit. now that i depend on medicare for my diabetes, the cgm's could

save my life. it almost saved my life when i was wearing them numerous times. again as i say, i will not accept the cms's decision -- those are the administrators of the medicare program, the cgm can mean literally a difference between life and death. i'm going to explain one instance. you've got to remember that we are trying to show the technology that has helped me for 67 years. be healthy, 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 to low blood sugar occurred. my car started to move back-and-forth and forth on the highway. i did not realize that. an 18-wheeler did realize. he saw what 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 saved my life. that did not have to happen. that did not have to happen. i could have been -- the cgm is what i'm trying to get at -- if

that -- if i had had that, i would have known ahead of time and things would have been taken care of. i could have taken care of them. about a month ago, i had a chance -- things have been difficult now that we are back out of this situation. about one month ago, i had a chance to visit providence college. i went up there alone. chairman collins: mr. amato, i hate to cut you off because your story is absolutely fascinating. i'm just worried because of the vote scheduling, so if i could ask you to wrap up, that would be great. mr. amato: i would like to thank you for the opportunity to be here and pleading for this particular situation. i hope that the vote will be taken from those who have been on assignment with you and they will continue. if anyone has any questions, and i know you do not have the time for this, but if you do have questions, please, be free to

contact me and i would be glad to talk with you. thank you. chairman collins: thank you. [applause] thank you for your compelling testimony. dr. rogers, great to have you back. dr. rogers: great to be back. chairman collins, senator mccaskill, and members of the committee, thank you for this opportunity to testify. type one diabetes is a lifelong disease that affects americans of all ages, including seniors. on behalf of the national institute of health, i am pleased to report that our research investment continues to improve the lives of people with type one diabetes. through coordinated efforts with

our research partners at jdrf and the ada as well as with the support of the recently renewed special statutory funding program for type i diabetes, we are helping children sitting here today and all people with type 1 diabetes live healthier lives and longer lives. i am pleased to report that -- since i testified before this committee two years ago -- we have made significant scientific advances that are putting us closer to reaching our ultimate goal of preventing, treating, and ultimately clearing type i diabetes and the convocations. what the renewal of the special

diabetes programs from the fiscal year 2017 that you alluded to, we are looking for to taking advantage of future opportunities that i would like to briefly describe or you today. before i highlight some of these advances, i would like to certainly acknowledge the important contribution that my fellow witnesses have made. i want to thank you for your personal testimony that you are not lending type i diabetes define you as a person. i am pleased to share the table with doctors who the -- with dr. huni, i'm sure she has research goals of her venting, -- preventing and curing type i diabetes. i would also like to thank everybody here today representing americans of all ages with type i diabetes. i'm happy to report that the outlook of people with type i diabetes is better than ever. people with the disease have new and emerging technologies and david stout manage the disease. the cousin of research conducted by an idd kay's landmark

diabetes control and complications trial and the follow-up study called edic, we know that early and intensive but sugar control is key to reducing the risk of the devastating complications of the disease. just this year we learned from the dccd edic that people with type ii diabetes who control their blood sugar levels early in their disease are more likely to live longer than those who do not. further emphasizing the importance of early and intensive blood sugar control. however, as everyone here today knows, controlling blood sugar is easier said than done. it is extremely challenging and burdensome and it is also limited by the potential for acute episodes of have a glycemia or dangerously low -- blood sugars. the artificial pancreas is the device that can sense blood sugar levels and automatically administer insulin. i'm pleased to report that with this special diabetes program support, there has been tremendous progress in this area. just last year with researchers testing portable cell phone-based devices in real-world settings.

the use of an automated by -- bihormonal bionic pancreas for five days and five nights by adults and adolescents led to lower blood sugar levels and reduced episodes of hypoglycemia. another study found that in adolescence, unsupervised and overnight use of artificial pancreas for 21 nights that to improved blood sugar controls during the day and the night and reduced the number of episodes of these hypoglycemia is. because of this tremendous progress, artificial technology -- pancreatic technology holds great promise in the near term approaching to help manage type i diabetes by improving their health. however, it is not a cure. replacing or restoring the function of the beta cells would be the biological care. in another area under vigorous investigation, one strategy to replace these beta cells is via

transplantation. our registry has shown both safety and efficacy outcomes have improved from the a 2007 -- 2007-2010 compared to, for example, 1999 two 2006. additional research progress areas that have both inmate by niddc with the co-lead technical pilot transparent consortium and they completed a pivotal trial, phase three trial, and have reached another endpoint in the second phase retrial. we look for to these exciting results to be submitted to the fda toward the pancreatic product for transplantation. a current barrier for using islet transplantation is the scarcity of donor islets for transportation. here is another major advance to overcome this difficulty that has been recently reported by researchers in niddk's biology consortium.

