July - August 2009

Nation’s Second Public Health Diabetes Registry Yields Greater than Expected Results

When Metro Health officially announced a plan to gain a sharper focus on the diabetes epidemic that is impacting our community, leaders conservatively estimated 50,000 entries in a diabetes registry. Those estimates changed as the department began receiving data from four local laboratories.

The biggest challenge was getting all four labs online but once the data started pouring in earlier hurdles were quickly forgotten. The registry is exceeding expectations with nearly 230,000 unduplicated patients as of April 1, three short months after all labs came online.

The Hemoglobin A1c (Diabetes) Registry allows Metro Health to conduct population surveillance of the disease in Bexar County by receiving hemoglobin A1c test results from local laboratories. The A1c test serves as a medical marker, indicating how well a diagnosed diabetic is managing his or her blood sugar levels over a period of time.

This initiative could be a start-up model for Texas to assess populations at risk from death or disability due to diabetes and to determine how the disease is being managed. The chronic health condition is resulting in a growing number of amputations, visual impairments, kidney failures, and other complications.

Registry data will help identify areas of the local population that are challenged with maintaning good diabetic control, the extent of areas at risk, and possible target areas for future diabetes research and education.

Initially an 18-month, State-authorized pilot project (House Bill 2132; 2007 session), the registry made diabetes a reportable disease for the first time ever in any area of Texas. Due to an extension in the most recent legislative session, the pilot will be extended into 2010 and more clinical data will be collected to help assess if the patient is truly a diabetic.

Then-Representative Joe Straus authored HB 2132 to make the pilot possible, with Senator Leticia Van de Putte sponsoring the legislation. Representatives Roland Gutierrez and Joaquin Castro authored HB 1363 for the extension. Sen. Van de Putte sponsored the bill while Sen. Carlos Uresti co-sponsored the legislation.

At the pilot’s conclusion, a summary report will ultimately be given to the governor and legislature.

The registry is the second such public health registry in the nation, with New York City initiating the first one. It is now a model for other areas of the country.

Additional Info
Currently, a snapshot of diabetes shows the following impact locally and statewide:

Local
 Rate is twice that of the nation’s – 14% compared to 7%
 Death rate is second-highest of the 54 largest U.S. cities
State
 Affects 1.3 million adult Texans and another potential 418,000
 Results in 30 deaths for every 100,000 people annually
 6th leading case of death, 4th leading case for Hispanics and African Americans
 Cost $3.7 billion for hospitalizations alone in 2003
 Second most common chronic childhood disease after asthma

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