Underinsurance before the implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net).

BACKGROUND: As the Affordable Care Act (ACA) is implemented and many uninsured become insured, rates of underinsurance may persist or increase. This study was designed to estimate the rate of underinsurance in primary care safety net clinics serving low income, multiethnic populations in New Mexico. METHODS: Data were collected from 2 primary care clinics in an urban setting during a 2-week period in 2011 and 2012. Voluntary, anonymous, self-administered surveys were distributed to adult patients waiting to be seen by their doctor. Surveys were available in English and Spanish. RESULTS: Of those insured, 44% were underinsured. The underinsured comprised higher proportions of patients who were Hispanic, young, and poor; 39% reported fair or poor health, 23% reported that their health suffered from an inability to seek care because of cost, and 53% had either Medicaid or state coverage insurance. Patients with an income of ≤$25,000 were 8 times more likely to be underinsured. CONCLUSION: A high level of underinsurance was found in these safety net clinics. Because millions of Americans gain health care insurance benefits, monitoring whether the current reform provides adequate health care coverage or whether those with new and existing health care insurance are underinsured is critical.

Targeting postprandial hyperglycemia: a comparative study of insulinotropic agents in type 2 diabetes.

This study was designed to compare the efficacy of three insulinotropic agents in the control of postprandial hyperglycemia in type 2 diabetes. Fifteen subjects with noninsulin-requiring type 2 diabetes were admitted to the General Clinical Research Center on four separate occasions. During the control study and following 7-10 d on each study medication, daylong glucose profiles were performed to investigate the effects of the assigned medication on postprandial hyperglycemia. During each admission, placebo or study medications were administered before three isocaloric meals as follows: immediate-release glipizide 30 min before breakfast and 30 min before supper, glipizide gastrointestinal therapeutic system (GITS) 30 min before breakfast, or nateglinide 120 mg 10 min before breakfast, before lunch, and before supper. Blood was drawn for analysis of glucose, insulin, and C-peptide at -0.05, 0, 0.25, 0.5, 1, 2, 3, and 4 h relative to each test meal. Immediate-release glipizide, nateglinide, or glipizide GITS administration resulted in significantly lower integrated daylong (glucose area under the curve) and peak glucose levels, compared with placebo. There were no significant differences in the daylong integrated glucose levels among the three study medications. The peak postbreakfast glucose level (but not glucose area under the curve) was lower with nateglinide, compared with either immediate-release glipizide or glipizide GITS. Postlunch and postdinner integrated glucose levels were significantly lower with immediate-release glipizide or glipizide GITS, compared with nateglinide. C-peptide levels were significantly higher with immediate-release glipizide, compared with glipizide GITS. Insulin levels did not differ among the three study medications. Once-daily glipizide GITS, twice-daily immediate-release glipizide, or three-times-a-day administration of nateglinide results in equivalent control of postmeal hyperglycemia in type 2 diabetes. The decision to prescribe one of these three insulinotropic agents should be based on factors such as the patient's ability to comply with complex dosing regimens, the need to control fasting hyperglycemia, the risk of interprandial hypoglycemia, and pharmacoeconomic considerations, rather than postprandial glucose-lowering efficacy.