By Fernando Guerra, MD, MPH
The San Antonio Metropolitan Health District (SAMHD) has been an early and enthusiastic supporter of the need to establish a state-wide Diabetes Registry. In 2006 this recommendation was accepted by City Council and was included in the City’s package of legislative initiatives to be considered during the 80th Legislative Session in Austin.
The proposed legislation would mandate Diabetes Mellitus as a reportable disease and establish a pilot project which develop and operate the new registry under the auspices of SAMHD.
Diabetes is a chronic disease which has reached epidemic proportions nationwide. In 2005, an estimated 20.8 million persons in the U.S. had diabetes, although the illness had been diagnosed in only two thirds of these individuals. In Texas, it is estimated that we have 1.7 million cases.
Older people, blacks, Hispanics and members of some other ethnic groups are disproportionately affected.
Nationally, nearly $132 million is spent annually by families coping with diabetes. There is a renewed interest among public health professionals to address the challenges posed by all chronic diseases. Diabetes represents a health problem that is rapidly escalating and without appropriate and timely action threatens to spiral out of control.
By establishing a Diabetes Mellitus Registry, SAMHD could share information and health recommendations to the public and medical practitioners alike.
Our experience with the Texas Cancer Registry demonstrates the proven benefits that can result from being able to track the prevalence, severity, treatment options and economic impact associated with the disease. In addition, it can yield important information on the most effective prevention strategies and the types of targeted outreach and education initiatives most appropriate for various high risk groups.
The Registry would be created by requiring clinical laboratories to electronically report all Hemoglobin A1C (HbA1C) values to SAMHD. That laboratory test shows an individual’s level of control over the disease or non-compliance. By having access to this type of information, SAMHD could help promote more discussion and public information programs about the long-term healthcare problems associated with diabetes in the community.
Maintaining a Diabetes Registry would require additional staff members, plus an investment in an electronic tracking system capable of analyzing and storing a large volume of data. Clinical laboratories and SAMHD, along with other diabetes-support organizations would work to develop an appropriate methodology for electronic exchange of data.
Special efforts will be made to address concerns relating to security and confidentiality of patient records. A unique identification code will be included in the program design for added protection. Funding sources, personnel and technology still need to be identified, possibly through local collaborations.
Currently, SAMHD has access to a secure network to report data on more than 70 reportable conditions. Reports on communicable diseases such as pertussis or typhoid are faxed directly from local laboratories to SAMHD’s epidemiology staff.
The volume of data that would be generated by such a registry – tracking individual patient Hemoglobin A1C
levels over many years – will require a sophisticated level of technology. The State of Vermont and the City of New York are the only other jurisdictions to have begun this vital process. We will be studying their systems, protocols and experiences as we go about developing our pilot project. Given the prevalence of this disease locally, San Antonio should be a leader in Texas for helping to track and analyze the medical and economic impact of diabetes.
Without this legislation, public health officials across the state must rely on data that are difficult to obtain and substantiate. As San Antonio’s public health authority, SAMHD feels strongly that this legislation is important to the department’s ability to accurately advise public officials and the community at large on the impact and risk factors associated with this disease.
This proposed legislation has the
support and endorsement of the Texas Diabetes Council and others active in the treatment of diabetes. It is our hope that our local physicians, as well as the wider healthcare community, will recognize the merits of this proposal and lend it all the support necessary to assure that it becomes law.
Fernando Guerra, MD, MPH is the Director of San Antonio’s Metropolitan Health District.
