The seven practices participating in the pilot project are of varying types, ranging from a large practice linked with an academic medical center to a small community health center and a small private practice.
Patients are stratified by success of glycemic control, with hemoglobin A1c levels less than 7% representing “good control” (the target recommended by the ADA), levels between 7% and 9% reflecting “poorly controlled” diabetes, and levels over 9% representing “very poorly controlled” diabetes.
“It's still very arbitrary,” Dr. Berger said. “We're [providing] a population-based snapshot of the provider's panel. … A provider [can look at the report] and say, 'here are my 15 patients who are doing particularly poorly. Maybe they need to be on insulin, or maybe they need to see a nutritionist.'”
It is too early to know, she and others say, exactly what the practices will do with the reports and what impact the information will have on disease outcomes.
Dr. Donald A. Smith of Mount Sinai School of Medicine said he's hopeful that the program will spur physicians to “get the patients who are lost and out of control back in” for help.
“It will be interesting to see how the sophistication of the report [evolves],” he said. “Publishing the average A1c by physician would be interesting. … It's incredible how, with stenting and angioplasty, [such physician profiling] has stimulated competitive efforts to improve.”
Dr. Berger said she has received calls from health officials in other municipalities who are seeking advice on starting similar registries.
“My advice is, wait to see what our experience is first. … It has great potential, but we need to implement it and evaluate it first.”
ELSEVIER GLOBAL MEDICAL NEWS
Survey: 13% of Adult New Yorkers Are Diabetic
Those who are awaiting an official description of data being collected in New York City's hemoglobin A1c registry have some other striking data to digest while they wait: A new citywide survey modeled after a well-known national survey finds that nearly 13% of the city's adults have diabetes and that about one-third of them—almost 4% of city residents—do not know it.
The first New York City Health and Nutrition Examination Survey (HANES)—and the first community-level HANES survey in the country, health department officials say—used a one-time screening test to estimate diabetes prevalence among approximately 2,000 randomly selected New Yorkers from 144 neighborhoods across all boroughs.
The survey findings confirm past estimates from telephone surveys that about 9% of adults in the city have been diagnosed with diabetes, slightly higher than the 7.3% of adults who have diagnosed diabetes nationwide.
But the laboratory results obtained as part of the HANES survey go further, revealing that an additional 3.8% of adults in New York City have undiagnosed diabetes (compared with 3% of adults nationally).
The survey also shows that another 23.5% of adults have prediabetes and that nearly half of all Asian New Yorkers have either diabetes or prediabetes, according to press officials at the New York City Department of Health and Mental Hygiene.
The prevalence of diabetes among Asians, the survey shows, is 16% (nearly 1 in 6). Significantly more Asians—32%–-have prediabetes compared with other ethnic groups. (See chart.)
The higher overall prevalence numbers are “not surprising, [since] we have an extremely ethnically diverse population,” said Dr. Berger.
The high prevalence among Asians specifically, she said, is “somewhat” surprising, though some Asian groups, particularly Southeast Asians, are known to be susceptible to the development of diabetes. “Unfortunately our sample size wasn't large enough to tease out the various Asian groups,” she said.
Among men and women of all ethnicities who have diabetes, the findings show, 52% have well-controlled diabetes (A1c less than 7), 32% have moderately poorly controlled blood sugar, and about 16% have very poorly controlled blood sugar (A1c greater than 9%).
Poor diabetes control appears to be common even among people with access to health care. Of New Yorkers with diagnosed diabetes that is uncontrolled, 94% have some sort of health insurance, including Medicaid.