Over 30% of people with diabetes (PWD) in the United States require insulin to manage their diabetes, and the rising cost of insulin over the past two decades has put a large financial burden on many of these PWD. This study aimed to understand differences in insulin affordability challenges across demographic groups and their association with mental well-being.

In 2022, 2,794 insulin-using adult PWD in the U.S. responded to three online questionnaires in which they reported challenges affording their insulin in the past 6 months and the mental health burden of their diabetes. Respondents also answered the 5-item WHO-5 Well-being Index. Results were analyzed across demographic groups (58% type 1, 66% female, 85% white).

The prevalence of insulin affordability challenges was highest among Black/African American PWD (20%) compared to Hispanic/Latinx (12%) and white PWD (11%). Among those who had challenges affording insulin, non-white respondents were more likely to experience these challenges “all of the time” compared to white respondents (39% vs. 23%, p=.015).

PWD who struggled to afford their insulin were more likely to have a poor well-being score as measured by the WHO-5 compared to those who did not (p<.001). They were also more likely to agree that diabetes management takes too much effort (p<.01) and that they felt overwhelmed by their diabetes (p<.001), unmotivated to manage their diabetes (p<.001), and burned out by their diabetes (p<.001).

PWD who struggle to afford their insulin have a higher prevalence of poor well-being and mental burden from their diabetes. These issues may disproportionately affect certain racial minority groups, among whom insulin affordability challenges are higher in prevalence and frequency. As new legislation capping insulin out-of-pocket costs come into effect this year, it will be important to understand how they impact inequalities in access to medical needs and quality of life for PWD.

Disclosure

E.Xu: Employee; dQ&A. A.Zeng: Employee; dQ&A. T.Bell: Employee; dQ&A. T.L.Bristow: Employee; dQ&A.

© 2023 by the American Diabetes Association
2023
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