About a year-and-a-half ago, John Brown got very sick.

"My leg started to swell up. My feet started to hurt, from my feet to my knee caps," said the 42-year-old Brown. "It got to where I couldn't put shoes on or anything."

When he was examined at Lincoln Medical Center, the doctor gave Brown the news that tens of thousands of New Yorkers have heard at one time or another: "You have diabetes."

In the beginning, Brown wrestled with the new lifestyle the disease imposed on him: keeping track of his medicine, checking his blood sugar level and blood pressure, and writing everything down. Then Brown, of Mott Haven in the Bronx, joined HHC's House Calls program.

Patients in the program use Telehealth technology: a glucometer the size of a flip phone, a blood pressure cuff, and a modem to transmit the data by telephone to a nurse on the other end. If the readings are off, the patient gets a phone call.

"We're coming into their house through the telephone," said program director Susan Lehrer. "They're not waiting in line for an appointment so they're not inconvenienced."

And patients use regular phone calls to ask questions and raise concerns.

"Somehow the anonymity of the voice with a person who knows you allows them to say things they might not tell their doctor. It's a very honest conversation. We find them often saying, 'I haven't told the doctor but …' "

People speak honestly about why they are not eating properly or taking their medicine when they are supposed to, Lehrer said, allowing the staff to respond better. Sometimes patients don't have the money to buy the proper food, or they live in a neighborhood where the grocery stores don't sell brown rice, which is healthier than white rice. Lehrer works with the patients to get them the food and resources they need.

"She calls in to check and make sure everything is OK," Brown said. "And if I have any questions I can get in contact with her. She's been very good. This way is much easier. The other way I was doing it, I had to write everything down. It was a lot of work and it was hectic."

As is usually the case with diabetes patients, the illness runs in Brown's family. Lehrer has also talked to him about nutrition and planning his meals. He says his height is about 5' 8" and when he started the program he weighed 400 pounds. So far he has lost 90 pounds.

Patients are selected for the program if they have a reading over 7 on their A1C, the test that measures their average blood sugar over the last three months. A normal A1C range for a non-diabetic is 4 to 6, and HHC's goal is to reduce A1c readings to below 7 for diabetic patients.

Patients in the HHC House Calls program have had consistent health improvements. Nearly 70% of patients involved in the program for more than 40 days during 2008 saw significant reduction in their blood sugar levels. The average A1c reading for that group was reduced 17%, from 9.5 to 7.9. More than 430 patients at HHC have benefited from the program since 2006.

"I'm feeling good, much better," Brown said. "I'm walking around better too. I see that if I stay on the diet it's much better for me, much healthier, and hopefully, I can live longer."

February 2009