Journal of General Internal Medicine

, Volume 27, Issue 4, pp 432–437 | Cite as

The Effects of Financial Pressures on Adherence and Glucose Control Among Racial/Ethnically Diverse Patients with Diabetes

  • Quyen Ngo-MetzgerEmail author
  • Dara H. Sorkin
  • John Billimek
  • Sheldon Greenfield
  • Sherrie H. Kaplan
Original Research



The Affordable Care Act is designed to decrease the numbers of uninsured patients in U.S. However, even with insurance, patients who have financial hardships may have difficulty obtaining their medications because of cost issues.


Among patients with type 2 diabetes, to examine the association between patients’ self-reported financial pressures on cost-related medication non-adherence and glucose control. Additionally, to examine whether having insurance decrease the financial pressures of diabetes care.

Design and Participants

Racially/ethnically diverse patients (N = 1,361; 249 non-Hispanic whites, 194 Vietnamese, and 533 Mexican American) with type 2 diabetes were recruited from seven outpatient clinics for a cross-sectional, observational study.

Key Results

Although both Vietnamese and Mexican-American patients reported having low annual incomes, more Mexican Americans reported the presence of financial barriers to getting medical care and perceived financial burden due to their diabetes, compared to whites and Vietnamese (p < 0.001). Over half (53.2%) of Mexican Americans reported cost-related non-adherence compared to 27.2% of white and 27.6% of Vietnamese patients (p < 0.001). Perceived financial burden was found to be associated with poor glucose control (HbA1c ≥8%), after adjusting for sociodemographic and health characteristics (aOR = 1.70, 95%CI 1.09-2.63), but not when adjusting for non-adherence. Similarly, a significant association between presence of financial barriers and HbA1c (aOR = 1.69, 95%CI 1.23-2.32) was attenuated with the inclusion of insurance status in the model. Being uninsured (aOR = 1.90, 95%CI 1.13-3.21) and non-adherent (aOR = 1.49, 95%CI 1.06-2.08) were each independently associated with HbA1c.


While having health insurance coverage eliminated some of the financial barriers associated with having diabetes, low-income patients still faced significant financial burdens. Thus, providing health insurance to more individuals is only the first step towards eliminating health disparities. It is important to address medication cost in order to improve medication adherence and glucose control.


Affordable Care Act type 2 diabetes ethnic groups race financial pressure adherence 



This work was supported by the Robert Wood Johnson Foundation (Generalist Physician Faculty Award #1051084 and Finding Answers: Disparities Research for Change #59758), the NovoNordisk Foundation, and the National Institute of Diabetes, Digestive and Kidney Diseases (R18DK69846 and K01DK078939). All authors have no relevant conflict of interest to disclose. Dr. Ngo-Metzger completed this work as an Associate Professor at the University of California, Irvine. The views expressed in this publication are solely the opinions of the authors and do not necessarily reflect the official policies of the U.S. Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA), nor does mention of the department or agency names imply endorsement by the U.S. Government.

Conflict of interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Quyen Ngo-Metzger
    • 1
    Email author
  • Dara H. Sorkin
    • 1
  • John Billimek
    • 1
  • Sheldon Greenfield
    • 1
  • Sherrie H. Kaplan
    • 1
  1. 1.Division of General Internal Medicine and Primary Care and Health Policy Research InstituteUniversity of California, IrvineIrvineUSA

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