Diabetes continues to garner more attention, this time in NEJM with a story about mandatory A1C reporting in NYC. This is a good piece - the full text is available online and there is an interview with Dr. Thomas Frieden, New York City Health Commissioner, who points out how astonishing the growth of diabetes and obesity have been and that it was never expected that a non-communicable condition like this could get worse so rapidly. There definitely seems to be growing energy behind disease reporting and the idea that disease reporting could be an end to better intervention. They are trying to discern, through the reporting, who has diabetes, who is in control, out of control, ages, geographies, providers - all to the end that better information will help them help people faster and help reduce the population A1C in the city.
The attention on A1C is great to see, especially because so much progress is needed. Unbelievably, the piece points out that "In New York City, 89 percent of adults with diagnosed diabetes do not know their glycosylated hemoglobin values, according to a survey the health department conducted in 2002." There is of course a focus on costs, as there always will be - the piece ends by noting that "If the city's information system works well and patients' confidentiality is maintained, the registry initiative could be a first step toward other effective — and no doubt more costly — interventions." Unfortunately, the piece doesn't note that these 'undoubtedly more costly' interventions are more than likely far less costly than the alternative, more hospital care (at $40 billion/year, these are the costs to avoid....)