WHITEPAPER

NOVEMBER 25, 2014 | ABBREVIATION OF PART 5 OF THE C2B CONSUMER DIAGNOSTIC

Analysis of Consumers
with Diabetes

Copyright @2104 c2b solutions. All Rights Reserved. c2bsolutions.com

ANALYSIS OF CONSUMERS WITH DIABETES

P A R T 5 : A N A LY S I S O F C O N S U M E R S
WITH DIABETES

This whitepaper is an abbreviated summary of data and insights on consumers with diabetes, from c2b
solutions’ national study on the U.S. health care consumer. The full set of data can be found in Part 5 of the
c2b Consumer Diagnostic.
The data described in this whitepaper come from an online survey of 4,878 (4,184 National Rep Sample)
respondents, ages 18 and over, across the United States. Among these respondents were 450 consumers who
indicated they were diagnosed with diabetes. Fielded and analyzed in early 2013, the robust survey covered
384 variables across channels of health care.
Part 5 of the c2b Consumer Diagnostic focuses on consumers who have diabetes, with data delineating those
respondents with Type 1 versus Type 2 diabetes. According to the American Diabetes Association (www.
diabetes.org), 25.8 million adults and children in the United States have diabetes, amounting to 8.3% of the
population. This is comprised of 18.8 million people diagnosed and 7.0 million undiagnosed. An additional 79
million people are thought to have prediabetes, using fasting glucose and A1C levels to derive these estimates.
Thus, diabetes is a leading health issue in the U.S., and with the increasing rate of obesity, the impact of
diabetes will grow.

The survey was developed by c2b solutions with assistance from Ipsos, a leading global consumer research
The total number of respondents in the c2b Consumer Diagnostic with diabetes is n = 450, of which 12% have
firm. Respondents were members of Ipsos’ national research panel, and the population of respondents in
Type 1 diabetes (n = 56) and 88% have Type 2 diabetes (n = 398). Because the majority of these respondents
this study mirrors U.S. Census data, with a balance for demographics, socioeconomics, and geography.
have Type 2 diabetes, their answers heavily influence -- and are similar to -- the overall percentages for a Total
Diabetes aggregation. Thus, many of the Figures in this Part of the c2b Consumer Diagnostic do not include a
With its number of respondents and scope of topics covered, the c2b Consumer Diagnostic offers significant separate representation (e.g., data bar in a bar chart) for Total Diabetes
depth and breadth of data on consumer attitudes and behaviors regarding:

• Health & wellness

• The roles of healthcare professionals
• Rx and OTC medicines, including:
o Brand vs. generic preferences
o Source of purchase
Figure 1: Among Respondents with Diabetes, Percentage by Type
o Adherence
• Health insurance prferences
• Health Care Reform
• Media Preferences 12%
Type 1 Diabetes
• A variety of other topics

This whitepaper provides a sample of the data found in the c2b Consumer Diagnostic. This sample will help Type 2 Diabetes
the reader determine whether he or she will want to explore the more comprehensive data set from c2b
solutions’ national study. For a full listing of the market research data on consumers with diabetes found in
the c2b Consumer Diagnostic or its PowerPoint supplement, please refer to the Appendix in this whitepaper.

If you are interested in discussing the more comprehensive data set on consumers with diabetes, or any of
88%
c2b solutions products and services, please contact:

Brent Walker, VP & CMO

brent@c2bsolutions.com Note, the c2b Consumer Diagnostic does not identify the stages of diabetes in which a respondent may belong;
844-c2b-data (844-222-3282) ext. 702 this study was not specifically designed for consumers with diabetes, as it included 44 health conditions with
which respondents could indicate they have been diagnosed. It is recognized that consumer needs and behaviors
can change at each stage of diabetes, and this provides a macro snapshot of consumers with this disease.
However, based on years of research and experience with health care consumers, the c2b solutions team believes
people are not “walking disease states” – that they are people first, with underlying, hardwired motivations that
influence behavior and approaches to disease management. Part 8 of the c2b Consumer Diagnostic examines
psychographic consumer segments to further explore these hardwire motivations.

PART 5 3
 SECTION 1: PROFILE OF THE C2B CONSUMER Respondents with Type 2 diabetes are statistically (95% confidence) older than those with Type 1 diabetes. The
average age of respondents with Type 2 diabetes is 58.7 years, while the average age of respondents with Type 1
DIAGNOSTIC POPULATION WITH DIABETES diabetes is 45.3 years.

This Section of the c2b Consumer Diagnostic provides a profile of the respondents managing diabetes, with
statistics and general health and wellness attitudes, as a foundation for understanding the consumer with this Figure 3: Age
condition. This prefaces Sections on specific health behaviors and attitudes regarding various aspects of the 30%  

health care delivery system. This section is presented as follows:

1A. Demographics and Socioeconomics 25%  

1B. Health Status and Attitudes

1C. The Role of Family 20%  
1D. Influencing Others
1E. Diet, Exercise, and Sleep General Population n = 4,184
1F. Appearance 15%  
Type 1 Diabetes n = 56*
1G. Emotional Health Type 2 Diabetes n = 398
1H. Financial Considerations
10%  
1I. Influence of Community and Social Environment
1J. Litigation Risk
5%  

This whitepaper provides a sample of the data offered in the more comprehensive c2b Consumer Diagnostic.
0%  
18  -­‐  24   25  -­‐  34   35  -­‐  44   45  -­‐  54   55  -­‐  64   65  -­‐  74   75  or  over  

* small base
SECTION 1A: DEMOGRAPHICS AND SOCIOECONOMICS
The following charts and tables provide the demographic and socioeconomic composition of the respondents to
the c2b Consumer Diagnostic survey who report to be managing diabetes. A higher percentage of male than of
female respondents report having diabetes, whether Type 1 or Type 2. The American Diabetes Association (www. Respondents with Type 2 diabetes tend toward White/Caucasian (not Hispanic) moreso than do respondents
diabetes.org) reports that the incidence of diabetes is relatively equal among males and females (13 million men, with Type 1 diabetes. There is a higher percentage of Blacks/African Americans and Hispanics/Latinos among
12.6 million women; 2011 Diabetes Fact Sheet), so there is an over-representation of male respondents with respondents with Type 1 diabetes relative to respondents with Type 2 diabetes.
diabetes in the c2b Consumer Diagnostic.

