NYC wants to track 530,000 diabetics

New York City's Department of Health could mandate automatic transmission of blood sugar tests to a patient registry.

The New York City Department of Health, which is dealing with an epidemic of diabetes, wants a central system for tracking 530,000 residents who suffer from the disease.

The department proposes requiring laboratories in the city to enter the results of all hemoglobin blood sugar in a central electronic laboratory system, an unprecedented but needed step, said Dr. Diana Berger, medical director of New York’s diabetes prevention and control program.

The department wants to collect the results of hemoglobin A1c tests, which measure the average level of blood sugar over several months. The information will help the department better manage the 530,000 diabetics in New York and focus on reaching out to the more than 250,000 undiagnosed cases.

Although no other jurisdiction in the country has ever attempted such a data collection effort – let alone on such a scale – the price the city and its citizens pay for diabetes calls for such an effort, Berger said.

Diabetes, the result of what Berger called “an obesity epidemic” causes nearly 2,000 deaths a year in the city, more than 1,700 amputations, as well as increased heart disease and kidney failures. Treating diabetics in New York has hit $7 billion, she said.

The department put the proposed mandate out for public comment July 7, Berger said. If the Board of Health approves the mandate this fall, Berger said the 127 commercial and hospital labs in the city hooked up the Electronic Clinical Laboratory Reporting System (ECLRS) run by New York State will have to start reporting the results of A1c tests to the department.

There are 800 labs in the city, but Berger said the department only wants results from the labs connected to ECLRS. “We want text file uploads, not paper or faxes,” Berger said.

The department will then use those lab results to develop a diabetic patient registry, help the department focus on areas with a high number of diabetics and work on intervention and treatment projects with local clinicians.

Berger emphasized patient privacy is paramount in development of the diabetic registry, with information available solely to the patient and clinicians. Information in the registry will not be provided to other agencies or organizations, including insurance companies.

The department has already targeted the South Bronx – which has 48,000 diabetics – for a pilot intervention project, Berger said, and plans to field a force of public health pharmaceutical salesmen, know as “detail men”, to call on clinicians in the South Bronx. These detailers will provide information gathered from the ECRS reports to help clinicians better manage their diabetic patients.

The ECLRS reports will also allow the department to alert doctors whose patients A1C blood sugar levels have risen to eight per cent or above – followed by a letter to the patient. Patients can opt out of the project at any time, Berger added.

Berger has no illusion that her project will make much of a dent in either diabetes or obesity in New York but has hopes it can help whittle away at high blood sugar levels. A one percent drop in A1c blood sugar levels can lead to a 35 percent drop on medical complications caused by diabetes, Berger said.

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