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In a bid to cut deaths, New York to monitor diabetics

NEW YORK (AP) _ Hoping to save hundreds of lives, New York adopted a health code regulation Wednesday that will make it the first American city to keep track of people with diabetes in much the same way it does with patients infected with HIV or tuberculosis.

The city will occasionally use its database to prod doctors to take better care of their patients and diabetics to take better care of themselves.

The policy breaks new ground because it involves collecting information about people who have a disease that is neither contagious nor caused by an environmental toxin. It also has raised privacy concerns in some quarters.

New York's health commissioner, Dr. Thomas R. Frieden, said the program's potential to save thousands of lives outweighs what it gives up in medical privacy.

``We will ensure that the utmost care will be taken to keep people's privacy and information protected,'' he said.

Under a revised city code passed by the Board of Health, most medical laboratories in New York will be required to electronically forward the results of thousands of blood-sugar tests to the city health department, which will then analyze the data to identify people having trouble controlling their diabetes.

Some patients might then get letters or phone calls from their doctors, prodding them to take medication, come in more frequently for checkups or change their diets.

Diabetes is the fourth-leading cause of death in the city, but people who aggressively monitor their condition are less likely to develop fatal or debilitating symptoms, including blindness, kidney failure and heart problems.

When it was first proposed last summer, the program was greeted with a mixture of excitement and trepidation.

A spokesman for the American Diabetes Association declined to comment on the plan Wednesday, saying the group needed time to review its specifics. In general, the ADA supports diabetes registries but says patients should be asked for their consent before their health information is seen by anyone other than their doctors.

Frieden said people skittish about their privacy will be allowed to opt out of the program. Details on how that process would work, however, are still being developed, city officials said.

But attorney Robin Kaigh, who is active in medical privacy issues, said her understanding was that patients could choose not to participate in one aspect of the program but could not opt out altogether. ``This is an incredible invasion of privacy,'' she said.

Privacy concerns have traditionally limited the instances in which public health agencies collect information used to identify the sick.

New York's first use of such a health registry came in the late 19th century as part of a battle against an epidemic of tuberculosis. Since then, the list of illnesses reported to city officials has steadily expanded, but it still consists mostly of contagious illnesses or ones with an environmental cause, like food poisoning.

Frieden said diabetes' status as a leading killer made it just as important to watch as any contagious disease.

Diabetes killed 1,891 New Yorkers in 2003, the last year for which figures were available.

The revised city health code will require clinical laboratories to report the results of something called an A1C test, which differs from the simple blood-sugar tests that diabetics perform in their homes.
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