Introduction and Objective: PA is often required for diabetes medications and technologies, but its impact on PwD is not well characterized. This study examined the perspectives of PwD regarding the PA process in diabetes care.Methods: A cross-sectional, anonymous survey was conducted among PwD aged ≥18 years or caregivers of children with diabetes in the U.S. A convenience sample was recruited through social media from August-December 2025. Data were analyzed using descriptive statistics, bivariate correlations, and logistic regressions.Results: Of 174 respondents (74.7% female, 79.9% White, 84.5% type 1 diabetes), 73.0% had private insurance. PA-related treatment delays were reported by 72.4%. Overall PA experience was rated as poor or horrible (56.3%) and was significantly associated with length of delay (ρ = 0.46; P < .001). Hospitalization, diabetic ketoacidosis, or severe hypoglycemia while awaiting PA approval were reported by 11.5% of respondents. Financial burden from delays was reported as significant (28.2%). PA documentation was found somewhat or very challenging (56.9%), and 53.4% described the process as very stressful. At least one PA denial was reported by 47.7% and 25.3% reported abandoning therapy due to PA barriers. Due to PA, respondents reported decreased trust in insurers (64.9%) and the health care system (66.1%). Patient involvement in the PA process was associated with significantly increased odds of distrusting insurers (OR = 3.56; 95% CI, 1.8-7.2), distrusting the health care system (OR = 3.47; 95% CI, 1.7-7.0), and a negative PA experience (OR = 4.77; 95% CI, 2.4-9.7).Conclusion: Administrative and financial burden from PAs was prevalent in diabetes care and reported delays, treatment disruption, and decreased trust in insurers and the health care system. These findings underscore the urgent need to reassess PA requirements for diabetes therapies as they impose a substantial burden that delays crucial care and exacerbates challenges faced by PwD.
N.A. Sears: None. K. Craft: None. U.C. Cay: None. E. Karaca: None. C. Yurumez: None. Z. Perez: None. E. Cengiz: Advisory Panel; Current; Novo Nordisk, Eli Lilly and Company, Sanofi, Tandem Diabetes Care, Inc., Abbott Diabetes, MannKind Corporation. Advisory Panel; Ended; PortalInsulin.
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