Introduction and Objective: Insulin is essential for managing T1D, yet many young adults face systemic barriers that limit access and consistent use. This study examined factors associated with using less insulin than prescribed and not filling insulin prescriptions over a 12-month period.Methods: A secondary analysis was conducted using data from the Resilient Empowered Active Living Telehealth (REAL-T) study, a randomized controlled trial of young adults with T1D (n=209, ≥1 year since diagnosis, A1c ≥7.5%). Participants self-reported insulin use quarterly over one year by answering: “In the past three months, did you use less insulin than prescribed?” and “Did you not fill an insulin prescription?” Logistic regression was used to examine predictors, including self-education, insurance type (e.g., Medicaid Managed Care [MMC]), unmet social needs, physician contact (from the DSMQ), and residence in a Medicaid non-expansion state. Models adjusted for race/ethnicity and gender.Results: After excluding nine participants with missing data, 200 participants (61% female, 45% Hispanic/Latinx, mean age 24.2 ± 3.8 years) were analyzed. Over 12 months, 48.5% reported using less insulin, and 33.5% reported not filling prescriptions, due to structural barriers. Each additional unmet social need (OR = 1.753, 95% CI: 1.32-2.327, P < 0.001) and living in a Medicaid non-expansion state (OR = 3.373, 95% CI: 1.374-8.278, P = 0.008) increased odds of limited insulin use. For not filling prescriptions, each unmet social need (OR = 1.4, 95% CI: 1.036-1.891, P = 0.029), living in a non-expansion state (OR = 11.771, 95% CI: 4.437-31.228, P < 0.001), and having MMC insurance (OR = 16.178, 95% CI: 2.648-98.846, P = 0.003) increased the odds.Conclusion: Insulin access and use are likely limited by state Medicaid policies, restrictions in Medicaid insurance plans, and unmet social needs. Addressing these barriers is critical for ensuring equitable insulin availability for young adults with T1D.
N.D. Nnoli: None. Y. Mo: None. J.D. Leite Junior: None. P. Lee: None. J. Raymond: None. D. Fox: None. G. Granados: None. J. Sideris: None. J. Blanchard: None. E. Pyatak: None.
National Institute of Diabetes and Digestive and Kidney Diseases Study (R01DK116719)
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