{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T18:51:34Z","timestamp":1781808694373,"version":"3.54.5"},"reference-count":24,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["5T32DK063687"],"award-info":[{"award-number":["5T32DK063687"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Multiple states have passed legislation limiting out-of-pocket insulin costs for individuals on private insurance, including Colorado in 2020. Because disruptions in insulin access are life-threatening for people with type 1 diabetes, this study examined the real-world impact of Colorado\u2019s law on patient\/parent-reported outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Patient\/parent-reported frequency of insulin insecurity (insulin rationing, running out early, or finding alternative sources of insulin), cost concerns, and most recent insulin out-of-pocket cost were assessed by a clinic-developed survey. Demographics, A1C, and glycemic time in range (TIR; 70\u2013180 mg\/dL) were obtained from medical record review. Linear regression models were fit to compare out-of-pocket costs, A1C, and TIR, adjusting for sex, diabetes duration, race\/ethnicity, insurance, and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 184 enrolled participants, 149 responded to insulin insecurity questions, with 34% reporting at least one insulin insecurity behavior. Insulin insecurity was associated with higher monthly insulin costs ($77.60 vs. $19.30, P = 0.004) and A1C (+0.69 \u00b1 0.23%, P = 0.003) and lower TIR (\u22129.78 \u00b1 4.03%, P = 0.02) compared with insulin security. Similar rates of insecurity were seen in emerging adults (46%, n = 18\/39) and those publicly insured (43.5%, n = 10\/23). There was no difference in mean copayments between those on public versus private insurance ($39.40 vs. $38.00).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Despite costs falling below the out-of-pocket cap, insulin insecurity remains common among emerging adults and families of youth with type 1 diabetes and is associated with worse glycemia. Further research into root causes of insecurity, such as limitations on early refills, is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/ds25-0010","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T19:45:32Z","timestamp":1757965532000},"page":"476-482","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Insulin Insecurity and Its Subsequent Impact on Emerging Adults and Families of Children With Type 1 Diabetes"],"prefix":"10.2337","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7712-7067","authenticated-orcid":false,"given":"Lauren A.","family":"Waterman","sequence":"first","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8494-1814","authenticated-orcid":false,"given":"Erin C.","family":"Cobry","sequence":"additional","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics, Colorado School of Public Health 2 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talia","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado Anschutz Medical Campus 3 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7602-0396","authenticated-orcid":false,"given":"Sarit","family":"Polsky","sequence":"additional","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Berrian","sequence":"additional","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Todd","family":"Alonso","sequence":"additional","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"2026061813571103900_B1","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1001\/jamainternmed.2020.1308","article-title":"Out-of-pocket spending for insulin, diabetes-related supplies, and other health care services among privately insured US patients with type 1 diabetes","volume":"180","author":"Chua","year":"2020","journal-title":"JAMA Intern Med"},{"key":"2026061813571103900_B2","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1001\/jamainternmed.2020.1302","article-title":"Trends in insulin out-of-pocket costs and reimbursement price among US patients with private health insurance, 2006\u20132017","volume":"180","author":"Meiri","year":"2020","journal-title":"JAMA Intern Med"},{"key":"2026061813571103900_B3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2337\/dci23-0085","article-title":"Economic costs of diabetes in the U.S. in 2022","volume":"47","author":"Parker","year":"2024","journal-title":"Diabetes Care"},{"key":"2026061813571103900_B4","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1177\/1932296820947100","article-title":"The rising cost of insulin for pump users: how policy drives prices","volume":"15","author":"Brown-Georgi","year":"2021","journal-title":"J Diabetes Sci Technol"},{"key":"2026061813571103900_B5","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1210\/clinem\/dgaa817","article-title":"Addressing insulin access and affordability: an Endocrine Society position statement","volume":"106","author":"Endocrine Society","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"2026061813571103900_B6","first-page":"3","article-title":"Comparing insulin prices in the United States to other countries: updated results using 2022 data","volume":"11","author":"Mulcahy","year":"2024","journal-title":"Rand Health Q"},{"key":"2026061813571103900_B7","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1016\/S0140-6736(18)31320-5","article-title":"Type 1 diabetes","volume":"391","author":"DiMeglio","year":"2018","journal-title":"Lancet"},{"key":"2026061813571103900_B8","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1038\/nature08933","article-title":"Genetics, pathogenesis and clinical interventions in type 1 diabetes","volume":"464","author":"Bluestone","year":"2010","journal-title":"Nature"},{"key":"2026061813571103900_B9","doi-asserted-by":"crossref","first-page":"100624","DOI":"10.1016\/j.ssmph.2020.100624","article-title":"\u201cLife or death\u201d: experiences of insulin insecurity among adults with type 1 diabetes in the United States","volume":"11","author":"Willner","year":"2020","journal-title":"SSM Popul Health"},{"key":"2026061813571103900_B10","unstructured":"American Diabetes Association\n          . Statistics about diabetes. Available from https:\/\/diabetes.org\/about-diabetes\/statistics\/about-diabetes. Accessed 11 November 2024"},{"key":"2026061813571103900_B11","unstructured":"Colorado General Assembly\n          . HB21-1307: prescription insulin pricing and access. Available from https:\/\/leg.colorado.gov\/bills\/hb21-1307. Accessed 20 August 2024"},{"key":"2026061813571103900_B12","unstructured":"The White House\n          . By the numbers: the Inflation Reduction Act. Available fromhttps:\/\/bidenwhitehouse.archives.gov\/briefing- room\/statements-releases\/2022\/08\/15\/by-the-numbers-the- inflation-reduction-act. Accessed 24 August 2024"},{"key":"2026061813571103900_B13","unstructured":"American Diabetes Association\n          . State insulin copay caps. Available from https:\/\/diabetes.org\/tools-resources\/affordable- insulin\/state-insulin-copay-caps. 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