According to the Centers for Disease Control and Prevention, more than 100 million Americans are either living with diabetes or have higher than average blood sugar levels with prediabetes.

Management of these chronic conditions requires consistent monitoring of blood sugar levels, robust medication regimens, and frequent health care appointments, all of which take time, resources and money. Because of these barriers, many Americans with diabetes often go undiagnosed or ignore the necessary treatment options altogether.

Affordable health care

A study published online in the Journal of the American Board of Family Medicine has confirmed one way to ensure the broader use of preventive and disease management services for patients: access to affordable health care.

Nathalie Huguet, Ph.D., and a team of researchers at OHSU in Portland, Oregon, compared with patients diagnosed with diabetes or prediabetes, and individuals with no diagnosis. Patients received care at community health centers in 13 US states, nine of which have Medicaid expansion programs.

Researchers found that the rates of uninsured visits to Community Health Centres decreased in all states across the three patient groups. Further, consistent with national averages, patients previously diagnosed with diabetes had higher clinical visit rates when compared with prediabetes or undiagnosed patients.

While Huguet, a research assistant professor of family medicine at the OHSU School of Medicine, says that due to higher rates of obtaining insurance, many patients were able to receive critical treatments and services, including preventive screenings, lab testing, specialized care and some medication not accessible to them before.

"This is particularly true for patients with lower socioeconomic status," she said. "The utilization rates of these services provide critical programs such as the Affordable Care Act and Medicaid Expansion are to a growing and vulnerable patient population."

Rates of uninsured visits decreased for all cohorts in expansion and nonexpansion states. For all cohorts, Medicaid-insured visit rates increased significantly more in expansion compared with nonexpansion states, especially among prediabetic patients (+71%).

In nonexpansion states, privately insured visit rates more than tripled for the prediabetes cohort and doubled for diabetes and no diabetes cohorts. Rates for glycosylated hemoglobin screenings increased in all groups, with the largest changes among no diabetes (rate ratio, 2.26; 95% CI, 1.97–2.56) and prediabetes cohorts (rate ratio, 2.00; 95% CI, 1.80–2.19) in expansion states.