573-P: Insulin and Supply Rationing in Emerging Adults with Type 1 Diabetes

Abstract

Over 25% of adults with diabetes have reported rationing insulin in the United States. Emerging adults, ages 18-25, may be even more vulnerable to rationing as they grapple with financial instability during this developmental period of increasing independence coupled with the rising cost of healthcare. The purpose of this study was to explore factors related to insulin and diabetes supply rationing in a sample of emerging adults with type 1 diabetes (T1D). Content analysis was used to examine a single open-ended response to the question, “Please tell me about your experiences rationing insulin or diabetes supplies,” in a parent cross-sectional study. The parent study explored financial stress factors, psychological factors, and self-management outcomes in 413 emerging adults from the T1D Exchange Clinic Registry. Chi-square tests were utilized to understand if rationing (yes or no) differed based on gender, race/ethnicity, employment status, type of health insurance, insulin pump usage, CGM usage, and A1c level (<8.9% or >9.0%). Alpha was set at .05. A total of 268 participants responded to the open-ended question about rationing. Over one-third of respondents (N=99, 36.9%) reported rationing insulin or diabetes supplies. Lack of private health insurance X2(3, N=224)=8.38, p<.05, racial/ethnic diversity (non-white, Hispanic) race/ethnicity X2(6, N=224)=13.54, p<.05 and no CGM usage X2(1, N=224)=9.75, p<.01 had significant relationships with rationing. Gender, employment status, A1C level, and insulin pump usage were not associated with rationing. A considerable number of emerging adults with T1D have experience rationing. Diabetes providers should routinely assess for insulin and diabetes supply rationing in this population. Attention should be paid to emerging adults who are racially/ethnically diverse, lack private insurance, and do not use CGM. Policy changes are necessary in order to improve access to affordable diabetes management tools in this vulnerable population. Disclosure J. E. Blanchette: Board Member; Self; JDRF, Consultant; Self; Insulet Corporation, Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Association of Diabetes Care and Education Specialists. V. B. Toly: None. J. R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation, Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes. Funding Sigma Theta Tau Alpha Mu; Frances Payne Bolton School of Nursing