the financial burden of diabetes: being open about costs can help improve outcomes
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the financial cost of diabetes is really the accumulation of components, like the cost of drugs and the cost of supplies, including strips for glucose testing and the one-use needle tips for insulin pens for injections.
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one of the first questions dr. christine ibrahim asks new patients is about their health insurance coverage and if they can afford medication. the reality is that anywhere from 20 to 40 per cent of people leave a clinician’s office and never fill their prescription, she says, which can be for a number of reasons, with financial cost likely high on the list. this is challenging for health-care providers who want to give patients the best care available.
dr. ibrahim is an endocrinologist with the scarborough health network in scarborough, ont., that serves a growing and diverse population, including refugees and new immigrants to canada who are just getting their lives resettled. many of her patients are living with diabetes, new to the diagnosis and trying to understand how to manage the condition.
diabetes happens when the body can’t produce the hormone insulin (type 1 diabetes) or isn’t using it properly (type 2 diabetes), requiring lifestyle changes and treatment. the cost can be an emotional and financial burden.
open conversation with doctors about costs
“first, it’s important for a patient to understand and accept the diagnosis of diabetes. without that, you won’t be able to discuss a management plan with them,” she says. next is being direct and bringing up the costs involved with therapy.
“if a patient can’t afford [the medication], then adherence suffers, outcomes suffer and they may feel like they have failed, but it is really the system that has failed them,” she explains. depending on the situation, she’ll outline a plan for less expensive medications that do the job but aren’t the “gold standard therapy,” which are more expensive. for example, there are newer drug classes of medications which have shown excellent cardiovascular and kidney protection but carry higher out-of-pocket costs for those without coverage. as a chronic and progressive condition, diabetes is hard on your heart and kidneys over time.
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she points out that being open about cost considerations helps normalize these conversations, making people feel more comfortable discussing financial commitments. it also reflects the patient-first approach that meets people where they’re at and builds a foundation of trust.
“unfortunately, it is a more common reality than we would like to think. patients are choosing between groceries and medications, sometimes not filling prescriptions or delaying when they pick up the next batch or stretching drug dosing for insulin. and if it is a life-saving medicine, like insulin for type 1 diabetes, this is dangerous and can lead to hospitalization. then that hospitalization costs the system far more than the medication would have if they had routine access.”
she’s also seeing increased rates of diabetes distress and burnout in her patients—not just because of the disease itself, but because of the financial pressure. “this is why it is important to keep an open and honest line of communication to see what we can do to help.”
health researchers in athens describe the term “diabetes burnout” as a psychosocial awareness and a state accompanied by feelings of exhaustion and frustration connected to the inflexible daily demands of managing the illness. this results in contradictory self-care attitudes, so they struggle to keep up with the diet, exercise, medication and daily blood glucose monitoring that are the therapeutic obligations of patients with diabetes. the ongoing stress also negatively influences their blood sugar levels. in a review of the science on diabetes burnout in clinical practice and epidemiology and mental health, these researchers note, “given that diabetes can require a great deal of personal effort and making rapid decisions every day, it is remarkable that anyone can manage diabetes successfully day after day and even year after year.”
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stress makes diabetes harder to manage
dr. ibrahim says that addressing financial obligations helps reduce the stress of managing the condition.
she explains the financial cost of diabetes is really the accumulation of components, like the cost of drugs and the cost of supplies, including strips for glucose testing and the one-use needle tips for insulin pens for injections. if you are on a high dose of insulin, the drugs and supplies add up quicker.
diabetes complications can derail finances
as well, there are hidden costs of lost wages from taking time off work to attend medical appointments, transportation in areas with poor transit access and dietary needs, because what you consume directly impacts blood sugar. there’s an emphasis on eating healthy, whole foods where you can control the ingredients and portions. there are also the unexpected complications that can derail finances.
“if you unfortunately developed a complication like a foot wound that impairs your ability to do daily activities of living, attending work and you may need daily wound care, so these things add up,” she says, adding that prevention and routine medical check-ins are key to reducing the risk of progression to this stage.
as with most chronic conditions, there are significant downsides to not pursuing treatment or underdosing your medication.
diabetes puts patients at risk of immediate harm with high blood sugar, hyperglycemia, or low blood sugar, hypoglycemia, which can be life-threatening. fluctuating blood sugars over the long-term, however, can affect sensitive organs.
there are microvascular, or small vessel, complications and macrovascular complications, which are large vessel complications. small vessels are the eyes, kidneys and nerves, while the large vessels impact the heart, heightening the risk of heart attack, heart failure and stroke.
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“it is like a small leak in the roof of your house,” she says of complications from diabetes that is not well-managed. “you may be able to ignore it initially, get a small bucket where the water drips slowly, but over time, the hole will get larger and more obvious. but you also have the hidden impacts of water seeping into the walls, leading to damage and mould. and this hidden destruction is significant and you will have no idea until it shocks you with how fragile the structure is. this is the same with diabetes as a chronic disease. the first issue may be high sugars, and you may not feel any symptoms, but if you let it fester, do not deal with it, or don’t monitor your whole body health, then the hidden cost of damage to your organs” will take its toll.
diabetes researchers in australia outlined the growing range of complications of diabetes in trends in endocrinology and metabolism in 2025, looking at rising liver disease, cancer, dementia and frailty from insulin resistance and chronic low-grade inflammation. they note that blood glucose levels appear to play a lesser role in these complications, and new approaches are being developed to prevent and manage them. but again, these newer therapies, with some drugs now available for protection against liver disease, are more costly.
as dr. ibrahim says, “when we make concessions, and when diabetes care is inaccessible due to cost, we do not save money, we simply defer costs to visits to emergency rooms, advancements of complications such as renal disease leading to dialysis, or foot infections leading to amputations. upstream investment in access is not without reason, and it does make health-economic sense.”
continuous glucose monitors not affordable for many
technology continues to advance in powerful ways to help people living with diabetes, but cost is a barrier to access and adoption. this is an inequity she sees regularly in her practice.
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“continuous glucose monitors, cgms, have changed the paradigm of diabetes awareness and management. with these devices, you get insight into when your glucose values are too high, too low or it allows you to see the trends and the ability to reflect and make changes to lifestyle and medications to improve diabetes health.” there is data showing that cgms improve quantitative metrics such as time in range of normal blood sugar levels and reduce hypoglycemia, and qualitative metrics such as quality of life and diabetes distress, she says. “but without private insurance, it is an added cost.”
people with type 1 diabetes can apply for assistive devices program coverage for certain sensors and in certain situations. for people with type 2 diabetes, health-care providers can give samples when they have them, look at manufacturer patient support programs, connect them to a diabetic education clinic for samples and continue to work on advocacy for access.
“to be honest, there are times that i feel that i am a social navigator as much as a clinician, but it matters, and it is very important for my patients.”
sometimes this ends up being the main focus of the appointment.
she also recommends people reach out to support organizations like diabetes canada to help them navigate financial aid programs. further, she points to canada-wide programs through veterans affairs and nihb (non-insured health benefits for first nations and inuit individuals), assistive devices programs, the disability tax credit, and the registered disabilities savings plan to consider.
“there’s a whole list of things that can be done, but the conversation doesn’t get started unless there’s an open and honest line of communication, and we prefer to have this with our patients so we can know how to best help them.”
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