The National Clinical Care Commission Report to Congress: Background, Methods, and Foundational Recommendations

Since the first Federal Commission on Diabetes issued its report in 1975, the diabetes epidemic in the United States has accelerated and efforts to translate advances in diabetes treatment into routine clinical practice have stalled. In 2021, the National Clinical Care Commission (NCCC) delivered a report to Congress that provided recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. In the five articles in this series, we present the Commission’s evidence-based recommendations to 1) reduce diabetes-related risks, prevent type 2 diabetes, and avert diabetes complications through changes in federal policies and programs affecting the general population; 2) prevent type 2 diabetes in at-risk individuals through targeted lifestyle and medication interventions; and 3) improve the treatment of diabetes and its complications to improve the health outcomes of people with diabetes. In this first article, we review the successes and limitations of previous federal efforts to combat diabetes. We then describe the establishment of and charge to the NCCC. We discuss the development of a hybrid conceptual model that guided the Commission’s novel all-of-government approach to address diabetes as both a societal and medical problem. We then review the procedures used by the NCCC to gather information from federal agencies, stakeholders, key informants, and the public, and to conduct literature reviews. Finally, we review the Commission’s three foundational recommendations: 1) improving the coordination of non-health-related and health-related federal agencies to improve the social and environmental conditions that are accelerating the diabetes epidemic; 2) ensuring that all Americans at risk for and with diabetes have health insurance and access to health care; and 3) ensuring that all federal policies and programs promote health equity in diabetes.