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Roughly 1 out of every 10 people in the U.S. has diabetes, but a quarter of them don't know it. A new study reveals that certain states are finding more of those undiagnosed diabetics while others are not. And the reason has to do with the Affordable Care Act, which turns 5 today. NPR's Anders Kelto reports.
ANDERS KELTO, BYLINE: A few years ago, Johnny Reynolds knew that something was wrong.
JOHNNY REYNOLDS: It was like waking up every morning and just putting a person over my shoulders and walking around with them all day long. You know, that was the fatigue and tiredness.
KELTO: And he was constantly thirsty.
REYNOLDS: I would find myself running to the restroom at least 20, 30 times. And overnight I would probably get up about eight or nine times a night.
KELTO: He was working as a cook in Ohio, broiling steaks at a family restaurant. And from an insurance standpoint, he was stuck. His job didn't provide health coverage, but he was making too much money for Medicaid. He was scared that if he went to the doctor he'd end up with a huge bill. So despite having all the telltale signs of type 2 diabetes, he just kept working.
REYNOLDS: It was just something that you grin and bear, you know? You just go through, you know, your daily - get done with what you need to do, come home and try to get as much rest as you can for the next day.
KELTO: It turns out Reynolds' situation is pretty common, says Dr. Vivian Fonseca. He's a professor of medicine and endocrinology at Tulane University.
VIVIAN FONSECA: We've known for a long, long time that a lot of people with type 2 diabetes go unrecognized for many years because they don't go and get screened.
KELTO: And one off the main reason they don't get screened, he says, is that they don't have insurance. That got Fonseca wondering, how would diabetes care be affected in states that expanded Medicaid under the Affordable Care Act? He and some colleagues first looked at states that chose not to expand Medicaid, and they saw a very small increase in new diabetes cases. But then they looked at states that did expand Medicaid.
FONSECA: And noticed that they had a 23 percent increase.
KELTO: Thousands more people with diabetes were discovered in these states because of Medicaid expansion, Fonseca says. Dr. Robert Ratner, the chief medical officer for the American Diabetes Association, says this finding is very important because early diagnosis of diabetes is crucial.
ROBERT RATNER: Early and aggressive therapy of diabetes has a major impact on long-term complications and on quality of life.
KELTO: If you don't get early treatment, he says, diabetes can lead to blindness, amputations, kidney failure, strokes, even death. And Ratner says early intervention may also save money in the long run. But he points out an irony of the study. Many of the states that did not expand Medicaid are in what he calls the diabetes belt, stretching from Louisiana to North Carolina.
RATNER: Those states who failed to expand Medicaid, they missed that opportunity, and they still have large percentages of people, perhaps as much as 20 percent, with diabetes who don't know it.
KELTO: Johnny Reynolds, the cook, left Ohio a couple years ago and moved to Washington, D.C. After the Medicaid expansion, he eventually got insurance. But it didn't happen without a scare. When he finally went to see the doctor, he says...
REYNOLDS: My blood sugar levels was over 700, which they told me was critical because you can go into what they call a diabetic coma.
KELTO: Now he's on insulin and is working with a nutritionist to control his diet. He says he's doing much better now. The only thing he's still getting used to is having help.
REYNOLDS: So this is something new to me to have, you know, constant care. Almost make you feel like royalty in a way (laughter) 'cause you got all this care at your disposal, so...
KELTO: Care that he says probably saved his life. Anders Kelto, NPR News, Washington.
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