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 The findings suggest that expanding Medicaid, the government-run
health insurance for the poor, allows people with diabetes to be
diagnosed earlier than before, which may improve outcomes later on,
the researchers say.
"This is important because diabetes is becoming more prevalent as
the population gets older,” said Dr. Harvey Kaufman, lead author of
the study and senior medical director at Quest Diagnostics, which
funded the analysis.
In the early stages of the disease, people can make lifestyle
changes and get care that helps delay complications, he added.
If left untreated, diabetes can lead to vision loss, kidney failure,
nerve problems and amputations of the legs and feet, according to
the U.S. Centers for Disease Control and Prevention. The agency says
$176 billion is spent on diabetes and its complications each year.
Diabetes occurs when the body can't properly use or make enough of
the hormone insulin to convert blood sugar into energy, according to
the World Health Organization (WHO).
About one in nine adults has diabetes, according to the WHO. Type 2
diabetes accounts for the vast majority of cases and is linked to
obesity and advanced age.
Kaufman and colleagues focused their research on the hemoglobin A1c
test, which measures the average blood sugar level for the past two
or three months.
Using Quest Diagnostics’ database of lab tests, which includes about
150 million patient encounters annually, they counted how many
people had at least one blood sugar test that was negative before
Medicaid expansion and positive afterwards.
In January 2014, 26 states expanded access to Medicaid and 24 did
not.
Where more people got Medicaid, newly diagnosed diabetes cases among
Medicaid recipients surged 23 percent, from 14,625 in the first six
months of 2013 to 18,020 in the first six months of 2014. In states
that didn't expand Medicaid, diagnosis increased just 0.4 percent.
People are considered diabetic when their A1c level is at least 6.5
percent. Where Medicaid was expanded, the average A1c levels of
newly diagnosed diabetes patients was 7.96 percent, compared with
8.14 percent in non-expansion states.
"It was apparent in the non-expansion states that you are making
diagnosis at a later stage when they are presenting at the hospital
with complications," said Dr. Robert Ratner, chief scientific and
medical officer of the American Diabetes Association.
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"The earlier you catch the disease, the easier it is to treat, and
the more responsive it is and the more stable it can be," said
Ratner, who wasn't involved in the study.
While more women in the study had diabetes, the increase in
diagnosis was steeper for men. Gains were also greater for older
people, aged 50 to 64, than for individuals aged 19 to 49.
The study had some limitations, including its reliance only on
records from blood sugar tests done by Quest Diagnostics and its
lack of clinical information. It's also possible that some patients
tested at Quest might have been diagnosed prior to the start of the
study period.
Because it's only based on tests at Quest, "you don't know 100
percent if this was a new diagnosis, and not something the patient
might have already known," said Dr. Benjamin Sommers, a health
economist at Harvard University. "But the overall study design makes
a lot of sense."
The number of newly diagnosed diabetes cases in the states where
Medicaid expanded bodes well for the detection of other chronic
health conditions which, like diabetes, may not immediately cause
symptoms that are easy for patients to detect on their own, Sommers
said.
"With the expanded coverage, you're not going to diagnose more
broken bones because whether or not they have insurance, when
somebody breaks a leg they are going to get an x-ray," said Sommers,
who wasn't involved in the study. "These findings with diabetes may
be the tip of the iceberg, and you can imagine similar outcomes for
earlier detection of high blood pressure, or cancer, or mental
illness."
SOURCE: http://bit.ly/1CMoIZg
Diabetes Care, online March 22, 2015.
[© 2015 Thomson Reuters. All rights
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