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Cited by 119Medication Adherence and ComplianceDiabetes Management and EducationEconomic and Financial Impacts of Cancer

Cost-related medication non-adherence among U.S. adults with diabetes

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Kang, Hyojung, Lobo, Jennifer Mason, Kim, Soyoun, Sohn, Min-Woong·2018·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2018.06.016PMC PMC6204232
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Abstract

Aims To examine factors that affect cost-related medication non-adherence (CRN), defined as taking medication less than as prescribed because of cost, among adults with diabetes and to determine their relative contribution in explaining CRN. Methods Behavioral Risk Factor Surveillance System data for 2013-2014 were used to identify individuals with diabetes and their CRN. We modeled CRN as a function of financial factors, regimen complexity, and other contextual factors including diabetes care, lifestyle, and health factors. Dominance analysis was performed to rank these factors by relative importance. Results CRN among U.S. adults with diabetes was 16.5%. Respondents with annual income <$50,000 and without health insurance were more likely to report CRN, compared to those with income ≥$50,000 and those with insurance, respectively. Insulin users had 1.24 times higher risk of CRN compared to those not on insulin. Contextual factors that significantly affected CRN included diabetes care factors, lifestyle factors, and comorbid depression, arthritis, and COPD/asthma. Dominance analysis showed health insurance was the most important factor for respondents <65 and depression was the most important factor for respondents ≥65. Conclusions In addition to traditional risk factors of CRN, compliance with annual recommendations for diabetes and healthy lifestyle were associated with lower CRN. Policies and social supports that address these contextual factors may help improve CRN.

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  • High out-of-pocket drug costs are identified as a factor that limits initiation of and adherence to prescribed glucose lowering therapies.

    “High out-of-pocket (OOP) drug costs are identified as a factor that limit initiation of and adherence to prescribed glucose lowering therapies.8,9,10,11,12”

    From Evaluation of Out-of-Pocket Costs and Treatment Intensification With an SGLT2 Inhibitor or GLP-1 RA in Patients With Type 2 Diabetes and Cardiovascular Disease (2023) · cites this paper as [11]

    The Introduction states that the high cost of diabetes care is associated with medication non-adherence and that the cost burden of prescribed medications can reduce adherence. It does not address whether out-of-pocket drug costs limit initiation of glucose-lowering therapy; a search for initiation found no supporting passage. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Medication costs can be a major source of stress for people with diabetes.

    “Medication costs can be a major source of stress for people with diabetes and contribute to worse medication-taking behavior (197); cost-reducing strategies may improve medication-taking behavior in some cases (198).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [197]

    The Introduction says medication costs can burden people with diabetes and reduce adherence; the Discussion reports cost-related non-adherence among U.S. adults with diabetes. The paper does not establish that medication costs are a major source of stress, so that part of the claim is unsupported. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Medication costs contribute to worse medication-taking behavior.

    “Medication costs can be a major source of stress for people with diabetes and contribute to worse medication-taking behavior (197); cost-reducing strategies may improve medication-taking behavior in some cases (198).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [197]

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Cited by

Sorted by citations

Authors
Kang, H., Lobo, J. M., Kim, S., & Sohn, M.-W.
Affiliations
University of Virginia (US)
Corresponding author
  • Kang, Hyojung
  • Kim, Soyoun
  • Sohn, Min-Woong
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2018-09
Volume
143
Pages
24-33
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2018.06.016
PMC
PMC6204232
OpenAlex
W2810733222
Cited by
119
References
3
Citations by year
2026: 9 · 2025: 15 · 2024: 22 · 2023: 18 · 2022: 23 · 2021: 13 · 2020: 16 · 2019: 3
FWCI
9.17
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Diabetes Research and Clinical Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Agency for Healthcare Research and Quality (R01HS018542, 1R01HS018542)
  • National Institute of Diabetes, Digestive, and Kidney Diseases (R01DK113295)
  • NIH/NIDDK (1R01DK113295)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
Keywords
diabetes mellitus, drug costs, health insurance, income, insulin use, depression, comorbidities, arthritis, chronic obstructive pulmonary disease, asthma, health policy, social support, medication regimen complexity
MeSH terms
Assessment of Medication Adherence, Aged, Diabetes Mellitus, Female, Humans, Male, Middle Aged, United States, Drug Monitoring, Medication Adherence

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