NIDDK Fiscal Year 2019 Budget Request
Prepared Statement of Griffin P. Rodgers, M.D., M.A.C.P.
Director, National Institute of Diabetes and Digestive and Kidney Diseases
Mr. Chairman and Members of the Committee: I am pleased to present the President’s Fiscal Year (FY) 2019 budget request for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH).
Combating Chronic Disease to Improve Human Health
NIDDK supports research on diseases and conditions affecting the health and well-being of millions of Americans. Its mission spans diabetes and other endocrine and metabolic diseases; digestive and liver diseases; kidney and urologic diseases; blood diseases; obesity; and nutrition disorders. Though diverse in nature, most of these diseases and conditions are chronic, consequential, and costly. For example, diabetes, kidney disease, and digestive diseases alone run into hundreds of billions of dollars yearly for medical care, disability, loss of work or productivity, and other costs. Obesity is at high prevalence among U.S. adults and youth and is a risk factor for many of these chronic and sometimes deadly health problems. The challenges are vast, and the needs urgent. Through research and related activities, NIDDK continues to seek out ways to prevent, treat, and cure chronic diseases and conditions to improve human health and quality of life.
To foster discovery important to combating chronic disease, NIDDK supports a multi-faceted scientific portfolio spanning basic to translational to clinical studies, while also creating and leveraging partnerships that can fortify and accelerate research. For example, in basic research, scientists have used a specialized microscopy technique to develop a three-dimensional picture of a cellular protein that is a target for certain diabetes drugs. Because this protein is also a member of a protein “family” targeted by about 40 percent of pharmaceutical drugs on the market today, the intricate knowledge gained from this work is not only important for diabetes but will inform the search for new drug treatments and refinement of current ones for other diseases. New findings in mice may also open up new therapeutic avenues important to prevention of obesity and type 2 diabetes: One research group has identified a group of brain cells that, upon activation, induces rapid binge eating and weight gain, while another has found that bones secrete a hormone that both suppresses appetite and regulates blood sugar levels. Studies in mice have also revealed a more complex view of the kidney’s role in salt and water balance and blood pressure regulation and suggest new areas of investigation for human hypertension. NIDDK-supported scientists have also been able to produce human intestinal “organoids”—small bundles of cells that model various aspects of the small intestine and its functioning, facilitating study of certain digestive system diseases and disorders and creating potential for tissue replacement therapy.
In FY 2019, NIDDK will build upon research accomplishments such as these and upon other research avenues and continue its support for basic studies of both normal and disrupted biological functions and systems. For example, the ReBuilding a Kidney (RBK) consortium will continue efforts to enable tissue repair or replacement in kidney disease; already, RBK scientists have found that selecting the proper substrate for growth and structural support is critical to creating blood supply in a “kidney on a chip.” Recent studies have shed light on the multiple levels of complex interactions that contribute to how human gut microbes affect health, from molecules produced by the microbes themselves to differences in human diet; a 2017 workshop on best practices for studies of diet and gut microbiome will help inform rigor and reproducibility in future efforts in this aspect of research on the gut microbiome, which is rapidly emerging as an important contributor to digestive diseases, obesity, nutrition, and many other chronic diseases and conditions.
Similarly, NIDDK-supported translational and clinical studies have yielded fruit. For example, in the translation of genetic discovery to treatment, NIDDK-supported scientists developed a personalized treatment plan for a child suffering from a severe anemia after discovering that the cause was a rare mutation affecting a protein already available in a therapeutic form. New findings about the impact of being diagnosed with diabetes before age 20 include that youth with type 2 diabetes are more than twice as likely as peers with type 1 diabetes to have or be at high risk of a diabetes health complication by age 21. The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network has yielded important new insights into the nature and course of the urologic chronic pelvic pain syndromes interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), such as new knowledge about the prediction of and bodily patterns of pain. NIDDK-supported scientists have also developed the first method for calculating the average rate of blood filtration by the individual functional units in the human kidney, an important measure of kidney health. Discoveries such as these can now be harnessed into new research toward interventions or into other actions to improve health.
NIDDK will continue its support of research that, in partnership with human volunteers, can elucidate causes of and treatments and cures for chronic diseases and conditions and ways to implement those findings. For example, the third phase of the Diabetes Prevention Program Outcomes Study, spearheaded by NIDDK with several NIH partners, will study outcomes that are of increasing concern in an aging population with a high burden of pre-diabetes and diabetes. These include evaluating the potential benefit of the diabetes drug metformin on the development of cardiovascular disease and cancer. Gestational diabetes has long-term health impacts for affected mothers and children, and NIDDK will continue to capitalize on new findings and efforts to better understand this condition and identify ways to improve outcomes. Efforts will continue in development and testing of artificial pancreas systems for treatment of type 1 diabetes. NIDDK will also continue support for many clinical research efforts to address overweight and obesity, including major ongoing studies to assess the health risks and benefits of weight-loss surgery in extremely obese adolescents. The new Kidney Precision Medicine Project will pursue innovative efforts to elucidate the heterogeneity of kidney disease in human study participants, which could lead to novel and tailored treatments for both acute and chronic kidney disease. NIDDK will sustain its long-term investment in the Drug-Induced Liver Injury Network (DILIN) so that it may continue its highly productive and informative efforts to characterize liver injury from herbal and dietary supplements and prescription and over the counter drugs.
To help tackle complex challenges and move discovery forward, NIDDK continues to forge effective partnerships with other NIH ICs and Offices, other federal agencies, and private organizations. For example, the NIH Nutrition Research Task Force chaired by NIDDK and co-chaired by the National Heart, Lung, and Blood Institute (NHLBI), National Cancer Institute (NCI), and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has sought input from across NIH and external stakeholders and is developing the first NIH-wide strategic plan on nutrition. The public-private Accelerating Medicines Partnership-Type 2 Diabetes (AMP-T2D) project, spearheaded by NIDDK with partners from industry and nonprofit organizations, continues to exceed expectations in terms of progress and will continue augmenting content and access to genetic and clinical data on diabetes and related traits made available through its Knowledge Portal.
Indivisible from research are the minds and hands that generate new ideas and bring forth results. NIDDK will continue to foster and grow a diverse biomedical research workforce that can meet, with innovation and creativity, the challenges posed by chronic diseases and conditions. NIDDK supports several special training opportunities spanning high school to medical school to attract students, including those underrepresented in science and medicine, to NIDDK research areas. Mentorship opportunities offered by NIDDK’s Network of Minority Health Research Investigators, which celebrated its 15th anniversary in 2017, focus on junior investigators and will continue to promote a diverse research pipeline. NIDDK will also continue efforts to help the new generation of biomedical researchers realize their potential, such as priority funding strategies for those early in their careers. NIDDK is also pursuing multiple efforts to enhance rigor and reproducibility in research. Simultaneously, NIDDK will continue disseminating health and scientific information through multiple venues to educate and inform the public, healthcare providers, and researchers about new developments germane to chronic diseases and conditions.
In closing, NIDDK has a robust and vigorous commitment to research and related activities to combat chronic diseases and conditions. This is reflected in its five guiding principles: maintain a vigorous investigator-initiated research portfolio, support pivotal clinical studies and trials, preserve a stable pool of new investigators, foster research training and mentoring, and disseminate science-based knowledge through education and outreach programs. Through research, NIDDK hopes to advance progress toward new and improved prevention, treatment, and curative strategies.