{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:51:38Z","timestamp":1791175898583,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23DK138324"],"award-info":[{"award-number":["K23DK138324"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Despite advancements in diabetes care, up to one in four Americans report rationing insulin due to cost concerns; emerging adults are especially susceptible to cost worries as they transition away from family support. Financial toxicity may help elucidate how emerging adults with type 1 diabetes (T1D) experience emotional burden. This study aimed to understand how emerging adults with T1D describe subjective financial distress, objective financial burden and difficulties navigating health insurance coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive design using semi\u2010structured interviews. Analysis was completed using standard qualitative content analysis procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants included 8 men and 7 women, 80% identified as White with a median age of 24\u2009years and diabetes duration of 12\u2009years. Sixty percent were on their parents' health insurance and 100% used diabetes technology. Four themes emerged: (1) diabetes distress is substantial and embedded within the developmental stage of emerging adulthood; (2) diabetes distress includes the new responsibility of affording diabetes care independently, which participants experience as an emotional burden, both in the present and when contemplating the future; (3) financial costs of diabetes are exacerbated by insurance barriers, leading to inadequate access to management resources; and (4) emerging adults endorse cost coping strategies, both in the present and when planning for the future.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emerging adults with T1D experience financial toxicity as a source of diabetes distress, leading to cost coping strategies, which are embedded in the larger context of the demands of this developmental stage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70475","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:10:59Z","timestamp":1791173459000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Financial toxicity as a source of diabetes distress resulting in cost coping strategies in emerging adults with type 1 diabetes in the United States"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3589-2980","authenticated-orcid":false,"given":"Katherine","family":"Wentzell","sequence":"first","affiliation":[{"name":"William F. Connell School of Nursing Boston College  Chestnut Hill Massachusetts USA"},{"name":"Pediatric, Adolescent, and Young Adult Section Joslin Diabetes Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2345-9941","authenticated-orcid":false,"given":"Jane","family":"Flanagan","sequence":"additional","affiliation":[{"name":"William F. Connell School of Nursing Boston College  Chestnut Hill Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Mooney","sequence":"additional","affiliation":[{"name":"William F. Connell School of Nursing Boston College  Chestnut Hill Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8159-0644","authenticated-orcid":false,"given":"Caitlin","family":"O'Connor","sequence":"additional","affiliation":[{"name":"William F. Connell School of Nursing Boston College  Chestnut Hill Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9675-3001","authenticated-orcid":false,"given":"Lori M.","family":"Laffel","sequence":"additional","affiliation":[{"name":"Pediatric, Adolescent, and Young Adult Section Joslin Diabetes Center  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Wood","sequence":"additional","affiliation":[{"name":"William F. Connell School of Nursing Boston College  Chestnut Hill Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2023.0320"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S014"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.5008"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.108996"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/m22-2477"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-025-09886-9"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.5007"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dsi21-0009"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-019-05006-6"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2022.0170"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13216"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/26350106221110817"},{"issue":"2","key":"e_1_2_10_14_1","first-page":"80","article-title":"Financial toxicity, part I: a new name for a growing problem","volume":"27","author":"Zafar SY","year":"2013","journal-title":"Oncology"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2023.05.020"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-025-01588-0"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcdhc.2024.1328444"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.afjem.2017.08.001"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","DOI":"10.4324\/9781003503538","volume-title":"Interpretive Description","author":"Thorne S","year":"2025"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.06.016"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06176-4"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.2337\/db25-317-OR"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.15282"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcdhc.2024.1293882"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjd.2022.02.004"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medj.2021.08.006"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70475","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.70475","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70475","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:11:00Z","timestamp":1791173460000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.70475"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,4]]},"references-count":25,"alternative-id":["10.1111\/dme.70475"],"URL":"https:\/\/doi.org\/10.1111\/dme.70475","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,4]]},"assertion":[{"value":"2026-02-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70475"}}