Figure 2: Gender
Figure 4: Racial/Ethnic Background

Type 1 Diabetes Type 2 Diabetes

Type 1 Diabetes Type 2 Diabetes
White/Caucasian
3%
2% 13% 1%
Black/African
3%
16% American

12% Hispanic/Latino
Female Female
Male
43% 40% Male
57% Asian
60% 18% 61% 71%
Other

n = 56* n = 398
* small base
n = 56* n = 398
* small base

4 PART 5 PART 5 5
 Respondents with Type 1 and Type 2 diabetes share similar education profiles, with over 80% attending at least Figure 7 examines the political views of respondents with diabetes. At 21%, respondents with Type 1 diabetes
some college, with equal college graduation rates of 30%. are statistically more likely (95% confidence) to characterize themselves as Very Liberal. Respondents with Type
2 diabetes are directionally more likely to consider themselves Conservative.
Figure 5: Education
Figure 7: Political Views

Type 1 Diabetes Type 2 Diabetes 50%  

45%  

40%  
4% 2%
21% 17% 15% Grade school or less
14% 35%  
Some high school
High school graduate 30%  
General Population n = 4,184
Some college 25%  
College graduate Type 1 Diabetes n = 56*
31% 30% 20%  
36% Post graduate Type 2 Diabetes n = 398
30%
15%  

10%  

5%  
n = 56* n = 398
* small base 0%  
Very  liberal   Liberal   Middle  of  the   Conserva<ve   Very  
road   conserva<ve  

* small base

According to the American Diabetes Association (www.diabetes.org), the total costs of diagnosed diabetes in the
U.S. is $245 billion, consisting of $176 billion for direct medical costs and $69 billion in reduced productivity
(updated March 6, 2013). After adjusting for population age and gender differences, average medical expenditures
among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence
of diabetes. Additionally, the costs of undiagnosed diabetes, prediabetes, and gestational diabetes could inflate
these costs further.

Figure 6: Annual Household Income

$250,000+

$150,000 - $249,000
$100,000 - $149,999
$75,000 - $99,999
$50,000 - $74,999
$25,000 - $49,999
$10,000 - $24,999
Under $10,000
Prefer not to answer
0% 5%
Health insurance helps cover many of these
costs, but diabetes can represent financial
hardship for many people. As the commentary
with indicates, diabetes is a financial burden
Type 2 Diabetes n = 398 and source of stress in many marriages. A
Type 1 Diabetes n = 56*
comfortable and stable income is important for
General Population n = 4,184
managing this disease. Respondents with Type
1 and Type 2 diabetes largely earn the same
income until the higher levels – respondents
with Type 1 diabetes are statistically more
likely (95% confidence) than those with Type 2
10% 15% 20% 25% 30%
diabetes to earn $150,000 and over.

* small base

6 PART 5 PART 5 7
 SECTION 1B: HEALTH STATUS AND ATTITUDES ATTITUDES TOWARD HEALTHY AND UNHEALTHY BEHAVIORS
This Section provides an overview of health, wellness, and life attitudes and behaviors for respondents with This overview of attitudes and behaviors among respondents with diabetes provides further context for
diabetes. This is context for understanding the motivations and behaviors behind how this population approaches understanding consumers managing this health condition. Awareness of these attitudes can help health care
the management of its health condition(s). professionals tailor their approach to the patient for optimizing care.

Figure 8 provides the self-reported health status of respondents managing diabetes. At 23%, respondents with While the diagnosis of diabetes can be a significant “wake up call” for a consumer to positively modify his or
Type 1 diabetes were nearly six times as likely to rate themselves in Excellent health than respondents with Type her health behaviors, not all consumers will adhere to healthy behaviors. Consumers with diabetes experience
2 diabetes, a statistically significant difference (95% confidence). Respondents with Type 1 diabetes were also different situations and approach health care differently. Even if two consumers exhibit similar behaviors, their
twice as likely as the General Population to rate themselves in Excellent health. Many consumers with Type 1 motivations can be very different. One patient may be motivated by a sense of duty to family while another patient
diabetes learned to manage their condition at a young age and became conditioned to observe a healthy lifestyle. is driven by a need for personal control over a disease – both patients adhere to a physician’s recommendations
and are dedicated to healthy behaviors, but the impetus (and ways to communicate with these patients) differ.
On the other hand, respondents with Type 2 diabetes are twice as likely as the General Population to rate
themselves as being in Fair or Poor health, reflecting the variety of health issues these consumers must manage
Figures 10 and 11 (shown with just a few of the data points
related to their condition. For many of the Attitude questions, respondents were
available in the c2b Consumer Diagnostic) compare the asked to answer according to the following direction:
Figure 8: Self-Reported Health Status percentage of respondents with diabetes who agree with
Please indicate how much you agree or disagree with
more proactive, preventative, and improvement-oriented each of the following statements regarding health and
50%   attitudes versus a more disengaged or uninvolved set wellness (Select one response for each statement)
of attitudes. The number in parentheses next to each
45%  
percentage is an index of that percentage versus that of Strongly Agree
Agree
40%   the General Population. An index of (100) indicates an Neither Agree nor Disagree
35%  
equal percentage between consumers with diabetes and Disagree
the General Population. Again, this is a simple mechanism Strongly Disagree
30%  
to gauge over- or under-development of a given attitude  
General Population n=4,184
25%   among consumers with diabetes.
Type 1 Diabetes n = 56*

Separately, each type of diabetes appears in a column assigned a   letter a or b. This designation allows for statistical
20%   Type 2 Diabetes n = 398

15%   comparisons among respondents with different types of diabetes: a letter appearing under the percentage
10%  
indicates a statistical difference (at a 95% confidence) between respective types of diabetes/columns.

5%   For example, 55% of respondents with Type 1 diabetes (in column a) either Agreed or Strongly Agreed with the
0%   attitude, “I invest a lot of time and effort in improving my health.” This is a statistically greater percentage (at
Excellent   Very  Good   Good   Fair   Poor  
95% confidence) than the 36% of respondents with Type 2 diabetes (column b) who answered Strongly Agree or
* small base Agree with this attitude.