who have achieved the long-standing goal of type i diabetes research, they discovered a way to create large numbers of these glucose responsive, insulin producing beta cells. we think with further research, the cells could be used for transplantation to restore insulin producing capacity in patients with type i diabetes. nih has also made important research and strives to combat diabetes complications. for example, a recent trial conducted by the national eye institute, diabetic retinopathy clinical research, they compared three drugs with widely different cost for treating diabetic eye disease. the result showed that in people with mild vision loss, all three drugs were equally affected. -- effective.

they could include clinical decisions and lead to more personalized treatment for diabetic eye disease by having the mythic and cost of locations and the drugs were found to improve vision which could make a difference in the quality of life that people with diabetes share. one other point is that the niddk and cdc have developed a research program and it has shown that type i diabetes in people under the age of 20 has risen by 21%. it has risen by 21% by the year -- during the years 2001 two 2009. it has risen by 21% during the years 2001 to 2009. these data suggest that there is some environmental factors or factor or factors that is contributing to disease risk and

our study of the environmental determinants of diabetes of the youth are teddy study, which follows 6000 kids from birth through the age of 15, we hope we will very soon get a handle on what these environmental risk factors are. i know that the time is limited, so let me just ended there and say, chairman collins and senator mccaskill and members of the committee, thank you for the opportunity to testify before you today. the nih is grateful for your continued support of congress, private and public partners, and 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 to live long and healthy lives, free of the burden of this disease. thank you for your attention and i look forward to answering any questions you might have.

chairman collins: thank you very much. [applause] dr. habib, as i'm going to call you -- dr. habib: i'm delighted to be here and i think the speech i'm going to give is more educational and hopefully to convince you how to invest in research more and more so we can get these children to become type none, not type i. thank you. if you focus on the slide, the poster. type i diabetes is a disease.

that means that the immune system, which is there to protect us from infection, cancer, and other diseases makes mistakes and then attacks the better cells so that the bugs are the new and the flowers of the dead flowers, so when the new system or the bugs attack the flowers or the beta cells die, therefore, sugar cannot be taken to the cells in the cells cannot have energy, therefore, they cannot function. we started by looking at how to get the bugs away so that they do not attack the beta cells so that we can get insulin again.

when we did that, we succeeded when we try to get the immune system away before they develop -- we tried to get the immune system away before the mice developed type i diabetes. but we failed when we tried. so we have to use to make a little bit of thinking and hearing the disease as diagnosed. we had the technology that can reverse the disease. when we looked harder, we understood that the immune system, when it attacks the beta cells, it also attacks the blood vessels that connect the beta cells to the rest of the body. they can no longer distribute that insulin or cannot get things to them to produce insulin and the blood vessels represented by the pipe, if you look at the pub, it is broken, so it is leaking. in order to fix the disease, it works like this. in order to fix the disease and

curate, you can just eliminate the bugs. if you eliminate the bugs with the drug and you fix the pipe with stem cells, then you can get the flowers to flower again and produce insulin and cure the disease. this is the experiment we set to test and we did. next slide, please. what we did here is we have a sick mouse in that panel, the left side. we are going to treat it or give it a drug to eliminate the immune system that the tax the beta cells.

-- that attacks the beta cells. we gave it stem cells we get from blood or bone marrow and watch what happened to the mouse. surprisingly, what we found -- a schematic representation -- we made the mouse happy. [laughter] it's back on its scooter and then i'm hoping we can get you all back on our scooters. [applause] so two more minutes, thank you. we looked at the pancreas, we're looking at the lower level, if you see, there is a brown dot with leftover beta cells.

the islet insulin became and it became full of insulin. that is what we want to do. that is what the experiment is aimed at. we were aiming to care type i diabetes and he would not need to give yourself insulin anymore. if this pans out and if we have funding for the research to continue and similar programs that will take us there. that is the science part of it. you can remove the thing. what i want to say is that i have been doing research for 20 years on type i diabetes. i have been making progress. now that we are getting closer

to really make the difference, i find myself really in trouble funding wise. i have to spend 70% of my time writing grants. so far, this year, i have not been successful. i would rather spend my time doing research rather than writing grants and writing again the same thing and writing again the same thing and getting nothing. so my advice or opinion is that chairman collins, you made the statement -- you said we keep pushing the accelerator, well, chairman collins, senator mccaskill, senators, keep

