New York City's diabetes prevalence and control numbers paint a dismal picture, but public health officials hope that the now 3-year-old hemoglobin A1c registry will help brighten the future for the city's nearly 700,000 adult residents living with the condition.
Newly published data from the New York City Department of Health and Mental Hygiene suggest that one in every eight adult residents in the city has diabetes, more than a third don't know it, and even among those who are aware they have the condition, few achieve adequate control of glucose, blood pressure and cholesterol levels (Diabetes Care 2009;32:57–62).
“Adult New Yorkers are at least as overweight or obese as has been reported recently in [United States] national data, and the prevalence of diabetes and impaired fasting glucose causes great concern. The Big Apple is sugarcoated, and improvements in obesity and lifestyle will be needed to improve this situation in the future,” Dr. Peter W.F. Wilson and Dr. K.M. Venkat Narayan, both of Emory University, Atlanta, said in an editorial accompanying the report (Diabetes Care 2009;32:204–5).
Indeed, improving the prospects for people with diabetes—and those at risk for it—has been deemed a high priority for the city's health department, under the leadership of Dr. Thomas Frieden. As part of that effort, on Jan. 15, 2006, the city implemented a rule requiring clinical laboratories to report all hemoglobin A1c (HbA1c) testing results electronically to the health department. Since then, more than 3 million results have been collected from more than 1 million individuals, Dr. Shadi Chamany, director of the department's diabetes prevention and control program, said in an interview.
“The original goal of the registry was to use public health tools to support the clinical community and the patient community in improving diabetes outcomes. … This is a starting point, a building block. It's the foundation,” Dr. Chamany said.
Beyond merely collecting the data, the health department offers quarterly reports of HbA1c results to providers and patients who opt to receive them and is also working in person with practices and providers to support diabetes management. “One thing I think has been really great about this project is that we're learning so much as we go out to all the practices and people are telling us what's going on and what they really need. … I think that as we're going out and reaching so many people, we're also raising awareness,” Dr. Chamany said. “I think this mobilizing of resources and efforts is really going to make a change.”
Clearly, improvement is needed. The newly released prevalence and control data come from another New York City health department project, the first-ever community-level Health and Nutrition Examination Survey (NYC HANES), a cross-sectional examination survey modeled after the National Health and Nutrition Examination Survey (NHANES) conducted annually by the Centers for Disease Control and Prevention. The NYC HANES data were obtained from face-to-face surveys and physical examinations conducted during June-December 2004 with 1,999 randomly selected adults aged 20 years and older (out of a total 3,047 eligible).
Based on the NYC HANES data, the estimated prevalence of diabetes for all New Yorkers aged 20 years and older was 12.5%, representing a population of approximately 696,000. This prevalence is significantly higher than the published NHANES estimate of 9.3% from 1999–2002. This difference is not likely to be caused by an increase in the national number; rather, there was a 17% increase in self-reported diabetes among New Yorkers between 2002 and 2004, whereas national rates did not increase significantly. The high concentration of poverty and racial/ethnic diversity most likely contributes to New York City's increasing diabetes prevalence, Dr. Lorna E. Thorpe and her associates said. (See sidebar for specific numbers.)
Given that these data are now 5 years old, the health department would like to conduct a follow-up, but it won't be easy because of current financial constraints, said Dr. Thorpe, deputy commissioner in charge of the division of epidemiology at the New York City health department. “We didn't get federal support for the first NYC HANES. It was done with New York City tax dollars only. We can't pull off a second one yet. We're exploring ways for how to do it,” she noted.
But funding for the HbA1c registry is ongoing thus far, Dr. Chamany said. More than 90% of clinical laboratories in the city that conduct HbA1c testing and that already do electronic reporting for other diseases currently are reporting HbA1c results. Inclusion in the registry is mandatory for all patients with diabetes in the city, but receipt of the quarterly reports is voluntary for providers and patients. Initially, the reports were offered to just seven health care facilities serving the south Bronx, an area of the city with exceptionally high rates of diabetes. The offer now has been extended to 60 facilities around the city, and more than 1,000 individual providers are currently receiving the reports.