Figure 10: Attitudes Toward Proactive Behavior

Figure 9 examines how respondents with diabetes approach their management of health and wellness.
Respondents with Type 1 diabetes are statistically more likely (95% confidence) than those with Type 2 diabetes
to prefer a directive approach from a health care professional, though the majority of respondents with diabetes Strongly Agree/Agree
indicate they prefer choices and options or more passive guidance. Type 1 Type 2
Proactive/Prevention/Enhancement Oriented Diabetes Diabetes
Figure 9: Managing a Healthy Lifestyle
n = 56* n = 398
Which Most Described the Way of Managing a HealthyHigh Cholesterol
Lifestyle? a b

Type 1 Diabetes Type 2 Diabetes 55% (157) 36% (103)

I invest a lot of time and effort in improving my health
b
I need clear direction from a health
professional (Doctor, Nurse, Nutritionist, 45% (136) 30% (91)
Fitness Trainer, etc.) and be instructed on I am constantly seeking new and improved health care products to manage my health & wellbeing
what to do in caring for my health and b
4%
7%
wellness
2% 3% 6%
15%
22% 48% (160) 33% (110)
I seek options or choices from a health I’ll spend whatever it takes to be healthy
16%
8% professional (Doctor, Nurse, Nutritionist, b
36% Fitness Trainer, etc.) because it is my
decision how I care for my health and
25% wellness
* small base
I am open to direction from a health
professional (Doctor, Nurse, Nutritionist,
Fitness Trainer, etc.) in caring for my health Despite the healthier attitudes expressed by respondents with Type 1 diabetes in Figure 10, this population is more polarized
and wellness, but I do not actively seek this
guidance in its attitudes about proactive/disengaged behaviors than are respondents with Type 2 diabetes. As Figure 11 shows, there is
29% a population of respondents with Type 1 diabetes who is highly over-developed in negative, disengaged health attitudes than
I consider myself self-sufficient and rely on
42% 44%
41%
myself for my health and wellness, without
any direction and guidance from a health
either respondents with Type 2 diabetes or the General Population. Over a third of respondents with Type 1 diabetes appear
professional (Doctor, Nurse, Nutritionist,
Fitness Trainer, etc.) unless it is absolutely
to have checked out on healthy behaviors, which may represent a potential “train wreck” if these attitudes and behaviors are
necessary not changed. These data underscore how different patients with diabetes think and act differently, and require health care
I don't really do much to manage a healthy
lifestyle professionals to understand their patients’ personal barriers and motivations for healthy living. A “one size fits all” approach
n = 56* n = 398 to caring for patients with diabetes will not succeed.
* small base  
8 PART 5 3. Cancer PART 5 9
Figure 3.1

n = 4,184 Figure 3.16: Managing a Healthy Lifestyle

Which Most Describes the Way of Managing a Healthy Lifestyle
 Figure 11: Attitudes Toward Disengaged Behavior SECTION 1E: DIET AND EXERCISE
Diet and nutrition are extremely important in managing diabetes, so one might assume that consumers with
Strongly Agree/Agree the health condition would be more attuned than others in watching what they eat. Over half of respondents
Type 1 Type 2
with diabetes claim that they constantly check the ingredients and nutritional content of foods before they buy
Diabetes Diabetes them, and only a third indicate say they have tried diets but they do not work. However, respondents with Type
Disengaged 1 diabetes are statistically or directionally more likely than those with Type 2 diabetes to successfully observe
n = 56* n = 398 healthy nutritional habits. Respondents with Type 2 diabetes are less likely than the General Population to agree
a b that they are successful in maintaining healthy nutritional habits or that they actively seek nutritious products that
help them live a healthy lifestyle. On the other hand, ¾ of respondents with Type 2 diabetes acknowledge that
45% (155) 29% (100)
I know what I should be doing to be healthy, but I don’t make my health a priority
b their future health depends on what they eat today, so a baseline understanding of the importance of nutrition
is present. Respondents with Type 2 diabetes are less likely than the General Population to agree that they are
36% (164) 28% (127)
I consider myself a “couch potato” successful in maintaining healthy nutritional habits.

34% (213) 13% (81) Figure 13: Attitudes on Nutrition and Diet
I accept my current state of health, and therefore I don’t do anything to change it
b

* small base Strongly Agree/Agree

Type 1 Type 2
Nutrition/Diet Diabetes Diabetes
SECTION 1D: INFLUENCING OTHERS n = 56* n = 398

In Figure 12, respondents with Type 1 diabetes are significantly more outspoken in their opinions, both in general a b
and specific to health and wellness, than their counterparts with Type 2 diabetes or the General Population. In 57% (114) 56% (112)
I constantly check the ingredients and nutritional content of foods before I buy them
fact, respondents with Type 1 diabetes are three times as likely as those with Type 2 diabetes to be outspoken on
health issues, giving advice to others. Seventy percent of respondents with Type 1 diabetes believe they are more 63% (134) 43% (92)
I am successful in maintaining healthy nutritional habits
educated than other people on health and wellness, statistically higher (95% confidence) than those with Type 2 b
diabetes, less than half of whom feel the same way. 34% (131) 34% (131)
I’ve tried diets but they don’t work
Respondents with Type 2 diabetes generally mirror the General Population across the influencer attitudes and
behaviors. Respondents with Type 2 diabetes are also statistically more likely than those with Type 1 diabetes to
agree that they do not consciously influence others when it comes to health and wellness. Figure 14 examines the exercise habits of respondents with diabetes. Respondents with Type 1 diabetes are
statistically more likely (95% confidence) than those with Type 2 diabetes to claim they exercise daily, though
the percentages are similar for engaging in physical activity 3-6 days a week. Respondents with Type 2 diabetes
are three times as likely to admit that they never exercise, which can be concerning for a population managing
Figure 12: Peer Influence weight issues.

