Financial toxicity as a source of diabetes distress resulting in cost coping strategies in emerging adults with type 1 diabetes in the United States

This is the authors' abstract. We don't add key points for this paper.

Aims Despite advancements in diabetes care, up to one in four Americans report rationing insulin due to cost concerns; emerging adults are especially susceptible to cost worries as they transition away from family support. Financial toxicity may help elucidate how emerging adults with type 1 diabetes (T1D) experience emotional burden. This study aimed to understand how emerging adults with T1D describe subjective financial distress, objective financial burden and difficulties navigating health insurance coverage. Methods A qualitative descriptive design using semi‐structured interviews. Analysis was completed using standard qualitative content analysis procedures. Results Participants included 8 men and 7 women, 80% identified as White with a median age of 24 years and diabetes duration of 12 years. Sixty percent were on their parents' health insurance and 100% used diabetes technology. Four themes emerged: (1) diabetes distress is substantial and embedded within the developmental stage of emerging adulthood; (2) diabetes distress includes the new responsibility of affording diabetes care independently, which participants experience as an emotional burden, both in the present and when contemplating the future; (3) financial costs of diabetes are exacerbated by insurance barriers, leading to inadequate access to management resources; and (4) emerging adults endorse cost coping strategies, both in the present and when planning for the future. Conclusions Emerging adults with T1D experience financial toxicity as a source of diabetes distress, leading to cost coping strategies, which are embedded in the larger context of the demands of this developmental stage.