pushing the accelerator. you will not get a police ticket. you will get a cure for type i diabetes. [laughter] chairman collins: thank you very much. [applause] thank you all for your excellent testimony. isabel, you talked about that you have warned of continuous glucose monitor -- worn a continuous glucose monitor since i think age three. does it send a signal to your parents on their phone or some other way if your blood sugar is getting too low? isabel: it does not matter if my blood sugar is high or low or no matter what like my blood sugar is saying. i have a little iphone in my bag and my cgm reads there and my

iphone sends it, all of my numbers, to my parents. even if they are across the globe, they can still see my numbers. chairman collins: that is great and it shows how important it is, as mr. amato says, it is truly a lifesaver. , truly a lifesaver. kate, you talked about your family changing health care plans and then you lost coverage for your cgm. is that right? >> yes. chairman collins: i want you to know that we are working very hard with your insurer, and we have some people for you to call. i am hoping we can get that situation taken care of. >> thank you so much. thank you. [applause] can you collins: 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 low in just 10 minutes without even realizing. usually either my parents or my trainer will be able to see my pleasure or the whole time that i am competing. if it says that it is going low that i can make the adjustment before it goes low so i will have those muscle cramps. it has been tough not having it recently. hopefully it works out. chairman collins: thank you. did medicare consult withcms you before they made the decision to not have coverage for cgm for medicare beneficiaries? i am unaware of any cms

officials contacting us on this. i'm in agreement with the comment that former commissioner hamburg of the fda made, that really other agencies should work together on this entire scheme. very recently we held a coordinating committee, which niddk chairs. we presented information about glucose monitoring, particularly in older adults. the proposals that came out of that meeting were presented to a group of experts and they uniformly agreed that this is really a high airy up for research priority. i think this is important to move forward with. chairman collins: thank you. i think it is absolutely incredible that medicare officials did not consult with you -- the foremost expert that we have at nih overseas --

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. amato, it something it certainly was medical for you, and literally a lifesaver. would you agree with that? >> yes. i would have to agree with that. i saw those two terms, precautionary and medically necessary, over and over again. it is still not believed to be medically necessary, at least in the data that has been sent to me. we will just keep our fingers crossed. chairman collins: as i mentioned in my opening statement, we have a bill to mandate the coverage and we will -- well, i can't

speak for my colleagues, but i'm pretty sure we will all be pushing very hard on that. amelia, you said in your testimony that there were 10 things that you wish to your parents had known when you were diagnosed. i am 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 that i wish they had known is that when i go low i get upset or angry or something, then every time i got angry or upset, they automatically jumps to the conclusion that i was low. after a while it got kind of annoying. [laughter] chairman collins: thank you very much. mccaskill: you needed them to know that you could just the angry. the doctor. with

in your testimony you talk about the need to involve pharmaceutical companies in type one diabetes research. at the federaly, level, is there anything we could do to encourage that type of collaboration? >> i think you can. ,he pharmaceutical companies when they take a drug to a clinical trial, when they succeed they make money. but 10 years ago i understand million -- i400 don't know if that is still true now. government can for themte something

that will push us forward to the cure. sen. mccaskill: dr. rogers, we know that research dollars are scarce. nih has been living under a dark cloud for several years now because of our cutting back on funding the nih. it is my understanding that to restore effort that this year. we still aren't going to get the level we need to be embracing to stay in our dominant position in terms of medical visit -- medical research around the world, but ddk, how do you decide what research studies you fund? are you giving priority to clinical studies that have a better chance of translational impact both in terms of quality of life or people like the young

people in front of me? and for the federal government saving money, for example -- all you have to do is turn on cable tv, not for type one, but for type two there is no question that glucose monitoring is one of the drivers of our debt at this point because of the cost of monitoring. all the ads for buying monitoring machines -- it is all being paid for by the federal government. >> senator mccaskill, you raise a very important point. the prevalence, the burden of the disease, the number of people affected. input that weekend. the unique scientific opportunities that we may have a particular time all factor into the type of trials that we conduct when we conduct them. and how expensive they are. there are other aspects in your question -- there are potential

opportunities, for example, that one would think the private sector would be more involved in . special diabetes has allowed us to work with our sister organization the national eye institute to conduct a study of three commonly used drugs for the treatment of one of the major publications -- diabetic eye disease. of thesele, as network particular treatments that i have mentioned, one costs about $2000 per injection. one costs $1200 projection. injection.0 per these were given to people that have mild vision loss, over half of them enrolled in this trial. it is important to indicate that

all of the results were quite substantial in terms of the improvement, but all three of these drugs had nearly equivalent of fact. of thely because financial aspects of this, this is not a particular study that a private sector pharmaceutical company would be likely to fund, but it is the kind of thing related to -- sen. mccaskill: why? lesko all in on the $70 right? >> i want to caveat. because of the diabetes program we are now able to fund a trial called prevention of end-stage renal disease -- real loss, or the perl trial, using a that isfective drug actually now a frequently used drugs for the treatment of gout. there is fairly good indication that this may prevent the

