The affordable care act: Effects of insurance on diabetes biomarkers

Miguel Marino, Heather Angier, Rachel Springer, Steele Valenzuela, Megan Hoopes, Jean O’malley, Andrew Suchocki, John Heintzman, Jennifer Devoe, Nathalie Huguet

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


OBJECTIVE We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers. RESEARCH DESIGN AND METHODS This was a retrospective observational cohort study using electronic health record data from 178 community health centers (CHCs) in the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) network. We assessed changes in diabetes-related biomarkers among adult patients with diabetes in 10Medicaid expansion states (n 5 25,279), comparing newly insured with continuously insured, discontinuously insured, and continuously uninsured patients pre– to post–ACA expansion. Primary outcomes included changes from 24 months pre-to 24 months post-ACA in glycosylated hemoglobin (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure, and LDL cholesterol levels. RESULTS Newly insured patients exhibited a reduction in adjusted mean HbA1c levels (8.24% [67 mmol/mol] to 8.17% [66 mmol/mol]), which was significantly different from continuously uninsured patients, whose HbA1c levels increased (8.12% [65 mmol/ mol] to 8.29% [67 mmol/mol]; difference-in-differences [DID] 20.24%; P <0.001). Newly insured patients showed greater reductions than continuously uninsured patients in adjusted mean SBP (DID 21.8 mmHg; P <0.001), DBP (DID 21.0 mmHg; P <0.001), and LDL (DID 23.3 mg/dL; P 0.001). Among patients with elevated HbA1c in the 3 months prior to expansion, newly insured patients were more likely than continuously uninsured patients to have a controlled HbA1c measurement by 24 months post-ACA (hazard ratio 1.25; 95% CI 1.02–1.54]. CONCLUSIONS Post-ACA, newly insured patients had greater improvements in diabetes-related biomarkers than continuously uninsured, discontinuously insured, or continuously insured patients. Findings suggest that health insurance gain via ACA facilitates access to appropriate diabetes care, leading to improvements in diabetes-related biomarkers.

Original languageEnglish (US)
Pages (from-to)2074-2081
Number of pages8
JournalDiabetes care
Issue number9
StatePublished - Sep 2020

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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