The Impact on Patients of the Diabetes Financial Burden


Nonadherence in patients with diabetes adversely affects glycemic control.

How many patients does the average community pharmacist see who are nonadherent because they can't afford their medications?

Many pharmacists don't understand copayments' financial repercussions, even if copayments are small. For patients who are at, below, or even slightly above the poverty line, copayments can make or break budgets. In fact, approximately a quarter of families indicate that out-of-pocket health care costs create an undue burden.

In a study conducted at the University of Michigan's School of Public Health and published in Health Education & Behavior, researchers piloted a financial burden resource tool to determine its feasibility in clinical practice.

Nonadherence, whether related to cost or not, in patients who have diabetes adversely affects glycemic control, increases symptom burden and disability, and increases risk of hospitalization.

The study researchers included 104 patients. Ninety-five percent of the patients completed an assessment at the end of 2 months. The researchers used an automated program that they developed in-house to identify barriers to adherence. In addition to focusing on diabetes related resources, the tool also expanded to look at social needs and tools to help patients develop financial literacy.

Although more than 70% of participants had at least some college education, the average annual income for their households was less than $40,000 per year for at least half of participants. Forty percent of participants were privately insured and a quarter of participants reported symptoms of depression. Almost half took more than seven prescriptions daily.

The researchers indicated that patients with financial burden sometimes took less medication than prescribed, skipped doses, or avoided treatment to save money.

After completion of the study, patients were more likely to engage in online diabetes education. The researchers did not measure absences in the workplace, but patients indicated that one reason they did not engage in education was because they would have to miss work. Online education removed this barrier.

The researchers also documented slightly increased levels of conversation about cost between physicians and patients after patients used the financial burden resource tool.

Use of blood glucose supplies during the study decreased significantly, and the researchers reported that this finding was unexpected. They concluded that increasing participants’ awareness of the different types of financial burdens they were handling may have precipitated changes in behavior.


Patel MR, Resnicow K, Lang I, Kraus K, Heisler M. Solutions to address diabetes-related financial burden and cost-related nonadherence: Results from a pilot study. Health Educ Behav. 2017 Apr 1:1090198117704683;doi: 10.1177/1090198117704683. [Epub ahead of print]

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