progression of kidney damage. end-stage renal disease in which patients have to undergo medicare coverage. this are able to show in trial that the safe and generic drug can effectively prevent the savese, it will likely tremendous amount of funds moving forward, and it may have application in a broader setting of type 2 diabetes, where the publications are quite similar. sen. mccaskill: thank you ray much. -- thank you very much. thank you all for being here and for your testimony and your advocacy on the hill. i had an opportunity today to meet with north carolinians. i know some of them are in the room. i think on behalf of all north carolinians we appreciate you wearing tar heel blue today. [laughter] but mr. amato, you mentioned

something that is i was speaking with my guest in my office, when we look at the need to provide coverage for cgm i think we have to take a look at benefits in economic terms that i think far outweigh the costs. when we look at your situation , the fact stella, ms. cole mother of stella who was in my office today, she was relating a story about an automated -- automobile accident that occurred at her car was damaged car of someone in circumstances you described. i think as we go forward and we build support for coverage of cgm we really need to articulate a lot of the hidden costs that are probably not being taken mind farunt that in my outweigh the cost of actually providing the drug. the greatest benefit of course

is for rachel's mother to be able to track her while she is playing volleyball and you know if she has a situation she needs to deal with. 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 wants to pick on you. i heard that when you set the junior record you are down in north carolina. there is something in the air down there. you ought to consider coming back. can you tell me again about some of your experiences where in real time the device has had an impact on you personally? >> i first got it a couple of years ago. right from when i got it i noticed a huge difference. it really helped me control my blood sugar. not only that, especially when competing it really helped me. tells me when it is going high or low, and i can keep it with me all the time. my bloodme to check

sugar every half hour. i can just look at that and know where it is heading and get insulin. and i don't get any muscle cramps. it helps me immediately. it is very helpful. >> thank you. dr. rogers, i know with the younger generation isabel was very matter-of-factly talking about the integration with her iphone and the ability to broadcast her levels, real-time, to her parents. but sort of challenges do we have with seniors also taking advantage of this, and what kind of a dobson to be cmn seniors -- what kind of adoption rates do we see among seniors? >> the adoption of these new technologies -- certainly seniors are embracing perhaps a level. i would say with the cgm in particular there is a fair

amount of data to recognize that hypoglycemia, very low pleasure levels among people 65 or older is atype one diabetes, 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 costs, when comparing costs imagine what the cost is of having to return to the emergency room repeatedly versus the cost of that type of care. having said that though, this is one of those areas, and again with the special diabetes program we recognize that we have to bring new talent into this field, not only in making these technologies more miniaturized and easier to use, but we have also bringing --

been bringing in people with knowledge of behavioral science. it is one thing to provide technology but getting people to use it may provide its own challenges. to get it to be used more effectively, for example, particularly with older individuals who may be suffering with visual problems, with hearing loss, etc.. my time is up, but really one thing i would like to spend some time on or get access to the information -- i really think to our case for build providing coverage for cgm, a look at the fully burdened cost of not doing it is critically important. when you think about seniors particularly -- my mother is 82, she lives alone, she did not have diabetes. but i know of many seniors who are living independently and the likelihood that they can

continue to live independently theyey have diabetes -- may need a family member who may not be residents but is in position to provide care. at theu take a look costs of not being able to live independently, or the emergency costs, i think you can really see the case for building coverage. chairman collins: thank you. senator donnelly. >> thank you medicare. thank you all for being here. i would like to mention my hoosiers who are here from indiana. to case, you will find on your way back from iowa to maine that you drive from indiana -- through indiana on the way. i have a home-cooked meal ready for you when you come back to indiana. charlie campbell, who came in third in the indy 500, lost by

maybe a car length. whos a type one diabetic drove that race car for 500 weather.100 degree he did an extraordinary job. one other thing, madam chair, i wanted to let you know a man for my hometown. gabeame is dave gabe -- martinez. he has had type one diabetes and since he had was very small. i told him we will cure type one the cubs win the world series. his father says you have to do a lot better than that. [laughter] , dr. rogers and dr. z -- i will call you if that's ok -- how do we protect the body from its own immune system when we put those

cells back in to go to work? we need you to turn up your mic. it is the flowers themselves. they have their own seeds. a rejuvenated again. >> so you are bringing the cells that are already in your body? >> yes. >> ok. and how you keep those cells from being attacked by the immune system? >> great question. kids.ve juvenile environmental factors that apply for one and not for the other. yourder for these to happen have to have those environmental factors to be there. it is like in the ocean.

