Patients of those providers also are receiving letters from the health department—imprinted with the name of the practice—indicating their HbA1c level, stratified by green (less than 7%), yellow (7%–9%), and red (above 9%). Patients can elect not to receive the letters, but fewer than 20 individuals have done so in the 3 years since the program began, Dr. Chamany said.
Indeed, while there was a great deal of concern voiced about privacy when the registry was launched, this doesn't appear to be a big problem now. “Whenever you have mandatory reporting, there is concern. We do get occasional questions about how the information is protected, but we're not getting a huge flood of opt-outs,” she noted.
The health department is planning to conduct interviews with medical directors of health care facilities around the city to find out how the reports are being received and aims to publish that information—along with the first 3 years' worth of registry data—later this year, she said.
In the meantime, the agency is moving forward with a pilot project designed to bring diabetes self-management to local communities. The 16-week course will focus on goal-setting skills for patients with diabetes relating to lifestyle modification. It initially will be piloted in Harlem, then expanded if all goes well. “One thing physicians have told us is they need services to refer patients to, Dr. Chamany commented. “There are … just not enough [providers] to do education,” Dr. Chamany commented.
And, with regard to the less-than-optimal data indicated by the NYC HANES, “We need more creative ways to get self-management support out there. Otherwise, those numbers aren't going to move.”
'The Big Apple is sugarcoated, and improvements in … lifestyle will be needed to improve this situation.' DR. WILSON
NYC's Diabetes Numbers Show Room for Improvement
The NYC HANES data revealed some telling facts about New York City's diabetic population.
Diabetes prevalence in NYC HANES increased with age, from 2.5% among those aged 20–39 years to 28.3% among adults aged 60 years and older, but did not differ significantly by sex, race/ethnicity, or nativity. Diabetes prevalence was significantly higher among those with incomes less than $20,000 versus those above that figure (17.0% vs. 9.1%).
The prevalence of diagnosed diabetes was 8.7% and undiagnosed diabetes, 3.8%, indicating that nearly one-third (30.4%) of adults with diabetes were undiagnosed. Blacks and Asians had the highest prevalence of diagnosed diabetes (12.1% and 11.4%, respectively), while the rate of diagnosed diabetes was significantly lower among whites (6.2%), compared with blacks.
Nearly one-fourth (23.5%) of the adults had impaired fasting glucose (defined as a fasting glucose level of 100–125 mg/dL). This also increased with age, reaching more than one-third of the population aged 60 years and older. Men had higher levels of IFG than did women (29.6% vs. 18.4%), and Asians had the highest rate of IFG of all racial and ethnic groups, at 32.4%.
After adjustment for other risk factors, Asians and blacks with normal weight (body mass index of less than 25 kg/m
Indeed, other published studies also have pointed to the fact that Asians—particularly those from south Asia, including India, Pakistan, and Bangladesh—tend to have higher levels of glucose impairment than do other races/ethnicities at lower BMIs. “It's very difficult to tease out, but there is probably a sufficient accumulation of literature suggesting that screening of these individuals should happen at lower weights, although the exact cutoff is not known,” said Dr. Lorna E. Thorpe.
Looking beyond prevalence to risk factor control, NYC HANES revealed that more than half of the adults with diagnosed diabetes (55.1%) had an HbA1c value of 7% or higher, and 17.1% had an HbA1c greater than 9%. A total of 12.3% were on insulin (with or without oral agents), 71.5% were on oral agents only, and 16.1% were not taking diabetes medications. Only 15.8% of those with HbA1c levels above 9% were taking insulin. “Our findings suggest that providers in New York City should consider insulin therapy earlier in the course of their patients' disease,” the investigators wrote.
More than two-thirds (69.7%) the adults with diagnosed diabetes were identified as hypertensive, and half (50%) had elevated blood pressures at the time of the interview. Of those with diabetes and elevated blood pressure, 43.1% were not on antihypertensive medications and 35.4% had not been diagnosed with hypertension. Similarly, nearly two-thirds with diagnosed diabetes had elevated LDL cholesterol levels, of whom three-fourths were not taking cholesterol-lowering medications and 42.8% were undiagnosed for hypercholesterolemia.
“All in all, the 2004 NYC HANES picture does not look so nice,” Dr. Peter W. F. Wilson and Dr. K.M. Venkat Narayan said in their editorial.