Strongly Agree/Agree Figure 14: Frequency of Exercise

How  Do  You  See  Yourself  Influencing  Others  Regarding  Their  Own  Health    
Exercise, Play Sports, or Do Some Type of Physical Activity that Requires Exertion?
Influence  on  Others  
90%  
and  Wellbeing  
80%  
80%  
70%  
70%  
60%  
60%  
50%  
50%  
5% 9%
40%  
40%   General  PopulaJon  n=4,184  
17%
30%  
Type  1  Diabetes  n  =  56*  
20% Daily
30%   Type  2  Diabetes  n  =  398  
14%
20%   12% 5-6 days a week
20%  

10%  
10%   3-4 days a week
0%  
0%  
I  am  more  educated  about  health  &  I  am  very  vocal  about  being  healthy.  I    set  an  example  by  being  as  healthy   I  do  not  consciously  influence   11% 2 days a week
I  am  outspoken  in  my  opinions;  people   It  is  difficult  to  get  to  know  me;  I   My  friends  and  family  follow  my  advice  
wellness  than  most  people  I  know   I  give  advice  to  friends  and/or  blog   as  I  can  be  but  let  everyone  make   others   7%
know  where  I  stand  on  things   generally  do  not  share  my  feelings  with  
others  
on  health  &  wellness  
online  on  the  best  way  to  become  
and  stay  healthy  
their  own  decisions   1 day a week
13% About once every 2-3 weeks
* small base 4%
9% 22% About once per month
7% Less often than once per month

On the whole, it would appear consumers with Type 1 diabetes are strong influencers of others on the topic of 5% Never
7%
health and wellbeing. While they are managing a chronic health condition, they are invested in knowledge of 7% 20% 11%
the disease as well as healthy living, and could be cultivated to teach others about this lifestyle. This is not to say
that there are not peer “Chat Leaders” among consumers with Type 2 diabetes; they may just be more challenging n = 56* n = 398
to identify in a population. However, once identified, these consumers might better relate to others with Type 2 * small base
diabetes and could prove a valuable asset in helping others manage their disease.

10 PART 5 PART 5 11
 SECTION 1F: APPEARANCE
The c2b Consumer Diagnostic survey asked respondents to provide
The formula for BMI is weight
their height and weight measurements to calculate their Body Mass One’s physical appearance is an important factor in emotional health, esteem, and motivations. Nearly half of
(in pounds) divided by height
Index (BMI). With some exceptions, BMI is generally a reliable (in inches) squared,
respondents with Type 2 diabetes indicate that physical appearance is Extremely or Very Important, as do 60%
indicator of body fatness for most people and is used to screen for multiplied by a conversion of those with Type 1 diabetes. As Figure 17 shows, respondents with Type 1 diabetes are more image conscious
weight categories that may lead to health problems (Centers for factor of 703 (i.e., weight (lb) than those with Type 2 diabetes, as well as the General Population. Nearly a third of respondents indicate that
Disease Control and Prevention). The CDC suggests that for adults / [height (in)]2 x 703).   one’s physical appearance is Extremely Important, statistically higher (95% confidence) than those with Type 2
20 years old and older, the standard weight categories associated diabetes. Respondents with Type 2 diabetes are statistically more likely than those with Type 1 diabetes to say that
with BMI ranges are: appearance is Not Very Important.

  One in five respondents with Type 1 diabetes claims he or she is Extremely Satisfied with his/her physical
appearance, while only 6% of respondents with Type 2 diabetes feels this way. Over half of respondents with
Figure 15: Body Mass Index Indicators Type 2 diabetes are Extremely or Very Satisfied with their physical appearance, while only 1/3 of those with Type
2 diabetes agree.
BMI Weight Status
Figure 17: Importance & Satisfaction – Physical Appearance
Below 18.5 Underweight
Importance  –  Physical  Apperance   Sa5sfac5on  –  Physical  Appearance  
18.5 – 24.9 Normal 45%   50%  

25.0 – 29.9 Overweight 40%   45%  

35%   40%  

30.0 and Above Obese 30%  

35%  

30%  
25%  
General Population n=4,184
25%  
20%   Type 1 Diabetes n = 56*
20%  
Type 2 Diabetes n = 398
15%  
Figure 16 shows the distribution of BMI across the population of respondents with diabetes, relative to the General 15%  

Population. There is a stark contrast between respondents with Type 1 diabetes and those with Type 2 diabetes.
10%   10%  

5%   5%  

0%  
While 50% of respondents with Type 1 diabetes have a BMI that classifies them as overweight or obese, 73% of 0%  
Extremely  Important   Very  Important   Somewhat  Important   Not  Very  Important   Not  At  All  Important  
Extremely  
Sa<sfied  
Very  Sa<sfied   Somewhat  
Sa<sfied  
Not  Very  Sa<sfied   Not  At  All  
Sa<sfied  

respondents with Type 2 diabetes are classified as such. Forty-three percent of respondents with Type 2 diabetes
qualify as obese, which is statistically higher (95% confidence) than the 27% of respondents with Type 1 diabetes
who are obese. Respondents with Type 1 diabetes are statistically more likely than those with Type 2 diabetes SECTION 1G: EMOTIONAL HEALTH
to be underweight according to BMI. Part 7 of the c2b Consumer Diagnostic provides a detailed analysis of
consumers with Obesity. Despite the seemingly proactive nature of respondents with Type 1 diabetes, a sizeable portion of this population
deals with emotionally taxing feelings. Over half of respondents with Type 1 diabetes admit that, deep down,
they are not very confident in themselves. This percentage is statistically higher (95% confidence) than those
of respondents with Type 2 diabetes, and highly over-developed relative to the General Population. Health
Figure 16: Body Mass Index care professionals should be cognizant of underlying concerns and stressors being managed by many of these
consumers who may present an outwardly empowered and proactive persona.
50%  
Interestingly, respondents with Type 2 diabetes are statistically more likely than those with Type 1 diabetes to
45%   believe their emotional health is as important as their physical health, only 29% often feel anxious or nervous,
40%  
and 27% -- half the percentage of Type 1 diabetes – admit a lack of confidence in themselves. While the data in
the preceding Figures point to a less proactive approach to health and wellness, respondents with Type 2 diabetes
35%   appear to be more at ease with themselves and laid back.