you have thousands of events that happened and they have to for the hurricane to occur. same thing with the cells. once you fix them in the same then if those environmental factors happen again it is not going to do anything for the immune system. >> is this something that you? >> that is my opinion. >> do get a rejuvenated? -- do you get a rejuvenated? >> they are seeds. once you fix the blood for -- blood vessels and you eliminate the immune system to attacking the self, the stem cells that we give our for blood type. they will grow, mature. that would that enable all of these youngsters to go to type none?

and how long do you think it will be until they would be on market? [laughter] >> i'm not looking for a guarantee, i am just looking to know. >> whatever money you put. [laughter] [applause] >> so how much will it cost to get it done next week? we are incredibly grateful for that effort. we will make sure that the funding is there for you to keep this moving along. dr. rogers, i want to note that ofind you are a whole bunch your team from the nih, and i would like them to stand up who have done such an extreme very job over the years. [applause]

>> dr. rogers, what is the most pressing thing you need from congress right now? obviously funds. what kind of funds the need to get this a place where we don't have another child congress. or the child congress two years from now is a celebration of having found the cure? >> well i think, as dr. z mentioned, certainly we have a lot of very good investigators with a lot of very good ideas. the present level of funding, we are only able to entertain and successfully fund may be one in five, or perhaps one in six of those. we think there is certainly room for other outstanding ideas, because obviously in this particular case we want to be thinking about multipronged

approaches. we want to be able to develop new sources of cells to implant. we want, at the same time, it has me know so much about the and who into arson -- are susceptible, we want to determine what the environmental actor is that has increased the incidence by 21% in a short. of time. period of time. if we can find out what it is in is anvironment, is it sickness we can develop a vaccine. dietary modification could have an effect. for people who have the existing in theirwe want to -- early stages of autoimmunity -- we want to selectively try to turn and reverse that autoimmune disease.

and as you heard from dr. z, not completely wiping out the immune system because it is there for a reason, and selectively attacking the cells that are attacking those beta cells. for people that have the existing disease, we want them to live a more comfortable life to try to prevent them from developing complications. >> and mr. amato, you are an inspiration to all of us. to you young kids, we hope to keep -- fix this thing so that when you are mr. amato's age, this is just a memory from long, long ago. think you madam chair. [applause] greatan collins: it's a pleasure to call upon senators that he, the cochair of the , the chairsenator

of -- cochair. >> thank you for letting me squat at this hearing. i very much appreciate being able to be here. i want to thank all of you delegates who are of the children's congress, because you are absolutely the best advocates for helping all of us who want to see a cure for diabetes and want to see the best new treatments available. i want to recognize sky her family from exeter, new hampshire, who is here as part of the congress. wasalso, senator collins kind enough to recognize my daughter and granddaughter, stephanie and ellie, who have been very much a part of the children's congress in the past. they are here today with their diabetes service dog. to all of you who have testified, thank you very much

for your work and your willingness to share your stories today. amato, i can't agree more with what senator collins and senator tillis said about the importance -- not just of making cgm that medicare funds the , because it is the right thing to do, but it is the economic thing to do. i just want to quote from a study that was done called diabetes research and the public good, by two economist. it points out the diabetes costs the united states $245 billion in 2012. that cost is expected to double by the year 2020. medicare costs from diabetes or $104 billion in 2012. they are protected to increase $226 billionn -- by 2020.

diabetes is the leading cause of blindness,ure, amputations, heart failure, and stroke. these things happened because people do not get the treatment they need. cgm is part of that treatment. there is no doubt that we should find that. hopefully with everyone else's we can getp your that legislation passed. dr. roger, i wanted to ask you. talking about the number -- a number of promises -- promising research that is going on. i wonder if you can say what you think is the most promising immediate breakthrough that we are looking at that will make a difference? preventionhink certainly is -- >> for prevention. >> yes.

i view this in terms of prevention, either preventing people who are genetically susceptible to this disease from getting it, based on what i mentioned before, the study of divine -- environmental determinants of the disease in youth is likely to answer that. and there is a study of kids from birth to the age of 15, but we already are developing important knowledge from that study. preventing people who have those genes and who have actually begun to show signs of our study is-- beginning to use certain types of drugs to actually reverse that autoimmune process and allow those cells to last longer. we know the longer they last the less likely it is that individuals with type one diabetes will develop serious competition.

