Sukumar Nagendran, MD

The Affordable Care Act (ACA), signed into law five years ago, is credited with expanding health insurance coverage in the United States, according to reports published last month by the U.S. Department of Health and Human Services and the U.S. Government Accountability Office. The data shows that 

of American adults were uninsured in March 2015, compared to 20% when the ACA’s first open-enrollment period occurred in October 2013.

But lowering the number of people who are uninsured was never in and of itself the end goal of the ACA. The ACA was premised on the theory that expanded access to health insurance would facilitate greater access to health services, thereby leading to earlier detection and treatment of disease for a larger number of people. With earlier diagnosis and treatment come better health outcomes and lower costs, both for the individual and society as a whole. 

As a physician, an active member of the board of the American Diabetes Association Research Foundation, and a patient with Type 2 diabetes for 20 years, many of my personal and professional goals have focused on controlling diabetes, educating others, and contributing to the development of drugs to treat diabetes, one of our country’s most prevalent chronic diseases. I have been greatly influenced by the wide body of research which demonstrates that improved outcomes in diabetes care are associated with identification and intervention at the earliest, and thereby most treatable, stages of the disease.

While the ACA has been the subject of five years of spirited dialogue, new evidence is emerging that suggests expanded access to care under the ACA may be having an impact on early identification of diabetes. A new study published in Diabetes Care, based on more than 430,000 de-identified results of patients with newly identified diabetes based on lab testing for hemoglobin A1C, a well-established clinical marker of diabetes, showed that people in states that expanded Medicaid under the ACA were far more likely to be newly identified with diabetes than in states that elected not to expand Medicaid. Under the ACA, states can choose to expand Medicaid to include a larger percentage of uninsured adults, and today more than half and Washington, D.C., have expanded Medicaid in this manner.

According to the analysis by my medical colleagues at Quest Diagnostics, the rate of diagnoses of newly identified diabetes surged 23% in Medicaid patients in expansion states, but increased less than half a percent (0.4%) in those states that opted out of expansion during six months after Jan. 1, 2014, when Medicaid expansion was permitted under the ACA.

The findings are noteworthy for several reasons. First, diabetes is a condition that has reached epidemic proportions. More than 29 million people in the United States have the disease, and an estimated additional 86 million have pre-diabetes, but do not know it, according to the Centers for Disease Control and Prevention.
 



The Quest research team found the newly identified patients with diabetes were more likely to be identified at earlier stages in states that expanded Medicaid than in those that did not. Through identification of more new patients with early diabetes, patients may be able to better manage their condition through a combination of lifestyle changes and drug therapy to prevent the progression of the disease to co-morbid conditions, including heart disease, chronic kidney disease, blindness and amputation.

Additionally, the improved rates of diabetes diagnosis observed in the study in states that expanded Medicaid would likely extend to other chronic diseases, such as hypertension and chronic kidney disease. Like diabetes, these conditions, when left undiagnosed and untreated, can produce significant health consequences for patients and their families, not to mention billions of dollars in healthcare costs and decreased productivity. The study suggests that expanding access to care may offer greater opportunity to identify more diseases at early and treatable stages, improving individual health as well as population health.

The diabetes epidemic takes a significant financial toll in the United States in terms of health care and lost productivity-by some estimates, $322 billion annually. My interactions with thousands of other patients with diabetes and my personal experience show me that it also causes unquantifiable human suffering.

It is my fervent hope that the combined efforts of researchers, physicians and policymakers will have a measureable difference in the rate of newly diagnosed diabetes for the next generation. As long as these efforts are informed by objective science, I will have hope that we are headed in the right direction.

Sukumar Nagendran, MD, is vice president, medical affairs, for Quest Diagnostics, the world’s leading provider of diagnostic information services. More than one in three American adults benefit from the company’s diagnostic test services each year. Dr. Nagendran is on the board of the American Diabetes Association’s Research Foundation and Chair of the NJ ADA Board. In 2014, the American Diabetes Association and the Father’s Day Council honored Dr. Nagendran with their Father of the Year Award.

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In this blog, the vice president of medical affairs for Quest Diagnostics discusses how Medicaid expansion has impacted diabetes diagnoses.

Author | Sukumar Nagendran, MD

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How health policies are impacting diabetes diagnoses