30%   Figure 18: Attitudes on Emotional Health

General Population n=4,184
25%  
Type 1 Diabetes n = 56*
Strongly Agree/Agree
20%   Type 2 Diabetes n = 398
Type 1 Type 2
15%   Emotional Health Diabetes Diabetes
n = 56* n = 398
10%  
a b
5%  
43% (139) 29% (94)
I often feel anxious or nervous
0%   b
Underweight   Normal   Overweight   Obese  
54% (164) 27% (82)
Deep down, I must admit I’m not very confident in myself
b
* small base 82% (95) 91% (106)
My emotional health is as important as my physical health
a

* small base
12 PART 5 PART 5 13
 SECTION 1H: FINANCIAL CONSIDERATIONS Figure 20: Impact of Illness

While respondents with Type 1 diabetes are more likely to be employed and have a higher income than those Strongly Agree/Agree
with Type 2 diabetes, this population are also more concerned with the costs of health care. As Figure 19 shows, Type 1 Type 2
respondents with Type 1 diabetes are statistically more likely (95% confidence) to have difficulty paying for health Diabetes Diabetes
Impact of Illness
care bills or a healthy lifestyle. Half of respondents with Type 1 diabetes claim their health care costs prevent
them from spending money on everyday expenses, two and a half times as likely as the General Population to n = 56* n = 398
express this concern. a b
70% (105) 66% (99)
Because respondents with Type 2 diabetes tend to be older (Figure 3), many may feel more comfortable with When I’m sick, I continue on with my daily routine even though I’m not at my best
health care costs being covered by Medicare; however, a similar percentage of respondents with Type 1 diabetes
66% (118) 46% (82)
are covered by some form of health insurance, as demonstrated in Figure 30. I don’t let being sick get in the way of my work b
57% (173) 36% (109)
I worry about my health even when I am feeling healthy b
Figure 19: Financial Considerations
* small base

Strongly Agree/Agree
Type 1 Type 2
Diabetes Diabetes SECTION 2B: COMORBIDITIES
Financial Considerations/Affordability
n = 56* n = 398
People managing diabetes are also often managing other health issues, making healthy living a challenge for
a b many of these consumers. According to the American Diabetes Association (www.diabetes.org), many patients
I worry that I will be forced to make hard choices about what I spend my money on 73% (133) 59% (107) with diabetes struggle with:
because of the rising costs of health care b
Heart disease and stroke
I have a hard time paying my health care bills 55% (196) 29% (104)
• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people ages 65+
b
• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without the disease.
I don’t have the money to put towards a healthy lifestyle 50% (185) 28% (104) • The risk for stroke is 2 to 4 times higher among people with diabetes
b

* small base
High blood pressure
• In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or
equal to 140/90 mmHg or used prescription medications for hypertension

SECTION 2: HEALTH CONDITIONS AND HOW THEY ARE MANAGED
Diabetes requires ongoing attention, to ensure that it is kept in check and under control. As the previous data in
this Part of the c2b Consumer Diagnostic have shown, there is a difference in attitudes with health and wellness
between respondents with Type I and Type II diabetes. This Section goes deeper into the behaviors of respondents
with diabetes pertaining to the management of their conditions.
SECTION 2A: IMPACT OF ILLNESS
Blindness
• Diabetes is the leading cause of new cases of blindness among adults aged 20-74 years.
Kidney Disease
• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008
Nervous system disease
• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage
Amputation
• In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes, accounting
for more than 60% of all such amputations in the United States

Two thirds of respondents with diabetes indicate that being sick does not get in the way of their daily routines.
Two thirds of respondents with Type 1 diabetes claim that being sick does not get in the way of their work, which Figure 21 provides a sample of the 44 other health conditions captured in the c2b Consumer Diagnostic, along
is statistically higher (95% confidence) than those with Type 2 diabetes. with the percentage of respondents with diabetes who also have these conditions. The number in parentheses
next to each percentage in an index of that percentage versus that of the General Population.

For example, among respondents with Type 2 diabetes, the index for Acid Reflux/heartburn/GERD is (150),
which is 24% (respondents with Type 2 who also have Acid Reflux/heartburn/GERD) divided by 16% (General
Population respondents with Acid Reflux/heartburn/GERD). An index of (100) indicates an equal percentage
between consumers with a diabetes and the General Population. This is a simple mechanism to gauge over- or
under-development of a given health condition among consumers with diabetes.

14 PART 5 PART 5 15
 For most conditions listed in Figure 21, incidence is over-developed for respondents with both Types of diabetes, SECTION 2C: TREATING HEALTH CONDITIONS WITH PRESCRIPTION
many notably so (200+ index). However, there are a few conditions of which respondents with Type 1 diabetes MEDICATION
are statistically more likely (95% confidence) than those with Type 2 diabetes to report having, and vice versa:
Given the incidence of comorbidities in Figure 21, it should be expected that respondents with diabetes are
more likely than the General Population to be taking a prescription for most health conditions captured in the
Type 1 Diabetes Type 2 Diabetes c2b Consumer Diagnostic.
Alzheimers Arthritis (General or Osteoarthritis) The c2b Insights Accelerator allows one to identify the specific prescription medications that respondents with
Anorexia/Eating Disorders High Cholesterol diabetes are taking.
Infection, Bladder or Urinary Tract High Blood Pressure/Hypertension
Inflammatory Bowel Disease Obesity Figure 22: Number of Prescriptions Taken
Stroke
Number of Prescriptions Currently Taken on Regular, Ongoing Basis
50%  
Respondents with Type 2 diabetes
currently take an average of 5.60 45%  

The c2b Insights Accelerator allows one to isolate respondents with single conditions or comorbidities and
prescription medications, compared 40%  

analyze the c2b Consumer Diagnostic survey results, to eliminate overlap or compare patient types depending
with 4.71 prescriptions for those with
on multiple health conditions.
35%  

Type 1 diabetes and more than twice 30%  

the number of prescriptions as the General Population n=4,184

General Population. Respondents

25%  
Type 1 Diabetes n = 56*
Type 2 Diabetes n = 398
with Type 1 diabetes are statistically 20%  

Figure 21: Comorbidities with Diabetes

more likely (95% confidence) than 15%  

respondents with Type 2 diabetes to 10%  

be only taking 2 or 3 prescriptions,

Personally Experiencing Currently lowering their average relative to Type
5%  

Type 1 Type 2 2 diabetes. 0%  

0   1   2  to  3   4  to  6   7  to  9   10+  

Health Condition Diabetes Diabetes

n = 56* n = 398
a b
16% (100) 24% (150)
Acid Reflux/heartburn/GERD Respondents with Type 1 diabetes are statistically more likely (95% confidence) than those with Type 2 diabetes
11% (110) 5% (50)
to prefer a Brand name prescription medication. Given the serious nature of treating diabetes, many patients may
Acne prefer Brand name medications because these products’ brand equity earns patient trust.
9% (450) 4% (200)
Alcoholism

32% (114) 31% (111) Figure 23: Brand vs. Generic Prescription Preference
Allergies

14% (1400) 2% (200)

Alzheimers
b 60%  

13% (1300) 2% (200)