for the people with the disease, the artificial pancreas that is linking the insulin infusion with continuous glucose monitoring brought together by some sort of -- i shouldn't say -- some sort of computer device, typically on phones now, on portable phones, is really the best technology. we know keeping blood sugar in really the best way to prevent these publications. as i mentioned, just in the last two years we have had such great success that it is quite likely, working with our friends at the fda, that many of these devices will be approved. that is really, in the short term, i think the best chance of success. >> thank you. i am almost out of time, but i wonder if i could get elliot

isabel to tell us what is the best device that you would give to someone who has just diagnosed with type one? well, the advice that i would give is to educate your friends and family members as quickly as you can about your disease. if you get them involved it takes the pressure off, and it is better for your safety and your mental health. >> thank you. how about you isabel? like, keepsay that trying to raise money and make sure no one stops you from doing anything just because you have type one diabetes. always do what you dream of. >> that is great advice. [applause] >> thank you madam chair. >> ok.

try the top that. >> i won't even try. but thank you so much, everyone, for being here. we should have more hearings like this where we not only have testimony but also have questions and audience for dissipation and reaction. that is pretty rare. i wanted to give a shout out to pennsylvanians i met with earlier. even howard, from wayne, pennsylvania. julia o'leary from lancashire. catherine from pittsburgh, and medicine from waterford. from waterford. give them a round of applause. [applause] we have some pictures. because they were so mobilized and so effective, and such good advocates, i figured they could come back here and sold our appropriations problems. work on foreign policy. so we are grateful for that. [laughter]

i first want to apologize for being late and missing a good bit of the testimony, but we are grateful to have a chance to talk for a minute. i won't be long because i was late. i wanted to make sure -- sometimes we have an exhaustive discussion of a topic, and often senators can leave here without getting it to do list, or at least one that is emblazoned on in our minds. before wet to ask, get to our younger witnesses on the left side of the table, dr., i just want to go back to you. what would you hope -- if you had a short list, what would you hope that congress would do not only in the near-term but over the next couple of years in terms of short-term assignments and longer-term commitments as well? senator, i want to say that i'm very grateful for all of the support that congress has in identifyingh

movingcal research forward. as i mentioned earlier, we have such great ideas out there, but unfortunately in recent years have not been able to have the opportunity to bring in as many new ideas and investigators as we certainly would like. in the short term, again, i want to thank you for the support that we have learned about, and we hope that as that progresses inward -- i will be happy two years to report to you what has happened with that incremental support that we have received. in niddk really want to focus on all aspects of this, from prevention to early intervention , to making certain that the primary and secondary convocations are considered.

it really is the secondary convocations, the eye disease, the kidney disease, the nontraumatic amputations, the neuropathy, that is really contribute greatly to the cost of $245 million that senator shaeehheen reference. that is really driving the cost of this, or our young as their older population. we are keenly aware of this. we are really targeting our efforts in all of these categories. >> for anyone else, we'll may have about a minute and a half. i want make sure you have a moment -- anyone else on the panel? >> i think my answer is relatively short. is funding.-- funding. funding again. important part of

the two list i am almost out of time, isabel, i wanted to ask you how your friends have helped you throughout the early years of your life when you have the challenge of not just getting to school, but also dealing with a significant health challenge. can you describe how your friends at healthy? -- can you describe how your friends have helped you? >> my friends are very helpful. when i was in preschool and mydergarten my login and -- mom came in and she helped me explain to the class why i was always getting pulled aside, so they weren't getting confused. know that i have it and they are very helpful because

my pump rings, as they go to the teacher and say oh, and she pump is ringing needs to go to bidders. they are very helpful. >> im going to give a round of applause to your friends, how about that? [applause] >> thank you. chairman collins: thank you. i apologize for being late. we are kind of running multiple things at lunch -- at once. i had to come this year and say special thank you to senator collins for pulling it all together. this is a terrific annual event. i also want to say a special shout out to jeffrey d'angelo. where are you jeffrey? i can't see you in this sea of blue. [applause]

we have all been talking about the cost of diabetes. type one diabetes imposes, obviously, a terrible personal cost. and the financial costs are staggering. 40% of families with diabetic children experience financial strain, and care for type one diabetes cost our health system and estimated $15 billion a year . i wants to start with a cost question from a different direction. dr. rogers, if we could delay the onset or reduce the severity of type one diabetes so that millions of americans could stop whining insulin glucose monitors, test strips, if we get to stop hang the cost of doctors visit, emergency room, what do you think we could save every year? warren, there is no doubt that if we could prevent diabetes from occurring and

reduce the severity of the disease that would result in a tremendous cost savings. i think organizations like the jerf have actually estimated what that would result in. a 10% or 20%. the nih has not made any of those cost estimates to my knowledge. what i can tell you, though, as i referred to before, a major cost is associated with these secondary convocations. i disease, kidney disease. nontraumatic ammunition. we think, and i have mentioned previously, some of the benefits easy in terms of cost effectiveness, one could potentially do estimations on those. but i do not have sitting here today a good estimate to tell you how much precisely we could save. >> but i take it though, based

