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Study finds earlier diabetes diagnoses in Medicaid expansion states


People in states that expanded Medicaid under the Affordable Care Act are far more likely to be newly identified with diabetes than in non-expansion states, according to a study published online in Diabetes Care.

People in states that expanded Medicaid under the Affordable Care Act (ACA) are far more likely to be newly identified with diabetes than in states that elected not to expand the public healthcare program, according to a study published online in Diabetes Care.

The study, by researchers at Quest Diagnostics, is believed to be one of the first nationally representative analyses of the impact of the ACA in promoting earlier diagnosis of, and potentially better outcomes for, diabetes. It showed that diabetes diagnosis rates surged in states that expanded Medicaid. Newly identified diabetes in Medicaid patients surged 23.2% in Medicaid expansion states, but increased less than 1% (0.4%) in states that chose not to expand.

Patients with diabetes were diagnosed at earlier stages in states that expanded Medicaid. As a result of being diagnosed earlier, it is likely that outcomes from the disease can be improved.

Related:Texas inquires about Medicaid expansion

Kaufman“The findings of the study indicate that Medicaid expansion states have had a positive impact on providing access to care for patients that previously may not have had access or more limited access.  It’s important that healthcare professionals and decision-makers have access to data that can help inform their medical decisions,” says study lead investigator Harvey W. Kaufman, M.D., senior medical director, Quest Diagnostics. “Cost control is an issue that currently threatens the stability of our healthcare system. Taking preventative measures to curb costs from skyrocketing is a strategy that also, and more importantly, benefits the patient.”

Quest Diagnostics is said to manage the largest database of de-identified clinical laboratory data which is based on more than 20 billion test results. Researchers at Quest Diagnostics analyzed de-identified test results for people between the ages of 19 and 64 years of both genders across the United States who met the definition of newly diagnosed diabetes during the first six months of 2013 (prior to Medicaid expansion) and the first six months of 2014 (following Medicaid expansion). Newly diagnosed diabetes was determined based on at least one blood test for hemoglobin A1c, a marker of diabetes, greater than 6.4% or an ICD-9 code for diabetes mellitus with no prior diagnosis for the preceding year.


NEXT: Other key findings from the study


Medicaid, including managed Medicaid, was listed on the test requisition as one of the payers. The residence (state or District of Columbia) of each patient was based on the address provided for the patient at the time of testing that was used for categorization of the patient as having newly identified diabetes.

Other key findings:

  • Older patients experienced the highest rates of diabetes diagnoses in Medicaid expansion states. For older patients (age 50-64 years), the increase of Medicaid patients with newly identified diabetes was 31.2% in the expansion states, compared to only 0.5% in the non-expansion states. For younger patients (age 19-49 years) Medicaid patients with newly identified diabetes increased nearly 15% in the expansion states, with essentially no change in the non-expansion states.

  • Men had higher rates of diabetes diagnosis than women. Diagnoses of Medicaid-enrolled men increased 25.5% in the expansion states, while diagnoses for women increased 22%. Among Medicaid enrollees in non-expansion states, rates of diagnoses for men increased 4.6% and decreased 1.4% for women. The Quest researchers hypothesize that because women tend to use health services more than men, women with diabetes may have been more likely to have been previously diagnosed. Men may also have higher diabetes risk than women.

“As we’ve seen in this particular study, patients with diabetes may experience better disease management when diagnosed and treated at an earlier stage,” says Kaufman. “Making access easier, by lowering barriers, more people should be able to obtain medical services that lead to better care and outcomes and prevent more costly complications.

Related:Two GOP-led states receive approval for Medicaid expansion cost-saving provisions

“We understand that more research is needed, and it can be theorized that the states that have expanded Medicaid will see fewer diabetes complications and reduced healthcare costs over time than the states that did not expand,” he adds. “We can also theorize that this pattern may extend to other chronic diseases.”

Diabetes is a disease that affects more than 29 million Americans. It is the 7th leading cause of death in the U.S. and a significant contributor to death. The disease is costly for both patients and providers.  Patients left undiagnosed with this serious disease can experience life-threatening complications that can also weigh down the healthcare system. 

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