1452-P: Financial Toxicity and Cost-Related Nonadherence (CRN) in Adults with Type 1 Diabetes (T1D)—Prevalence and Associations with Social Determinants of Health

Introduction: Financial toxicity with healthcare needs and CRN, such as insulin rationing, are increasingly recognized as challenges to optimal T1D self-care in the US. This study examined prevalence of financial toxicity, CRN, and associations with SDOH. Methods: This study included 130 adults with T1D with A1c ≥7.5% and unmet social needs. Sociodemographic and clinical variables, as well as the COST-FACIT modified for diabetes (lower score=more financial toxicity; cut-point ≤20) were collected. CRN was defined as endorsing at least 1 diabetes-specific behavior in the past year: took less medication, skipped medication, delayed/did not fill prescription, delayed/did not see healthcare provider because of cost. SDOH-related factors included income, employment, and insurance status. T-tests, ANOVAs, chi square, Fisher’s exact tests, and Pearson correlations determined the strength and direction of relationships. Results: Mean age of the sample was 41 years (range 19-74), 65% female, 79% Non-Hispanic White, T1D duration was 24 years, A1c was 8.0±1.4%, 55% reported financial toxicity, and 32% reported CRN. Participants who endorsed CRN had significantly more financial toxicity (17±7 vs 21±8, p=.007). Financial toxicity and A1c were not correlated and A1c did not differ between those endorsing vs not endorsing CRN. Financial toxicity was substantial in those with lower income, not in the workforce, or with public health insurance (p.01) while CRN did not differ statistically by these SDOH. Financial toxicity and CRN did not differ by gender or race/ethnicity. While financial toxicity did not differ by age, adults over age 30 endorsed less CRN vs those ≤30 (p=.03). Conclusion: More than half of this sample endorsed financial toxicity and nearly one third reported CRN. Multiple SDOH appear related to financial toxicity. Financial concerns should be further probed among patients with T1D to facilitate disease management. Disclosure K. Wentzell: None. A.N. Smith: None. M.R. Patel: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R01 DK116715-01A1); (P30DK092926) (Michigan Center for Diabetes and Translational Research); Mary K. Iacocca Foundation