Financial toxicity and diabetes distress in adults with elevated A1C

In plain language

“Financial toxicity” is the financial burden that comes with managing a health condition, such as the cost of medication, supplies, and care. We asked whether it is associated with “diabetes distress,” the emotional burden of living with diabetes, in 566 adults whose blood sugar was above target. Even after we accounted for people’s health, mental health, and other social and economic circumstances, financial toxicity stood on its own as a factor associated with greater diabetes distress.

About this study

Guided by the biopsychosocial model, we used sequential multiple regression to test whether financial toxicity explained diabetes distress beyond biological, psychological, demographic, and other social factors. We measured diabetes distress with the 2-item Diabetes Distress Scale, financial toxicity with a validated measure, psychological distress with the 4-item Patient Health Questionnaire, and unmet social needs with a 21-item index.

Psychological distress was the strongest correlate of diabetes distress, followed by A1C and then financial toxicity. Once financial toxicity was included, unmet social needs were no longer significant on their own, suggesting that social and economic stressors overlap. The takeaway for care: screening for financial toxicity alongside mental health, and pairing financial and emotional support, may help people living with diabetes.