Health insurance status and control of diabetes and coronary artery disease risk factors on enrollment into the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.
The purpose of this study was to examine measures of chronic disease severity and treatment according to insurance status in a clinical trial setting.



Baseline insurance status of 776 patients with type 2 diabetes and stable coronary artery disease (CAD) enrolled in the United States in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was analyzed with regard to measures of metabolic and cardiovascular risk factor control.



Compared with patients with private or public insurance, the uninsured were younger, more often female, and less often white non-Hispanic. Uninsured patients had the greatest burden of CAD. Patients with public insurance were treated with the greatest number of medications, had the greatest self-reported functional status, and the lowest mean glycosylated hemoglobin and low-density lipoprotein (LDL) cholesterol values. Overall, for 5 measured risk factor targets, the mean number above goal was 2.49 ± 1.18. After adjustment for demographic and clinical variables, insurance status was not associated with a difference in risk factor control.



In the BARI 2D trial, we did not observe a difference in baseline cardiovascular risk factor control according to insurance status. An important observation, however, was that risk factor control overall was suboptimal, which highlights the difficulty in treating type 2 diabetes and CAD irrespective of insurance status.
Grogan
Mary
M
The Department of Medicine, Rhode Island Hospital, Providence, Rhode Island (Ms Grogan, Dr Abbott)
Jenkins
Margaret
M
The Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Ms Jenkins)
Sansing
Veronica V
VV
The Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sansing, Ms MacGregor, Dr Brooks)
MacGregor
Joan
J
The Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sansing, Ms MacGregor, Dr Brooks)
Brooks
Maria Mori
MM
The Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sansing, Ms MacGregor, Dr Brooks)
Julien-Williams
Patricia
P
Georgetown University Medical Center, Washington, DC (Ms Julien-Williams)
Amendola
Angela
A
New York University School of Medicine, New York, New York (Ms Amendola)
Abbott
J Dawn
JD
The Department of Medicine, Rhode Island Hospital, Providence, Rhode Island (Ms Grogan, Dr Abbott)
D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D006233:Persons with Disabilities; D004651:Employment; D005006:Ethnicity; D005260:Female; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D044469:Racial Groups; D012179:Retirement; D014481:United States