1595-P: Predictors of Financial Toxicity in Emerging Adults with Type 1 Diabetes in the iHERO Study

Introduction and Objective: Emerging adults (EA, 18-30 years) with type 1 diabetes (T1D) face transitions in employment, insurance, and financial independence, increasing vulnerability to financial toxicity—the burden from diabetes care costs. Financial toxicity is linked to disrupted care and suboptimal outcomes. This study examined predictors of financial toxicity in the Insurance, Health, and Economic Resources Online (iHERO) Study, a waitlist-control RCT. Methods: EA with T1D were recruited online and from four clinical sites. Financial toxicity was measured by the Comprehensive Score for Financial Toxicity (COST-FACIT; lower scores = greater toxicity). Multivariable linear regression examined baseline associations among financial toxicity and demographic (age, race, ethnicity, gender identity, employment status, student status, highest level of education, marital status), clinical (T1D duration, CGM and insulin pump usage, meeting glycemic goal 70% time 70-180mg/dL or A1c 7%), and insurance (primary insurance plan, policyholder) factors. Categorical variables were dummy coded. Analyses used listwise deletion. Results: Participants (N=168) were predominantly White (66%), non-Hispanic (84%), female (70%), employed (67%), residing across 30 US states, and using CGM (89%) and insulin pumps (75%). Less than half met glycemic targets (47%). The most common insurance group was private (48%) with majority self-policy holders (58%). Demographic, clinical, and insurance-related factors explained 42% of variance in financial toxicity (COST-FACIT; R²=0.42, p=.007). Older age (p=0.038) and insurance type (p=0.006) were independently associated with financial toxicity; private insurance was linked to lower financial toxicity, while uninsured or undisclosed insurance was associated with higher financial toxicity. Conclusion: Health insurance is a structural factor associated with financial toxicity in EA with T1D. Interventions should address insurance access, navigation, and coverage, especially during insurance transitions. Disclosure D.A. Grant: None. B. Alasad: None. J. Rieke: None. K. Bass: None. A. Kinsella: None. E.L. Lundgrin: None. N.A. Allen: Research Support; Current; Dexcom, Inc. J. Blanchette: Advisory Panel; Ended; Eli Lilly and Company. Advisory Panel; Current; MannKind Corporation. Research Support; Current; Leona M. and Harry B. Helmsley Charitable Trust, American Heart Association. Speaker's Bureau; Current; Insulet Corporation. Consultant; Current; Sequel MedTech. Consultant; Ended; Embecta. Research Support; Current; National Institute of Diabetes and Digestive and Kidney Diseases. Funding The Leona M. & Harry B. Helmsley Charitable Trust Grant (2305-05992)