DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Budget Request for FY 2011
Witness appearing before the
House Subcommittee on Labor-HHS-Education Appropriations
Griffin P. Rodgers, M.D., M.A.C.P., Director,
National Institute of Diabetes and Digestive and Kidney Diseases
April 28, 2010
Mr. Chairman and Members of the Committee:
I am pleased to present the President’s Fiscal Year 2011 Budget request for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH). The FY 2011 budget includes $1,857,589,000, which is $50,225,000 more than the comparable FY 2010 appropriation of $1,807,364,000. Complementing these funds is an additional $150,000,000 also available in FY 2011 from the Special Statutory Funding Program for Type 1 Diabetes Research. This year marks the NIDDK’s 60th anniversary of supporting research on a wide range of common, chronic, costly, and consequential health problems that affect millions of Americans. These include diabetes and other endocrine and metabolic diseases; digestive and liver diseases; kidney and urologic diseases; blood diseases; obesity; and nutrition research.
UNDERSTANDING THE GENETICS OF COMPLEX DISEASES TOWARD PERSONALIZED MEDICINE
Many of the diseases that fall within the purview of the NIDDK research mission result from interactions between multiple genetic and environmental factors. The last few years have seen unprecedented discoveries in genetics research. Recent research has identified at least 43 genes or genetic regions associated with type 1 diabetes, 38 with type 2 diabetes, and 30 with Crohn’s disease. Many genetic factors that had proved important for Crohn’s disease risk were not associated with susceptibility to ulcerative colitis, suggesting that these two forms of inflammatory bowel disease have overlapping but unique genetic profiles. Scientists have also identified a major contributor to disparities in kidney disease: variations in the region of the MYH9 gene are associated with excess risk of non-diabetic kidney disease among African Americans. These studies may lead to enhanced ways to predict who is at high risk for these diseases as well as inform possible personalized interventions.
The NIDDK seeks to expand upon recent genetics findings to improve health. For example, new research is examining the recently-discovered genetic associations for type 2 diabetes in multiethnic populations. Other research aims to pinpoint the exact genes that influence type 1 diabetes susceptibility and study their biological role in health and disease, as well as to build on genetic discoveries to inform the development of new therapeutic agents for treating inflammatory bowel diseases, autosomal recessive polycystic kidney disease, urologic diseases, and other diseases and disorders within the Institute’s mission. These efforts may allow future health care to be more personalized and tailored by a person’s genetic profile. The NIDDK will continue to capitalize on recent genetics discoveries to transform the ways we predict the development of, prevent, diagnose, and treat diseases within the Institute’s mission.
FORGING NEW PATHWAYS TO CARE
NIDDK-supported research continues to make dramatic strides in improving the health and well-being of people with chronic diseases. Research shows that the outlook for people with longstanding type 1 diabetes greatly improved in the past 20 years, largely due to long-term NIDDK-supported research showing the importance of early and intensive blood glucose control in reducing risk for disease complications. In addition, building on strong results from NIH-supported clinical trials, national data show improvement in blood glucose levels, blood pressure, and lipid control in people with diabetes, which is projected to reduce health complications due to diabetes and to increase longevity.
Even with this good news about improved health outcomes for people with diabetes, the disease is a growing public health burden in the U.S. and worldwide. However, the NIDDK’s landmark Diabetes Prevention Program (DPP) clinical trial showed that people with pre-diabetes –defined as having blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes—can dramatically reduce their risk of developing type 2 diabetes through lifestyle changes that achieve modest weight loss or through treatment with the drug metformin. Research now shows that, after a 10-year period of following DPP participants, the interventions result in long-term benefits: people still had a lower risk of developing type 2 diabetes and those who made lifestyle changes also had reduced cardiovascular risk despite taking fewer drugs to control their heart disease risk factors. Building on these critically important results, the NIDDK supports research to translate DPP findings to improve public health. One successful research effort utilizes the YMCA for delivery of a group-based DPP lifestyle intervention. Rather than the one-on-one approach used in the DPP, the YMCA approach reduced costs to deliver the intervention from about $1,500 (in the case of the DPP) to $300 per person per year, while achieving similar levels of weight loss in participants.
