Facing the diabetes epidemic--mandatory reporting of glycosylated hemoglobin values in New York City.

n engl j med 354;6 www.nejm.org february 9, 2006 545 the long term and other major risk factors, such as hypertension, cigarette smoking, obesity, and elevated levels of cholesterol or blood lipids. Although physicians know how to treat diabetes in individual patients, overall progress against the epidemic requires widespread improvement in glycemic control, as underscored by the recent finding that intensive insulin therapy reduces the risk of cardiovascular disease among patients with type 1 diabetes.1 In 2005, an estimated 20.8 million persons in the United States, or about 7 percent of the population, had diabetes, although the illness had been diagnosed in only about two thirds of these people, according to the Centers for Disease Control and Prevention (see line graph). Older people, blacks, Hispanics, and members of some other ethnic groups are disproportionately affected. Diabetes is the sixth most common cause of death in the United States and was the fifth most common cause in New York City in 2004. In December 2005, the New York City Board of Health approved a novel response to the diabetes epidemic: mandatory electronic reporting of glycosylated hemoglobin values by laboratories to the city’s Department of Health and Mental Hygiene. The requirement, which took effect on January 15, 2006, was promulgated under the department’s statutory authority to report and control chronic diseases and to regulate clinical laboratories. The endeavor has aroused concern about patients’ privacy and raised questions about the role of health departments. However, Thomas Frieden, the city’s health commissioner, said the aim is to respond to an epidemic of a chronic disease with the type of surveillance and other tools that health departments routinely use to prevent and control communicable diseases. As he explained in an interview, “We have to get a better handle on what is really the only major health problem in the United States that is getting worse, and getting worse rapidly.” There are an estimated 530,000 adults in New York City with diagnosed diabetes. About 9 percent of adults report having received a diagnosis of diabetes; in the Facing the Diabetes Epidemic — Mandatory Reporting of Glycosylated Hemoglobin Values in New York City