2020 T1International Out-of-Pocket Cost Survey

Survey Highlights

  • This study is the most extensive patient-led out-of-pocket cost survey for people living with type 1 diabetes.
  • Significant positive correlation was observed between out-of-pocket expenses and reported household income for respondents with partial healthcare coverage.
  • Worldwide, one out of every four respondents reported having underused their insulin at least once within the last year due to high cost.
  • 63.2% of participants reported disruption of insulin supplies and 25.3% reported an increase of insulin prices related to the COVID-19 pandemic.


In 2016, T1International carried out our first global out of pocket cost survey for people with type 1 diabetes. We asked respondents to answer questions regarding insulin utilization, insulin delivery methods, and out-of-pocket costs for insulin, test strips and other diabetes management tools. 

In 2018, we improved the survey, learning more the situation for people with type 1 diabetes around the world, and growing our response rate. The majority of the data can be viewed in the visualizations and graphics at the above links.

2020 was our third iteration of the survey, and we added additional questions about the impact of COVID-19, and focused on US rationing and healthcare coverage results as they compare to those of other countries. Results were published as a research paper in the Journal of Diabetes Research and Clinical Practice. Visualizations from the 2020 data can also be found below.