Financial Toxicity and Cost-Related Nonadherence in Adults with Type 1 Diabetes

BACKGROUND: With the rising costs of insulin and overwhelming financial burden of managing diabetes, there is heightened concern for financial toxicity and cost related nonadherence (CRN), particularly in people with type 1 diabetes (T1D). OBJECTIVE: To describe the prevalence of financial toxicity and CRN in adults with T1D, examine associations with social determinants of health (SDOH), and explore the impact of lifespan development. DESIGN: This is a secondary analysis of baseline data from a larger randomized controlled trial of adults with diabetes and unmet social needs. PARTICIPANTS: A subsample of 130 participants with T1D. MAIN MEASURES: The primary outcome was CRN, defined as reporting using less insulin, medication, or supplies, or delaying/avoiding filling a prescription or seeing a healthcare provider because of costs. KEY RESULTS: Participants had a mean age of 41.1 ± 15.5 (range 19-74), 64.6% were female, 78.5% identified as non-Hispanic White, and 54.6% reported ≥ $60,000 in annual income. In total, 51.5% were employed and 56.9% had private insurance; 32.3% endorsed at least one CRN behavior and 78.5% reported elevated financial toxicity. The only significant difference in CRN was by age, where 44.4% of participants ≤ 30 years reported CRN compared to only 25.9% of participants > 30 years (p < 0.05). A logistic regression analysis to predict CRN found that two factors were statistically significant predictors: elevated financial toxicity (OR 7.29, 95% CI 1.96, 27.16) and having private insurance (OR 2.88, 95% CI 1.17, 7.08). Age was nearly significant (p = 0.057), with participants ≤ 30 years 2.25 times more likely to report CRN compared to older age groups. CONCLUSION: Adults living with T1D experience high levels of financial toxicity and CRN. Young adults appear to be at higher risk for CRN, a pattern that does not appear to be explained by conventional SDOH-related factors often attributed to CRN during other life stages.