Erika Lundgrin, MD, is an adult and pediatric endocrinologist at University Hospitals Cleveland Medical Center and Rainbow Babies and Children’s Hospital.

Erika Lundgrin, MD

Health Insurance Largely Controls Financial Toxicity in Patients With T1D

Among the myriad causes for financial toxicity in 

 treatment, health insurance is a core component that may prevent patients from receiving the care they need, according to recent research.

American Diabetes Association (ADA) Scientific Sessions 2026

 in New Orleans, LA, by Dionne Grant, PhD, of University Hospitals, this analysis aimed to address the key factors keeping patients from achieving optimal care in patients with T1D – particularly, the most impactful components of financial toxicity.

“Financial toxicity is something that impacts most of us, but in varying degrees,” Erika Lundgrin, MD, an adult and pediatric endocrinologist at University Hospitals Cleveland Medical Center and Rainbow Babies and Children’s Hospital and an investigator in the study, told 

 in an exclusive interview. “Most of the time, we’re in busy clinical scenarios, and we don’t have a lot of time to delve into the social aspects – but it impacts everything we do, from whether or not a medication is going to be picked up to whether somebody is interested in pursuing diabetes technology, which we know highly correlates with improvement in care and glycemic outcomes. It needs to be addressed, even if there’s not always a ton of time to do it.”

Financial toxicity is made up of several key components, including out-of-pocket costs, productivity loss due to treatment or recovery time, medical debt, asset depletion, and bankruptcy. Additionally, out-of-pocket costs include everything from direct medical costs, such as for treatment or medications, and indirect costs, such as lost income or travel expenses. Not only can these issues affect a patient’s treatment adherence, but they can directly influence quality of life as well.

To this end, Lundgrin and colleagues recruited emerging adults – defined as aged 18-30 years – both online and from 4 clinical sites. The team measured financial toxicity via the Comprehensive Score for Financial Toxicity (COST-FACIT), in which a lower score equates to greater toxicity. Multivariable linear regression was employed to examine baseline associations among financial toxicity and demographic (age, race, gender identity, employment status, et cetera), clinical (T1D duration, insulin pump/continuous glucose monitor [CGM] usage, meeting glycemic goal), and insurance factors.

Of the 168 included participants, 66% were White, 70% were female, 67% were employed, 89% used CGM, and 75% used insulin pumps. However, only 47% met glycemic targets. A total of 48% held private insurance, with 58% self-policy holders. Lundgrin and colleagues noted that insurance, clinical, and demographic factors explained 42% of variance in financial toxicity (COST-FACIT; R2 = .42; 

 = .007). Older age and insurance type were also independently associated with toxicity, while private insurance was associated with lower financial toxicity. Uninsured or undisclosed insurance typically had higher financial toxicity.

Ultimately, Lundgrin and colleagues determined that health insurance and age were the most significant factors in financial toxicity. The analysis provides clinicians with a target, but not a method of discussing and addressing it.

To this end, Lundgrin also discussed her approach to discussing these sensitive topics with patients. Financial issues are often considered taboo to some degree, resulting in hesitancy in discussing potential barriers to treatment or outcomes. Taking a gentler and more open-ended approach, Lundgrin says, is key to getting the necessary information without straining the patient-clinician relationship.

“You have to be open-ended, starting by saying, ‘these are all the various options that we have at our disposal. What concerns do you have about these options?’” Lundgrin said. “I’ve been surprised when I take an approach like this at the answers I get. Sometimes I think it might be one thing, and it’s actually something else entirely.”

Editors’ Note: Lundgrin reports no relevant disclosures.

Grant D, Alasad B, Rieke J, et al. Predictors of Financial Toxicity in Emerging Adults with Type 1 Diabetes in the iHERO Study. Abstract presented at the American Diabetes Association (ADA) Scientific Sessions 2026, New Orleans, LA. June 5-8, 2026.

Patel MR. Financial Toxicity in Diabetes: The State of What We Know. Curr Diab Rep. 2025;25(1):32. Published 2025 May 13. 

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Erika Lundgrin, MD, discusses her recent work comparing the various components of financial toxicity, determining what has the greatest effect on negative outcomes.

Erika Lundgrin, MD

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