The following text introduces the article “Examining out-of-pocket health expenditures of individuals with Type 1 diabetes: The case of Türkiye”. This study, authored by Mesut Ardıç and Mehmet Akif Erişen from Tokat Gaziosmanpaşa University, addresses the substantial economic burden posed by chronic diseases like diabetes mellitus globally.
Noncommunicable chronic diseases account for a significant portion of global deaths and disabilities, and they place a considerable strain on health expenditures, often leading to financial hardship for households. Diabetes, specifically Type 1 diabetes, is a chronic condition requiring continuous and multifaceted care, including daily blood sugar monitoring, insulin use, and regular check-ups. This lifelong management can result in significant physical and economic difficulties for affected individuals. The authors note that high out-of-pocket healthcare costs can lead to severe financial hardships, such as debt and risk of bankruptcy. Against this backdrop, the study’s primary aim was to investigate the “devastating out-of-pocket expenses of Type 1 diabetes” in Türkiye. The researchers also sought to quantify these expenditures to inform policymakers in designing strategies to alleviate the financial burden on individuals with Type 1 diabetes.
This quantitative, descriptive, cross-sectional study collected data between November 30 and December 15, 2024, from a convenience sample of 279 individuals with Type 1 diabetes living in Türkiye. Data were gathered through an online structured survey consisting of 38 questions, covering socio-demographic information, healthcare service utilization, and detailed monthly out-of-pocket payments for various diabetes-related items. Importantly, insulin costs were excluded from out-of-pocket calculations if provided by the government or purchased with social security. All expenditure and income data were converted from Turkish Lira to US Dollars using the exchange rate of 1 USD = 34.96 TRY as of December 16, 2024. Data analysis was performed using IBM SPSS Statistics version 27.
The study revealed that participants had an average HbA1c of 7.61% and measured their blood sugar more than four times a day. The mean total monthly out-of-pocket expenditure for individuals with Type 1 diabetes was $339.94, amounting to $4079.28 annually. When broken down, the highest monthly out-of-pocket expenses were for:
- Consumables ($205.84), which included Continuous Glucose Monitoring (CGM) sensors and insulin pumps.
- Hospital-related costs ($113.90).
- Healthy living expenses ($82.62).
- Other expenses ($41.24).
- Transportation costs ($33.14).
A significant finding was that participants spent an average of 30.4% of their monthly household income on managing Type 1 diabetes. Over 80% of participants considered diabetes-related products “excessively expensive” and reported that these out-of-pocket expenses severely impacted their finances, leading them to reduce other expenditures. The study highlighted that CGM sensors and insulin pumps were the two most costly expenditure items. While CGM sensor users had significantly lower HbA1c levels, both CGM sensor and insulin pump users incurred significantly higher out-of-pocket expenses compared to non-users.
The study concluded that individuals with Type 1 diabetes face substantial and “catastrophic” out-of-pocket expenses for their diabetes management. Given that a significant portion of these costs stems from essential devices like CGM sensors, and the study found no statistical difference in total expenditures or HbA1c levels between individuals with Type 1 diabetes under or over 18, the authors emphasize the critical need to extend CGM sensor reimbursement to all individuals with Type 1 diabetes, irrespective of age, to ease their financial burden.
Reference: Ardıç, M., & Erişen, M. A. (2025). Examining out-of-pocket health expenditures of individuals with Type 1 diabetes: The case of Türkiye. Diabetes Research and Clinical Practice, 226, 112362. https://doi.org/10.1016/j.diabres.2025.112362