a 10%e of the estimates, reduction would be about $3 billion. in other words, a lot of money. when youare talking -- combine it with the dull the delta sitting costs, i think it costs, i-- devastating think it would be a no-brainer to invest more money in research for diabetes. [applause] so let's turn this down a little bit more. dr. rogers, you direct the national institute of diabetes research. how much money do you have for compared, and inflation-adjusted, with what you had 10 years ago? that, ifs a question one were to include, in addition to our regular appropriations as well as the special diabetes program appropriations, because has lostion, niddk

about 24% in our buying power. we are.re we see the costs imposed. i did you have got, effectively, about 24% less money to work with than you had 10 years ago when a kind of research that you are doing. as we know, you are not alone. nih funding overall is down 25% since 2003. that means for nih we are investing about $12.5 billion less in medical research this year that if we had just kept up with inflation over the last decade. last week the house passed the 21st century cures act, which includes the cures innovation fund that gives nih about $1.9 billion per year for the next five years. a $12.5t does not fill billion hole, but it certainly

is something. here is what i am concerned about. i am concerned the nih may not even get that much. before this bill passed the house, a section requiring the appropriators to continue to fund the nih at current levels was taken out. it was called the maintenance of effort provision, and without it there is nothing to stop congress from cutting the nih -- adding 1.9 of the top, but budget.from their base if that happens, nih's budget would actually not increase at billion fundn $1.9 for the cure is added on top. so let me ask you, if the result of the 21st century cures bill is a fund that gets great fanfare but does not actually

result in any extra money for nih, does that help the research community? to downsizei began my laboratory because i could the appropriate funding to maintain. i was speaking with the director ger, and i need to have three grants of about $2 million apiece every five years. so altogether, in order to maintain my operation. foruse i could not do it the last two years i have started downsizing. downsizing is not only a problem for the people, it is research that now is going to be stopped. there is one more problem. by doing this research, i am training people to take over when i am out.

i can it no longer trend is people anymore. is youhat you are saying can't make it, in fact you're cutting back. you are certainly not in a position to do further research. withies with diabetes, parkinson's, with alzheimer's, with other serious conditions, deserve more than lip service from congress. they deserve a real increase in funding. that is what we need to do. i introduced the medical innovation act that could boost the nih budget by 20%. it is not enough but i hope it a start. i hope senator collins will join me. or improve the 21st century cures bill. if we are serious about saving lives through research, and saving money, the congress has to step up and make a real commitment of real dollars. thank you madam chairman. [applause]

chairman collins: i want to thank all of our witnesses today, particularly the delegates who have come from every state in the union and across the globe to make the case for more support for diabetes funding. that is the shared goal of everyone in this community, and i would point out that it is because of the efforts of families all across this country , whose children have juvenile diabetes or type one diabetes, that we have been able to triple the funding for diabetes 1997, when we first started the diabetes practice. s nodding in. rodger

agreement. i am proud of the fact that we have extended the special diabetes program, which focuses on type one and on diabetes among native american populations, then we have been able to extend that important program. we could not have done those spending increases that are so vital to progress without the ,elp of the people in this room the people who have testified, the children who testified previously at our children's congress in past years. without the advocacy of the jdr jdrf, the american diabetes association, and other groups. , longlly have come a long way. that is why we have the technology that we do. , for many, many

years, always came to our hearings to review the progress and talk about her old life living with type one diabetes -- her own life living with type one diabetes. she was not able to be here this year but she is certainly in the thoughts of many of us. she once told me that you have to be a mathematician, a physician, a personal trainer, and a dietitian all rolled into one to keep your diabetes under control. i think there is a lot of truth in that. fortunately today we also have some wonderful advancements in technology, and we are going to for that, as well as a change in medicare policy so that when mr. amato -- when the young people here become mr. ahmad is a they are not going to have the fight that he has had

to get the coverage for the cgm. we are going to make sure that that happens. my thanks to the more than 160 delegates and all of their families, because after all, it does take the entire family who have traveled to washington to tell your story. you are the ones who really make a difference by putting a human face on this disease. i want to thank everyone at jdrf for your help in organizing this. , for coming as well. mr. amato. the young people on our panel. emilio, kate, it was wonderful to have you here in washington. committee members will have until friday, the 24th, to

submit any additional questions for the record. i want to take all the members of the panel who have been here today and all of you who are sitting so patiently so long. i know that i can be a trial. .hank you let's end this hearing in an unconventional way by giving a round of applause to all the delegates who are here. [applause] chairman collins: this hearing is now adjourned. [captions copyright national cable satellite corp. 2015]

[captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [indiscernible]