Anorexia
b 50%  

18% (139) 13% (100)

Anxiety
40%  
20% (111) 33% (183)
Arthritis (general or osteoarthritis)
a General Population n=4,184
30%  
11% (275) 6% (150) Type 1 Diabetes n = 56*
Arthritis (rheumatoid arthritis) Type 2 Diabetes n = 398

11% (157) 9% (129) 20%  

Asthma

10%  
* small base

0%  
Brand  name   Generic   No  Preference  

* small base

16 PART 5 PART 5 17
 SECTION 2D: USE OF, AND ATTITUDES TOWARD, NON-PRESCRIPTION Figure 25: Attitudes Toward Types of Medicine

REMEDIES
Strongly Agree/Agree
Non-prescription remedies can offer many benefits to patients with diabetes. Patients with diabetes have 3 times Type 1 Diabetes Type 2 Diabetes
the incidence of gingivitis, so an effective oral care regiment is critical. Patients with diabetes also have skin Attitudes Toward Medicines
conditions for which moisturizers and other skin creams can be beneficial. High cholesterol can be addressed n = 56* n = 398
with some OTC fiber products. a b
Prescription Medicine
In Figure 24, which is abbreviated from the data available in the c2b Consumer Diagnostic Health Condition
Report: The Consumer with Diabetes, some respondents with diabetes indicate they use non-prescription I’m uncomfortable taking prescription medications
39% (156) 20% (80)
remedies to specifically treat their health condition. Respondents with Type 1 diabetes exhibit a higher use of b
these products. Over-The-Counter (OTC) Medicine
Over-The-Counter (OTC) medicines have benefits I value for managing my 45% (85) 52% (98)
health issues
Alternative/Holistic/Natural Medicine
I believe Alternative/Holistic/Natural medicines are effective for helping 46% (112) 31% (76)
Figure 24: Non-Prescription Remedies Used in Treating Types of Diabetes
maintain my health & wellbeing b

Using Non-Prescription Remedies * small base

to Treat Specific Types of Diabetes

Types of Non-Prescription Remedies Type 1 Diabetes Type 2 Diabetes

n = 56* n = 398
a b SECTION 3: HEALTH CARE PROFESSIONALS
Over-The-Counter Medication 18% ( - ) 5% (500)
Interaction with health care professionals is an ongoing occurrence for patients with diabetes, a population that
Personal Care Products (e.g., Oral care, Skin Care, etc.) 14% ( - ) 3% ( - ) needs constant monitoring and management of their condition. These respondents are much more likely than
Homeopathic or Home Treatments 9% ( - ) 4% ( - ) the General Population to maintain regular check-ups and screenings, and to go to the doctor at the first sign of
health concerns.
Vitamins/Multi-Vitamins, Minerals, or Supplements 13% ( - ) 9% (900)

Index vs. Gen Pop (-) because Gen Pop use of these items for this type of diabetes is below 1% and unreadable However, the role of health care professionals differs somewhat between respondents with Type 1 and Type 2
* small base diabetes. Nearly ¾ of respondents with Type 2 diabetes consider their doctor the most credible authority on their
health and wellness needs, a statistically higher (95% confidence) percentage than that of respondents with Type
1 diabetes. While health care professionals are very important to them, respondents with Type 1 diabetes are
more self-driven – nearly 2/3 of respondents with Type 1 diabetes agree with the statement, I know my body and
its health & wellness needs better than anyone, including my doctor a statistically higher percentage than that for
respondents with Type 2 diabetes, and +60% higher than the General Population.
SECTION 2E: COMPARISON OF ATTITUDES TOWARD RX, OTC, AND
ALTERNATIVE MEDICINES
Figure 26: Attitudes Toward Health Care Professionals
Figure 25 provides a sample of the attitudes measured in the c2b Consumer Diagnostic held by respondents with
diabetes regarding prescription and non-prescription remedies.
Strongly Agree/Agree
Approximately half of respondents with diabetes recognize the benefits OTC medicines in managing health Type 1 Diabetes Type 2 Diabetes
issues. Attitudes Toward Health Care Professionals
n = 56* n = 398

Respondents with Type 1 diabetes are statistically more likely (95% confidence) than those with Type 2 diabetes a b
to believe that Alternative/Holistic/Natural medicines are effective for maintaining health and wellbeing. I would be willing to be treated by a nurse for non-life threatening issues if a doctor was not 80% (110) 75% (103)
available
Many more data points on these topics are available in the c2b Consumer Diagnostic Health Condition Report: 57% (102) 72% (129)
My doctor is the most credible authority for my health & wellness needs
The Consumer with Diabetes. a
64% (160) 36% (90)
I know my body and its health & wellness needs better than anyone, including my doctor
b

* small base

18 PART 5 PART 5 19
 SECTION 4: SHOPPING/PURCHASING HABITS & PRACTICES
The Section of the c2b Consumer Diagnostic examines where respondents with diabetes make retail purchases
in the treatment of their health conditions. This includes prescription and non-prescription medications and
remedies, as well as use of retail health clinics.
Figure 27: Importance of a Personal Relationship with Health Care Professionals

