Housing Instability Associated With Cost-Related Nonadherence and Financial Toxicity in People With Uncontrolled Diabetes
In brief
Half of uncontrolled diabetics face housing instability, raising nonadherence odds by 60%
In a baseline analysis of 600 adults with uncontrolled diabetes, 50% reported housing instability, which was linked to a 64% higher likelihood of skipping or delaying medication because of cost and to markedly worse financial toxicity scores. The association with nonadherence weakened after accounting for depression and diabetes distress, while the financial impact persisted, highlighting the need for broader socioeconomic support.
- Journal
- Diabetes care (Q1)
- Published
- 13 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Victoria H Davis, Roshanak Mehdipanah, Minal R Patel
- PMID
- 42594248
- DOI
- 10.2337/dc26-1152
Why clinicians should know about it
- Picked for Internal Medicine (top studies of the week, 16 August 2026): Housing instability and diabetes adherence, social determinant focus
Abstract
OBJECTIVE: To assess the prevalence of housing instability and its associations with cost-related nonadherence and financial toxicity among adults with uncontrolled diabetes. RESEARCH DESIGN AND METHODS: We analyzed baseline randomized controlled trial data from 600 adults with uncontrolled diabetes and cost-related barriers to care. Logistic and linear regression assessed associations of housing instability with cost-related nonadherence and financial toxicity. RESULTS: Half (n = 298) reported housing instability, which was associated with greater odds of cost-related nonadherence (adjusted odds ratio 1.64; 95% CI 1.05, 2.56) and worse financial toxicity (B = -4.64; 95% CI -6.20, -3.09). Cost-related nonadherence was not significant after adjusting for diabetes distress and symptoms of depression and anxiety; financial toxicity remained significant. In sensitivity analyses, worry about housing costs, not housing or utility needs, was associated with financial toxicity. CONCLUSIONS: Housing instability was associated with financial toxicity and, in primary models, with cost-related nonadherence. Findings should be validated in longitudinal, nationally representative samples.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.