Investigating the Impact of Financial Toxicity in Young Adults with T1D - PROJECT SUMMARY About 1 in 4 Americans who use insulin report rationing their insulin to save money. Emerging adults living with type 1 diabetes (T1D) have worse glycemic outcomes than other age groups. During this developmental stage, young people are compelled to navigate healthcare and insurance for the first time independently, while also experiencing the highest rates of poverty and unemployment among adults. Notably, researchers in the cancer literature have begun to describe this objective financial burden and subjective financial distress of healthcare costs, collectively named financial toxicity. In the last 10 years, financial toxicity has been described, measured, and targeted as the focus of interventions in cancer research. It is timely to elucidate how emerging adults with T1D experience these financial and healthcare burdens, mirroring the understanding of financial toxicity in the cancer literature into diabetes research. Katherine Wentzell, PhD, PNP, BC-ADM is a pediatric nurse practitioner and early-career clinical researcher who will target this understudied area in T1D in her K23 proposal focused on emerging adults. In her recent doctoral and postdoctoral work, she developed a new measure of diabetes distress in emerging adults, which included an item about the worry about diabetes costs and this item was the most highly endorsed on the survey. This preliminary work underscored her interest in investigating the impact of financial stressors in emerging adults with T1D, especially those with suboptimal glycemic control. She has assembled a multidisciplinary mentorship team led by national experts in diabetes clinical and behavioral research, as well as advisors with focused methodological and cost-related expertise. This K23 career development proposal includes 3 specific aims incorporating mixed-methods research and culminating in a pilot randomized controlled trial. In Aim 1a, Dr. Wentzell will use semi-structured interviews to describe the experience of financial toxicity, health insurance access, and cost-coping behaviors in a diverse sample of emerging adults. In Aim 1b, she will utilize the innovative methodology of asynchronous online text- based focus groups to expand the understanding of cost related non-adherence and financial toxicity in emerging adults with T1D. In Aim 2, Dr. Wentzell will develop and validate a new measure of financial toxicity and explore relationships among social determinants of health, health insurance access, and psychological factors as they relate to objective financial burden, subjective financial distress, and glycemic outcomes in a diverse nationwide sample of emerging adults with T1D. Finally, building on the results in the prior aims, in Aim 3, she will develop, implement, and evaluate a pilot psychoeducational intervention to reduce subjective financial distress and cost related non-adherence in emerging adults with suboptimal glycemic control. Through the proposed career development award, Dr. Wentzell will acquire important skills in mixed-methods and intervention research to reach her goal of becoming an independent clinical investigator.
