State-level Legislative Efforts to Improve Diabetes Care and thereby Mitigate Complications

Objective: Diabetes (DM) is a complex chronic illness with multiple complications and co-morbid conditions. DM affects 9.3% of the U.S. population and costs $245 billion or more annually. Most U.S. states have enacted laws requiring coverage of DM care and supplies but the effect of these public health laws is not well understood. This study aims to examine whether state’s legislative actions can improve access to care and mitigate DM’s rising prevalence thereby reducing complications. Methods: Econometric modelling provided DM-related trends and assessed state-level variation in DM prevalence. Ordinary least squares (OLS) regression assessed the impact of different law enactment dates and key factors that contribute to the effectiveness of DM-related state laws, including demographic characteristics related to DM: median household income, educational attainment, obesity, and state population size. Results: All but four US states have enacted diabetes-related laws requiring coverage of diabetes care and treatment. States that had enacted DM-related laws and had a higher percentage of people covered by insurance, experienced lower increases in diagnosed DM over time. Education proved to be a key factor in helping to decrease the prevalence of DM and its complications. Conversely, increasing obesity rates explain much of the rising prevalence of diagnosed DM. Conclusion: Enactment of DM-related laws at the state-level has proven somewhat beneficial in mitigating the rise in DM rates and alleviating complications. There is a need for future research to further examine the various payers’ reimbursement policies for healthcare professionals providing services such as diabetes self-management education within each state. The findings from this study offer policy insights about the benefits of state-level DM laws for controlling the disease, reducin