Primary Care Physician

40%  
SOURCE OF FILLED PRESCRIPTIONS
35%  
Figure 28 is a small sampling of 50 possible locations respondents with diabetes have filled a prescription in
30%  
the past 12 months, as well as the usual location where these respondents typically fill prescriptions. Because
25%   a consumer can purchase prescriptions from more than one pharmacy, the full c2b Consumer Diagnostic also
20%  
General Population n=4,184 includes Unduplicated percentages for each major pharmacy channel (e.g., Drug Store, Grocery Store, Mail
Type 1 Diabetes n = 56* Order), to examine overall pharmacy channel preferences.
15%   Type 2 Diabetes n = 398
The relationship desired by respondents
10%  
with diabetes pertaining to their health care Note, the data in Figure 28 are not geographically weighted, so this should not be taken as market shares for a given
5%   professionals is presented in Figure 27. While pharmacy in its competitive geographies. The c2b Insights Accelerator allows one to define specific geographies
the role of the health care professional may differ and analyze these behaviors and preferences. The c2b Insights Accelerator also allows one to specify a pharmacy
0%  
Extremely  
Important  
Very  Important   Somewhat  
Important  
Not  Very  
Important  
Not  at  All  
Important   to some degree, as examined in Figure 26, the and analyze how its purchasing consumers answered all questions in the c2b Consumer Diagnostic survey.
importance of a relationship with one’s Primary
Care Physician is consistent across respondents
with Type 1 and Type 2 diabetes.
Specialist Physician Figure 28: Source of Filled Prescriptions
45%   Respondents with Type 1 diabetes are statistically
40%   more likely (95% confidence) than those with Type
35%  
2 diabetes to indicate that a personal relationship Where Purchased Prescription USUAL Location Where Purchased
with one’s Specialist Physician is Very Important. Medication in Past 12 Months Prescription in Past 12 Months
30%  
Respondents with Type 1 diabetes are much Pharmacy/Channel Type 1 Diabetes Type 2 Diabetes Type 1 Diabetes Type 2 Diabetes
25%  
General Population n=4,184
likelier to visit a Specialist throughout the year, so
Type 1 Diabetes n = 56* n = 56* n = 398 n = 56* n = 398
20%  
Type 2 Diabetes n = 398
the increased desire for a personal relationship is
15%  
understandable. a b c d
10%  
CVS 36% (150) 20% (83) 7% (50) 9% (64)
5%   Moreover, respondents with Type 1 diabetes are b
0%   also statistically more likely than those with Type Target 21% (350) 6% (100) 4% (133) 2% (67)
2 diabetes to say that a personal relationship with
Extremely   Very  Important   Somewhat   Not  Very   Not  at  All  
Important   Important   Important   Important   b
a Pharmacist is Extremely Important. This may tie Kroger 11% (275) 6% (150) 0% ( - ) 3% (150)
back to these respondents’ belief that they know
Pharmacist their own health and wellness needs better than
Sam’s Club 9% (450) 3% (150) 0% ( - ) 1% (100)
40%   anyone (Figure 26) – these respondents may level b
35%  
the health professional playing field somewhat,
not relying solely on physicians to gather the Express Scripts 14% (350) 9% (225) 7% (233) 5% (167)
information necessary for self care.
30%  

25%  

General Population n=4,184

* small base
20%  
Type 1 Diabetes n = 56*
15%   Type 2 Diabetes n = 398

10%  
SOURCE OF OTC, PERSONAL CARE PRODUCTS, AND VITAMINS/MINERALS/
5%  
SUPPLEMENTS
0%  
Extremely   Very  Important   Somewhat   Not  Very   Not  at  All  
Important   Important   Important   Important  
Figure 29 lists a few of the 63 locations where respondents with diabetes have purchased Over-The-Counter
* small base (OTC) medicines, Personal Care Products, or Vitamins/Minerals/Supplements over the past 12 months, including
these respondents’ usual source for these products. Many more data points are available in the full c2b solutions
Consumer Diagnostic.

20 PART 5 PART 5 21
 Figure 29: Source of OTC, Personal Care Products, and Vitamins/Minerals/Supplements
5% (500) 3% (300)
Son/Daughter 18 years or older

5% (167) 3% (100)
Where Purchased Over-The-Counter (OTC) USUAL Location Where Purchased Over-The- Mother (Mother/Mother-In-Law)
Medication(s), Personal Care Products, or Counter (OTC) Medication(s), Personal Care
Vitamins/Minerals/Supplements in Products, or Vitamins/Minerals/Supplements in 2% (100) 2% (100)
Past 12 Months Past 12 Months Father (Father/Father-In-Law)
Retailer/Channel
Type 1 Diabetes Type 2 Diabetes Type 1 Diabetes Type 2 Diabetes 0% ( - ) 3% (150)
Other Relative
n = 56* n = 398 n = 56* n = 398
a b c d 50% (65) 79% (103)
No one in the family has visited a retail store health clinic in the past 12 months a
Walgreens 21% (91) 24% (104) 4% (44) 8% (89)
* small base
Walmart 48% (150) 36% (113) 16% (84) 22% (116)

Giant 9% (900) 1% (100) 0% ( - ) 0% ( - )

b
Costco 14% (175) 9% (113) 5% (125) 5% (125)
SECTION 5: HEALTH INSURANCE COVERAGE
Amazon.com 7% (175) 3% (75) 2% (200) 1% (100)
Most respondents with diabetes have some form of health insurance coverage. Respondents with Type 2 diabetes
Dollar General 11% (367) 3% (100) 4% (400) 1% (100) are statistically more likely (95% confidence) than those with Type 1 diabetes to be covered by Government
b d sponsored coverage, reflecting the older nature of the population with Type 2 diabetes (Figure 3). Thirteen
percent (13%) of respondents with Type 1 diabetes, and 10% of those with Type II diabetes, claim they do
* small base
not have any form of health insurance coverage. While this is lower than the uninsured among the General
Population, patients with diabetes are managing a serious condition -- often multiple health conditions -- that
require medical care, which can be personally costly without help.
RETAIL CLINICS
Retail clinics, or those health clinics located in a retail space such as a drug or grocery store (as opposed to
an Urgent Care clinic), are a viable alternative for much routine medical care. This channel could grow in Figure 31: Provider of Current Health Insurance/Coverage
importance if Health Care Reform has any negative impact on physician access. As Figure 30 shows, half of
respondents with Type 1 diabetes have had at least one family member visit a retail clinic in the past year, and
respondents with Type 1 diabetes are statistically more likely (95% confidence) than those with Type 2 diabetes Type 1 Diabetes Type 2 Diabetes
to have visited a retail clinic themselves. Respondents with Type 2 diabetes more closely resemble the General
Population in terms of visiting retail clinics.

