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

Diabetes Educ. Sep-Oct 2010;36(5):774-83. doi: 10.1177/0145721710374653. Epub 2010 Jun 28.


Purpose: The purpose of this study was to examine measures of chronic disease severity and treatment according to insurance status in a clinical trial setting.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Continental Population Groups
  • Coronary Artery Bypass
  • Coronary Disease / economics
  • Coronary Disease / epidemiology*
  • Coronary Disease / surgery
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Angiopathies / economics
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / surgery
  • Disabled Persons
  • Employment
  • Ethnic Groups
  • Female
  • Health Status
  • Humans
  • Insurance, Health / statistics & numerical data*
  • Male
  • Medicare
  • Middle Aged
  • Retirement
  • United States