For the First Time, NYC Health + Hospitals Reaches 70% of Patients in Primary Care with Controlled Type 2 Diabetes – NYC Health + Hospitals

Report on NYC Health + Hospitals’ Progress in Diabetes Management and Contribution to Sustainable Development Goals

A recent report from NYC Health + Hospitals indicates a significant milestone in public health management, directly contributing to the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). For the first time, the health system has achieved a 70% control rate for primary care patients with type 2 diabetes. This achievement is critical for reducing premature mortality from non-communicable diseases (NCDs) and addressing health inequalities within the urban population, aligning with SDG 10 (Reduced Inequalities).

Alignment with SDG 3: Good Health and Well-being

Milestone Achievement in Non-Communicable Disease (NCD) Management

The successful control of type 2 diabetes in a majority of patients is a direct contribution to SDG Target 3.4, which aims to reduce premature mortality from NCDs through prevention and treatment. Effective diabetes management is crucial for preventing severe complications and promoting long-term well-being.

• Key Achievement: 70% of primary care patients now have their type 2 diabetes under control (A1C level below 8.0%).
• Health Impact: This control rate significantly reduces patient risk for diabetes-related complications such as cardiovascular disease, kidney disease, blindness, and lower-extremity amputations.
• Recognition: The American Heart Association conferred the “2025 Target: Type 2 Diabetes Gold award” upon twenty-three of the system’s primary care sites, validating the high quality of care.

Programmatic Impact and Scale

Two key initiatives, the Collaborative Drug Therapy Management Program and the Treat to Target Program, have been instrumental in achieving this goal by expanding access to quality, personalized healthcare services, a core component of SDG Target 3.8 (Universal Health Coverage).

• Collaborative Drug Therapy Management Program: In the last year, this program served over 9,000 patients through more than 35,000 visits.
• Treat to Target Program: This nurse-led initiative served nearly 24,000 patients, completing over 63,000 visits in the same period.

Addressing Socioeconomic Disparities (SDG 1 & SDG 10)

Targeting Health Inequalities

The initiative actively works to reduce health inequalities (SDG 10) by providing robust care in a city where diabetes disproportionately affects vulnerable communities.

• Context: Adults residing in high-poverty neighborhoods are at least twice as likely to have diabetes compared to those in low-poverty areas.
• Equity Focus: By making comprehensive diabetes management accessible, NYC Health + Hospitals helps close the health outcome gap between different socioeconomic groups.

Mitigating Economic Burdens

Effective management of chronic diseases like diabetes can alleviate significant financial strain on individuals and families, contributing to poverty reduction efforts (SDG 1).

• Economic Impact: The average annual medical expenditure for a person with diagnosed diabetes is approximately $19,736.
• Financial Relief: Proactive and preventative care reduces the need for costly emergency interventions and long-term complication management, lessening the economic burden on patients.

Comprehensive Care Model and Strategic Partnerships (SDG 17)

Integrated Support Systems

NYC Health + Hospitals employs a multi-faceted, collaborative approach, reflecting the spirit of SDG 17 (Partnerships for the Goals), by integrating various services to provide holistic patient care.

1. Clinical Pharmacists in Primary Care: Pharmacists are integrated into care teams to help manage complex medication regimens.
2. Treat to Target: An intensive, nurse-led program for patients needing focused support.
3. Chronic Disease Outreach: Proactive contact with patients to ensure engagement in their care plans.
4. Community Health Workers: Staff who address social determinants of health, such as housing, food, and financial needs.
5. Teleretinal Screening: Integrated screening during primary care visits to prevent diabetic retinopathy.
6. Text-Based Support: Digital tools for insulin adjustment and medication transition support.
7. Educational Support: In-person classes, one-on-one sessions, and dietitian support.
8. Lifestyle Medicine Program: A program focused on plant-based diets, physical activity, and stress management.
9. Diabetes Prevention Program: A structured program for patients with prediabetes.
10. Weight Management: Services including bariatric surgery to improve metabolic health.
11. Specialty Referrals: Coordinated access to endocrinologists, cardiologists, nephrologists, and other specialists.

