Financial Toxicity and Diabetes Distress in Adults With Elevated A1C: A Cross-Sectional Study

PURPOSE: The purpose of this study was to examine whether financial toxicity was independently associated with diabetes distress among adults with diabetes and elevated A1C. METHODS: This cross-sectional study included 566 adults with diabetes and elevated A1C. Guided by the biopsychosocial model, we used sequential multiple linear regression to test whether financial toxicity explained additional variance in diabetes distress after accounting for biological, psychological, demographic, and other social factors. We measured diabetes distress using the 2-item Diabetes Distress Scale, financial toxicity with a validated financial toxicity measure, psychological distress with the 4-item Patient Health Questionnaire, and unmet social needs with a 21-item index. RESULTS: Financial toxicity was independently associated with higher diabetes distress after accounting for biological, psychological, and other social factors. Psychological distress was the strongest correlate of diabetes distress, followed by A1C and financial toxicity. As a block, social factors added significant variance, but the association of unmet social needs was no longer significant once financial toxicity was included, indicating shared variance among social and economic stressors. Male gender was associated with lower diabetes distress, whereas the associations for lower education and unemployment emerged only after adjustment and should be interpreted with caution. CONCLUSIONS: Screening for financial toxicity and psychological distress, together with an integrated mental health and financial support model, may help diabetes care and education specialists address the emotional and material contributors of diabetes distress in adults with elevated A1C.