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Paula M. Trief, PhD

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In reply

Flansbaum asks for information about interventions that will pass the "ethical ‘sniff test’ and assure the efficient use of taxpayer dollars." We proposed several alternative uses for the estimated $2.3 million spent on the New York City diabetes registry, but he questions the evidence supporting them. In fact, there is quite a bit of evidence supporting the benefits of various types of interventions both in terms of improving glycemic control and quality of life. Evidence supports diabetes education,¹ training in self-management,² various quality improvement strategies,³ and others. Evaluation of public policy interventions is best left to policy analysts. However, even if the diabetes registry is beneficial, the potential risks and ethical concerns we identify (eg, risks to patient autonomy, physician-patient relationships, adherence, discrimination, and confidentiality) are more than a "sniff test." We believe they must be at the heart of the discussion.

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Mandated Diabetes Registries Will Not Benefit Persons With Diabetes
Paula M. Trief and Richard A. Ellison
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Bradley Flansbaum
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