a test, you have to do something with it.'"

For those with diabetes, testing the blood sugar at home daily will also aid in control.

ECLRS on Alert

Physicians, health-care facilities and licensed clinical laboratories are already required by law to report all pertinent facts to public health authorities whenever a New York resident is examined to determine blood lead level, or when results are positive for a reportable communicable disease or cancer.

The New York State Department of Health collects this information at the state level using the Electronic Clinical Laboratory Reporting System (ECLRS) -- a single electronic Web-based system for secure and rapid transmission of the above information.

In the collection of hemoglobin A1c results, the testing laboratory accesses the ECLRS through New York's Health Provider Network (HPN), a password-protected Web site, and manually enters test results or uploads a special data file.

The HPN is a secure network that meets the Health Insurance Portability and Accountability Act of 1996 and New York state health data security policy requirements.

"We have the infrastructure to collect large quantities of data for all of the communicable lab values, and lead," Berger said. "So we'll be asking labs to tack on one extra lab value. If the recommendation is that people get an A1c two to four times a year, we anticipate getting millions of A1cs in."

This large amount of data will be useful from a surveillance perspective, Berger said, so the DPCP and the New York City Department of Health can get a sense of pocket areas in New York City where patients' blood sugar control is better or worse, and how they can focus more resources on those areas.

"The reason the commissioner is approaching this so seriously is [that] this type of collection of A1c has never been done anywhere -- in the country or the world -- on a population level," Berger said. "Traditionally the New York City Department of Health, and all departments of health, have focused on diseases that killed people 100 years ago, so for him to start thinking about prevention and control of chronic disease is very forward-thinking."

Targeting Type 2

Of New York City residents diagnosed with diabetes, approximately 95 percent have type 2 diabetes. With type 2, according to the American Diabetes Association, either the body does not produce enough insulin or the body's cells ignore it.

Because the majority of those with diabetes have type 2, that's where the Department of Health is focusing its efforts.

"With type 2, you have diabetes an average of five to seven years before you're diagnosed, and type 1 is usually very rapid," Berger said. "In the very early stages [of type 2], the symptoms are milder and vague, nonspecific -- some fatigue or being more prone to infection. It's not the severe weight loss you get with type 1 or the severe thirst. It's kind of slow and insidious with type 2, and that's why people can go for so long and not even present to the doctor that they're not feeling well."

And the longer one goes without being diagnosed, the more the disease takes a toll on the body, and the more likely complications -- such as heart disease, stroke, kidney failure and amputations -- will arise in the future.

Privacy Problem?

Concerns about patient privacy cover the spectrum, Berger said, adding that the Department of Health has a 150-year history of handling and collecting very sensitive and confidential medical information without any breaches.

"Any information collected will only be released to the ordering clinician and the patient, so any fears around it being released to health insurance, or life insurance, or department of motor vehicles --

Jessica Jones  |  Managing Editor