Obesity is also a major public health problem in the U.S., and it increases people’s risk for type 2 diabetes, kidney disease, heart disease, and other health problems. In an exciting development, researchers discovered that energy-burning “brown” fat is not only present in infants, as previously known, but is also active in adults. NIDDK research is building upon these findings, which may speed efforts to combat obesity. Research has also linked obesity to a mix of intestinal bacteria. Further understanding of the roles of bacteria in obesity may inform the development of probiotic interventions to modify microbial content of the human gut. With respect to liver disease, recent results from a clinical trial showed that vitamin E was superior to placebo and pioglitazone at improving liver function in people with non-alcoholic steatohepatitis. The type of vitamin E used in the study is readily available, inexpensive, and had no side effects in the people studied.
Other new pathways to patient care may emerge from comparative effectiveness research examining bariatric surgery compared to a non-surgical weight loss program as a treatment option for people with type 2 diabetes. In people with type 2 diabetes, the disease can resolve after surgery but before weight loss, suggesting that gastrointestinal factors may modulate insulin production. Another comparative effectiveness research study NIDDK supports is the Systolic Blood Pressure Intervention Trial (SPRINT), which is led by the National Heart, Lung, and Blood Institute (NHLBI). SPRINT is testing whether a lower blood pressure goal could reduce people’s risk of kidney and heart disease and other health outcomes. The NIDDK’s Chronic Prostatitis Collaborative Research Network found that a drug commonly prescribed for men with chronic prostatitis and chronic pelvic pain syndrome did not improve symptoms compared to placebo—a finding that can spare patients from the burden and cost of ineffective treatment. NIDDK-supported researchers have also made progress in treating rare diseases. Scientists successfully used a modified bone marrow transplant procedure to treat adults with sickle cell disease. Researchers have also shown that aggressive insulin therapy, begun earlier in the course of diabetes than previously recommended, can help people with cystic fibrosis-related diabetes maintain their body weight and avoid the excess mortality associated with this comorbidity.
ENHANCING FUTURE HEALTH RESEARCH
The continued success of biomedical research depends on the talents and innovative ideas of future generations of scientists. The NIDDK has developed new programs to encourage students to pursue careers in biomedical research. For example, the NIDDK plans to continue a new Medical Student Research Program in Diabetes, which encourages medical students to conduct research under the direction of an established scientist in the areas of diabetes or obesity.
The NIDDK also utilizes strategic planning—with broad external input—to enhance and guide future health research. The statutory Diabetes Mellitus Interagency Coordinating Committee, chaired by the NIDDK, has undertaken a diabetes research strategic planning process to help guide the federal investment in diabetes research. The draft plan was recently posted on the NIDDK website for public comment and is expected to be published later this year. The NIH is also in the process of updating its 2004 “Strategic Plan for NIH Obesity Research” to review research progress and identify new research opportunities. The updated draft Plan will soon be posted on the NIH website for a period of public comment. This strategic planning effort is overseen by the NIH Obesity Research Task Force, which I co-chair with Dr. Susan Shurin, Acting Director, NHLBI. Research on digestive diseases continues to be guided by the recent long-range research plan of the National Commission on Digestive Diseases, for which NIDDK provided leadership and support.
DISSEMINATING HEALTH INFORMATION
The NIDDK is mindful that that the ultimate goal of medical research is to improve public health. Toward this goal, we support several education, outreach, and awareness programs to bring science-based knowledge gained from NIDDK-supported research to health care providers and the public. Activities include the National Diabetes Education Program (NDEP), the National Kidney Disease Education Program, the Weight-control Information Network, and the Celiac Disease Awareness Campaign. Many of NIDDK’s education and outreach materials are tailored for minority groups disproportionately burdened by diseases and disorders within the Institute’s mission. Recently, the NIDDK enhanced its health information materials with the release of new fact sheets on Wilson disease and two different birth defects of the kidney: kidney dysplasia and medullary sponge kidney. In addition, the NDEP, in collaboration with the NIH Office of Research on Women’s Health, is expanding its educational campaign for women with a history of gestational diabetes to raise awareness of the health risks for these women and their offspring.