Case Studies: Patient-Level Impact

Case Study 1: Collaborative Drug Therapy Management

• Patient: Chateranie Shivram
• Challenge: A 20-year struggle with type 2 diabetes and an initial A1C of 11.1%.
• Intervention: Monthly meetings with a clinical pharmacist to simplify her medication regimen and provide education on diet and physical activity.
• Outcome: A1C improved to 6.7%, daily medications were reduced from six to two, and insulin dose was lowered by approximately 40%.

Case Study 2: Treat to Target Program

• Patient: Jaime Siesquen
• Challenge: An initial A1C of 7.6% and a need for education on diabetes management.
• Intervention: Worked with a nurse to understand insulin, monitor blood glucose, and make dietary and exercise adjustments.
• Outcome: Within 3 months, A1C dropped to 6.6% and the patient lost 14 pounds.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This is the primary SDG addressed in the article. The entire text focuses on improving health outcomes for patients with type 2 diabetes, a non-communicable disease. The article details the success of NYC Health + Hospitals in controlling the disease, thereby preventing serious complications like heart disease, kidney disease, blindness, and amputations, which directly contributes to ensuring healthy lives and promoting well-being.

• SDG 10: Reduced Inequalities

  The article implicitly addresses this goal by highlighting disparities in health outcomes. It states, “Adults living in high-poverty neighborhoods are also at least twice as likely to report having diabetes compared to adults living in low-poverty neighborhoods.” By implementing programs that successfully manage diabetes for a large and diverse patient population, including those in underserved communities, NYC Health + Hospitals is working to reduce health inequalities and ensure that quality care is accessible to all, regardless of their economic status.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   The article directly relates to this target. The programs described, such as the “Collaborative Drug Therapy Management Program” and “Treat to Target Program,” are treatment initiatives aimed at managing type 2 diabetes. The article emphasizes that “Poorly controlled diabetes can cause heart disease, kidney disease, and complications like blindness and amputations,” and that “Most diabetes-related deaths are due to cardiovascular disease.” By achieving a 70% control rate, the health system is actively working to prevent these complications and reduce premature mortality from this non-communicable disease.

2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   The article showcases the provision of quality essential healthcare services. NYC Health + Hospitals, as a large municipal system, provides a “robust network of outpatient, neighborhood-based primary and specialty care centers.” The various programs listed, from clinical pharmacist support to teleretinal screenings and lifestyle medicine, represent a comprehensive toolkit of services designed to make high-quality diabetes care accessible to its one million patients.

3. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

   This target is relevant because the health system’s mission is to “deliver the highest quality care to NYC, without exception.” The article notes the higher prevalence of diabetes in high-poverty areas. By successfully implementing these programs across its entire network, which serves diverse boroughs and populations, the system is actively reducing health disparities and promoting the inclusion of economically disadvantaged groups in receiving high-quality health outcomes.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicators for Target 3.4

  The article provides several clear, quantitative indicators to measure progress in treating non-communicable diseases:

  1. Percentage of patients with controlled diabetes: The headline and body of the article state that “70% of its primary care patients have their type 2 diabetes controlled.”
  2. Clinical measurement for control: Progress is measured by a specific clinical value, “an A1C level below 8.0%.”
  3. Individual patient A1C reduction: The article gives specific examples of progress, such as one patient’s A1C improving from 11.1% to 6.7% and another’s from 7.6% to 6.6%.
  4. Reduction in medication dependency: The case of Chateranie Shivram, who simplified her regimen “from six medications a day to two and reduce her insulin dose by approximately 40%,” serves as an indicator of improved health and well-being.

• Indicators for Target 3.8

  The article implies indicators related to the coverage and reach of essential health services:

  1. Number of patients served: The “Collaborative Drug Therapy Management Program served over 9,000 patients” and the “Treat to Target Program served nearly 24,000 patients” in the last year.
  2. Volume of healthcare interactions: The programs completed “over 35,000 visits” and “over 63,000 visits,” respectively, indicating the scale of service delivery.

• Indicators for Target 10.2

  Progress towards reducing health inequalities is measured by:

  1. Equitable health outcomes: The achievement of the 70% control rate across the entire NYC Health + Hospitals system, which serves a diverse population including those in high-poverty neighborhoods, is a key indicator that quality care is reaching and benefiting groups that are disproportionately affected by diabetes.

4. SDGs, Targets, and Indicators Table

Source: nychealthandhospitals.org