Dec. 14 (Bloomberg) -- New York City health officials will create a database to monitor the blood-sugar levels of about 500,000 diabetics, alerting them and their doctors to changes in condition and helping them obtain medical care.

The program approved by the Board of Health today, the first of its kind for a patient population as large as New York's, will require laboratories to send the health department blood test results showing any abnormally high level of hemoglobin A1C, a three-month average measure of glucose indicating diabetes. The department will then notify patients and their doctors.

As many as 250,000 more of New York City's 8.1 million residents have diabetes and don't know it, Health Commissioner Thomas Frieden said. The disease, a leading cause of kidney failure, blindness, amputations and death, costs the U.S. more than $132 billion a year, including $40 billion in lost productivity, according to the American Diabetes Association.

``The advantage is that for the first time we'll know the scope of the problem,'' Frieden said in an interview Nov. 22. ``We're in the middle of an epidemic. Cases have nearly tripled in the past 10 years. I can't tell you what portion of how many people are in poor control. Ninety percent don't know themselves.''

The program will cost about $1 million to establish, and reporting of test results will begin as soon as possible, health department spokesman Andrew Tucker said. The cost doesn't include a pilot treatment plan to begin in 2007 in the Bronx, where surveys have found at least 18 percent of adults have diabetes.

Officials will work through 270 public and private health workers in the borough.

Every Three Months

Under the system, which Frieden said will be voluntary, laboratories will relay laboratory results indicating HA1C levels of 9 percent to patients and the physicians who ordered the tests. A healthy measurement would be less than 6 percent, according to the American Diabetes Association.

After the diagnosis, the patient will be referred to the private physician who ordered the test or to a community clinic. Follow-up care might include at-home testing kits, medicine, exercise regimens and nutritional counseling designed to bring the HA1C level down.

The patient's blood-sugar level will be tracked every three months, with alerts sent to the doctor and the patient in the event the 90-day period expires without a follow-up blood test.

Opposition

Those opposed to the plan, including the Association of American Physicians and Surgeons, the National Lawyers Guild and the National Libertarian Party, express concern that the registry could lead to higher insurance premiums for patients or denial of life, health or car insurance coverage.

``This tracking plan would appear to violate each citizen's right to medical informational privacy,'' those groups said in an August letter to the Health Department.

Scott Strumello, a consultant to credit card companies who described himself as a Juvenile Diabetes Research Foundation advocate, said the city program had ``unrealistic expectations.''

``I doubt the city will be in the position to provide the testing kits, drugs, medical care and follow-up these patients would need,'' he said. ``I also doubt if companies can't keep their identity information of credit-card holders confidential, that a big city government will be able to apply the necessary controls to protect patients' privacy.''

Not Aware

Frieden said he understands such concerns and will work to provide the necessary safeguards -- including the choice for doctors and patients to opt out of the system.

According to a citywide telephone survey conducted by the Health Department last year, 89 percent of those who knew they had diabetes remained unaware of their A1C level. Of those who did know, 9 percent reported levels indicating high, uncontrolled blood sugar levels, Frieden said.

A laboratory that fails to report blood-sugar results to the city would be in violation of the city's health code, bringing warnings and possible fines, department counsel Wilfredo Lopez said.

The Health Department already requires the reporting of individuals diagnosed with contagious diseases such as tuberculosis and Hepatitis C, and non-communicable conditions such as cancer, lead poisoning and low-birth weight.

The commissioner works in the administration of Mayor Michael Bloomberg, founder and majority owner of Bloomberg News parent Bloomberg LP.

To contact the reporter on this story: Henry Goldman in New York City Hall at hgoldman@bloomberg.net.

Last Updated: December 14, 2005 16:28 EST