As the NIDDK reflects on the past 60 years of supporting and conducting research, it is clear that the scientific progress achieved during this time period has been remarkable. Looking to the future, we will continue to build on the landmark scientific discoveries of the past to foster new research breakthroughs. Toward this goal, the NIDDK will continue to emphasize my guiding principles: support a robust portfolio of investigator-initiated research; vigorously support clinical studies to identify better ways to prevent and treat disease; preserve a stable pool of new investigators; foster research training and mentoring; and disseminate science-based knowledge gained from research through education programs.
The NIDDK is also continuing to build on past investments in research to maximize research progress. For example, the Institute plans to expand its adult liver failure and pediatric liver failure consortium studies and to support research to enhance adherence to treatment recommendations in adolescents with diabetes or chronic kidney or urologic diseases. In the future, the NIDDK will pursue scientific opportunities emerging from these investments to improve public health.
In closing, thank you Mr. Chairman and members of the Committee for the opportunity to share with you a few highlights of NIDDK’s research and outreach efforts to improve the health of Americans. I would be pleased to answer any questions you may have.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Institute of Diabetes and Digestive and Kidney Diseases
Griffin P. Rodgers, M.D., M.A.C.P.
Dr. Griffin P. Rodgers was named Director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)—one of the National Institutes of Health (NIH)—on April 1, 2007. He had served as NIDDK’s Acting Director since March 2006 and was the Institute’s Deputy Director from 2001-2009. Dr. Rodgers also has been chief of the Molecular and Clinical Hematology Branch since 1998; the branch is now administratively managed by NIH’s National Heart, Lung, and Blood Institute.
Dr. Rodgers received his undergraduate, graduate, and medical degrees from Brown University in Providence, R.I. He performed his residency and chief residency in internal medicine at Barnes Hospital and the Washington University School of Medicine in St. Louis. His fellowship training in hematology/oncology was in a joint program of the NIH with George Washington University and the Washington Veterans Administration Medical Center. In addition to his medical and research training, he earned a master's degree in business administration, with a focus on the business of medicine, from Johns Hopkins University in 2005.
As a research investigator, Dr. Rodgers is widely recognized for his contributions to the development of the first effective—and now FDA approved—therapy for sickle cell anemia. He was a principal investigator in clinical trials to develop therapy for patients with sickle cell disease and also performed basic research that focused on understanding the molecular basis of how certain drugs induce gamma-globin gene expression. Recently, he and his collaborators have reported on a modified blood stem-cell transplant regimen that is highly effective in reversing sickle cell disease in adults and is associated with relatively low toxicity. He has been honored for his research with numerous awards, including the 1998 Richard and Hinda Rosenthal Foundation Award, the 2000 Arthur S. Flemming Award, the Legacy of Leadership Award in 2002, and a Mastership from the American College of Physicians in 2005.
Dr. Rodgers has been an invited professor at medical schools and hospitals in France, Italy, China, Japan, and Korea. He has been honored with many named lectureships at American medical centers and has published over 150 original research articles, reviews, and book chapters and has edited four books and monographs.
Dr. Rodgers served as Governor to the American College of Physicians for the Department of Health and Human Services from 1994 to 1997. He is a member of the American Society of Hematology, the American Society of Clinical Investigation, the Association of American Physicians, and the Institute of Medicine of the National Academy of Sciences, among others. He served as chair of the Hematology Subspecialty Board and is a member of the American Board of Internal Medicine Board of Directors. He is board certified in Internal Medicine, in Emergency Medicine, and in Hematology.