Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. W. Jay Christian

Committee Member

Dr. Anna Hoover

Committee Member

Dr. Mary Lacy

Committee Member

Dr. Joseph Benitez


Diabetes mellitus, commonly referred to as “diabetes”, is currently at epidemic proportions in the United States as its prevalence has drastically increased over the past several decades. The percentage of Americans with diagnosed diabetes has risen from 0.93 percent of the population in 1958 to 10.5 percent in 2018 (ADA, 2021). Diabetes also impacts record numbers of Kentucky residents.

Regular screening for those considered at-risk can encourage patients to implement lifestyle modifications, pharmacological therapy, or other interventions earlier in the course of disease. This can help prevent or delay onset of T2D and can reduce diabetes-related complications in those who go on to develop T2D (Ahmad, 2010).

Obtaining health insurance makes preventive care measures such as T2DM screening more accessible for those who need it. This project used Kentucky Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2011 to 2019 to analyze screening data for Kentuckians at risk of developing prediabetes or T2DM, based on the ADA guidelines described above. Survey data from before and after Kentucky’s rollout of the Affordable Care Act (ACA) in 2014 were examined to determine the variation in diabetes screening rates for eligible residents comparatively. The goal was to determine whether increased insurance coverage rates affected diabetes screening rates, with emphasis on comparing regions of the state with one another, i.e. Appalachian versus non-Appalachian areas.

Results were not significant between regions of Kentucky or when comparing pre-ACA and post-ACA data. While findings did not support the original prediction that increasing access to health coverage would also increase diabetes screening as a preventive care measure, there is still room for optimism. In the meantime, targeted interventions such as identifying/addressing disparities, policy education, increased advertising and expanded screening events could encourage uptake of ACA-driven preventive care opportunities.

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