>> this week lawmakers return

from their summer recess and will begin debate on the iran nuclear agreement. consider ais set to disapproval resolution when it comes back september 8. as it stands right now, 38 senators have voiced support for the nuclear agreement compared to 36 who are opposed. there are six remaining senators who have yet to say how they will vote. as always it you can watch the senate live on c-span2. the house is inspected to begin debate on the nuclear agreement as well on september 9. setting up a possible vote by the end of the week. you can watch the house live here on c-span. >> a signature feature of look tv is our all-day coverage of book fairs and festivals from across the country, with top nonfiction authors. here is our schedule. near the end of september we are in new york with the brooklyn book festival celebrating its

10th year. in early october it is the southern festival of books in nashville. the weekend after that we are live in austin for the texas book festival. and near the end of the month we will be covering to the festivals on the same weekend. our nation's heartland, it is the wisconsin book festival in medicine. and back on the east coast, the boston book festival. at the start of november we will be in portland oregon, followed by the national book awards from new york city. and at the end of november we are live where the 18th year in a row in florida for the ime book fair international. that is a few of the fairs and festivals this fall on c-span's tv. -- book tv. >> the american legion homestead -- posted its national convention this year -- in baltimore. ashton carter spoke to the group for about 20 minutes. carter: good morning and

thank you. i want to thank the leadership great organization for inviting me and each and every one of you here for your tireless advocacy on behalf of our veterans and our men and women in uniform. and i want to thank baltimore for hosting this year's convention. . know whether bob mcdonald is here but i also want to they can for his determined v.a..ship of the ba -- to thee second battle battle of the bulge, from here,a to every person who proudly called themselves a soldier, sailor, airman, or marine, who know probably calls themselves legionnaire, thank you. you are defending those who

defend us. [applause] sec. carter: there is someone friend anda great distinguished predecessor who i want to mention and thanks, chuck hagel. [applause] chuck was a soldier in vietnam. the stories of his bravery are well known. throughout the rest of his life of public service, check dedicated himself -- chuck dedicated himself to those who serve, and that is why he probably worth the goldenseal. waynam taught us the hard that while one may question why we fight we must never question the honor of the men and women who do the fighting. [applause] sec. carter: our vietnam that's

-- vets were not given the recognition or respect they deserve. we cannot reverse that wrong, but we can learn from it. that is what we are trying to do together. never forgetting the sacrifices of american -- america's bravest sons and daughters make is what drives, inspires, and gives meaning to his organization. for nearly 100 years legionnaires like you has fought for freedom's nobly earned by our country's finest patriots. you are driven by an enduring truth, that above all the strength of our military and our nation is our men and women in uniform. and given that truth, we have a responsibility to defend those who have defended asked. as a secretary defense, among the three

principal commitment i made, first and foremost is my commitment to our people, the current force, including reservists, guard, and their families, and veterans to. second is my commitment to lead with a national security newtegy suited to this century, protecting our country and keeping us strong, respected by our friends, feared by our enemies, always ready. and third is my commitment to our future and to the force of the future, where innovation and technology remain pillars of american strength, and making sure tomorrow's force is as great as today by continuing to and retain the best america has to offer. because above all else, our people are what make our military the finest fighting force the world has ever known.

it is demo that make it back. that.is them that make it [applause] knowcarter: few others better than you. our great responsibility is to make sure we never put a single one of america's bravest sons or daughters, or their families, and harm's way without the greatest care and reflection about why we are doing it and how it benefits our nation. our responsibility extends to all generations. our veterans, our wounded warriors, to the fallen and their families. partnership we have made tremendous progress in recent years, and i am grateful for partnership with this wonderful organization. today, for example, we know that traumatic rain injuries and prose -- posttraumatic stress are features that increase the

risk of suicide, and we take action to make sure service members treated for metal health conditions can continue their care as they transition to the v.a.. we are expanding suicide prevention training so warning signs are easier to spot and health -- help is easier to get. we are also overhauling our electronic health records. transition assistance, we are upgrading our programs the benefits like program -- counseling and financial planning are interlaced throughout careers rather than tacked on at the end. you provided these vital too, and we are grateful. i travel around the country and i talked to employers. the recognition today is widespread that a veteran makes a fantastic fleet -- employee. that was not always so.

iran when people did not therstand, and now with exception of a very few, they do. better transition assistance is partly why veterans are getting jobs at record rates, but i think there is more we can do. we have established a licensing program to give service members becausehere it is due if you are certified to drive a truck or provide medical attention in a war zone, you should not have to get recertified back home. [applause] over the next few years, we expect 1.5 million 9/11 generation vet to join the 2.5 million will have already left service. we need to lay a foundation for veterans support 10 years, 20 years, 30 years from now.