13%
Figure 30: Use of Retail Clinics 21%
0% Self
9%
% 2% 17%
18% Employer/Previous
Family Members Who Have Visited a Health Clinic Inside a Retail Store Type 1 Diabetes Type 2 Diabetes
Employer
for Health Care Needs in the Past 12 Months n = 56* n = 398
Spouse/Partner
a b 4% Employer
30% 34%
39% (260) 15% (100) 26% Parents
Self b 14%

25% (313) 7% (88)

Spouse/Partner b Government
0% 12%
2% (200) 1% (100) n = 56* n = 398
Son/Daughter under 2 years * small base

5% (500) 1% (100)
Son/Daughter 3 to 5 years b
16% (800) 3% (150)
Son/Daughter 6 to 12 years b
9% (450) 2% (100)
Son/Daughter 13 to 17 years b

22 PART 5 PART 5 23
 Figure 33: Satisfaction with Health Insurance Coverage
Over half of respondents with diabetes indicate they are covered by some type of commercial Managed Care Figure 33 shows the level of
plan. Respondents with Type 1 diabetes are statistically more likely (95% confidence) than those with Type 2 45%   satisfaction respondents with
diabetes to indicate they are covered by an indemnity plan or a High Deductible Health Plan. Respondents with diabetes have with their health
Type 1 diabetes are also statistically more likely to be a part of a Managed Medicare plan, while respondents with 40%  
insurance coverage (among
Type 2 diabetes are more likely to be part of traditional Medicare. Note, there appears to be significant overlap in 35%   those with health insurance
coverage as the percentages in Figure 32 do not add up to 100%; many respondents indicated they are covered coverage). A higher percentage of
30%  
by more than one form of health insurance. respondents with Type 1 diabetes
25%  
General Population n=3,515 versus the General Population
20%   Type 1 Diabetes n = 49* are Extremely Satisfied with their
Figure 32: Type of Health Insurance Coverage Type 2 Diabetes n = 367 insurance coverage (31% vs.
15%  
21%, respectively). When the
10%  
% percentages are added across
Type 1 Diabetes Type 2 Diabetes
5%   Extremely and Very Satisfied,
Current Type(s) of Health Care Insurance/Coverage 0%  
respondents with Type 2 diabetes
n = 56* n = 398 Extremely   Very  Sa3sfied   Somewhat   Not  Very  Sa3sfied   Not  at  All   stand at 69%, while those with
Sa3sfied   Sa3sfied   Sa3sfied  
a b Type 1 diabetes are 66% and the
General Population is 63%.
41% 30% * small base
PPO (Preferred Provider Organization)

36% 19%
HMO (Health Maintenance Organization)
b
14% 4%
POS (Point of Service)
b
64% 52%
Total Managed Care
PERCEPTION OF VALUE FROM HEALTH INSURANCE COVERAGE
14% 3%
Traditional Indemnity Plan (or “Fee-for-service” plan)
b
The c2b Consumer Diagnostic included a Van Westendorp pricing analysis to understand the price points at
13% 3% which consumers consider their health insurance premiums reasonable and unreasonable. Figure 34 shows the
HDHP (High Deductible Health Plan)
b
monthly premium that respondents with diabetes feel would be a bargain. Price points included in the c2b
13% 5% Consumer Diagnostic include the average price at which consumers consider health insurance premiums to be:
Medicaid – Managed Care Plan
b

Medicaid – Standard
16% 10% • So inexpensive they doubt its quality and would not buy it
• So inexpensive they consider it a bargain
18% 9% • Getting expensive
Medicare – Managed Care Plan
b • So expensive they would not buy it
13% 29%
Medicare – Standard or Supplemental
a
4% 9%
Other Type Figure 34: Health Insurance Coverage Price Sensitivity Analysis

4% 5%
Don’t Know/Not Sure
Average Price

Price Points Type 1 Diabetes Type 2 Diabetes

13% 9% n = 56* n = 398
Do not currently have health care insurance/coverage
a b
* small base
Average Price at Which You Consider Health Care
$161.32 (149)
Insurance/Coverage Premium (Monthly Cost) So b
$103.55 (96)
Inexpensive You Would Consider It a Bargain
* small base

24 PART 5 PART 5 25
 SWITCHING BEHAVIORS
PREFERRED COMPONENTS OF A HEALTH INSURANCE PLAN
Figure 36 helps explain why respondents with Type 1 diabetes are so apt to switch their health insurance plans.
The data in the following Figure 35 can help a health insurance company develop the products, services, and
While cost issues topped the list, many other reasons that were acutely felt played into the value equation for
consumer experience preferred by respondents with diabetes to best meet their needs and preferences.
these respondents. Across all reasons (other than other), respondents were much more likely than the General

Population to recognize service and image issues, and statistically more likely (95% confidence) than respondents
Figure 35 shows the percentage of respondents with diabetes who indicated which attributes of a health insurance
with Type 2 diabetes to cite many of these reasons. Even though respondents with diabetes did not rate the health
company were either Extremely or Very Important. This is a small selection from 33 attributes measured in the
insurance attributes in Figure 35 as important as did those with Type 2 diabetes, they were more easily dissatisfied.
c2b Consumer Diagnostic.

Several attributes stand out for respondents with diabetes – while these are not the top rated attributes, they are Figure 36: Reasons for Switching Health Insurance Company/Plan
notable for their themes and ratings relative to the General Population:
%
Type 1 Diabetes: Reasons for Switching or Altering Health Care Insurance Company or Plan Type 1 Diabetes Type 2 Diabetes
• Offers disease management programs to help address my/family’s health condition(s) (73%, 122 index) Options (Select all that apply) n = 56* n = 398
Type 2 Diabetes: a b
• Having doctors who communicate well with me (87%, 106 index)
23% (153) 17% (113)
• Effectively addresses issues/complaints by taking corrective action (85%, 108 index) Premiums became too high

18% (200) 12% (133)

Co-pays too high

18% (225) 10% (125)

I did not get sufficient value/benefit for what I was paying
Figure 35: Preferred Health Insurance Company Attributes
18% (600) 4% (133)
Working with my health insurance company was too difficult
b

Extremely/Very Important Health insurance company thought of its profits more than my health and wellbeing
16% (267) 8% (133)
b
Type 1 Diabetes Type 2 Diabetes
Attributes Health insurance company stopped covering one of my prescription medications
16% (533) 5% (167)
n = 56* n = 398 b

a b 14% (350) 4% (100)

Health insurance company failed to cover a medical procedure
b
80% (94) 87% (102)
Annual premium is reasonable 14% (700) 3% (150)
My doctor spoke negatively about my health insurance company
b
82% (100) 87% (106)
Having doctors who communicate well with me 11% (367) 3% (100)
I could not trust my health insurance company
b
80% (101) 85% (108)
Effectively addresses issues/complaints by taking corrective action 9% (180) 5% (100)
I changed jobs
73% (122) 66% (110)
Offers disease management programs to help address my/family’s health condition(s) 9% (900) 3% (300)
Heard something negative in the media about my health insurance company
b
* small base 9% (300) 3% (100)
I could not find a doctor or specialist that accepted my coverage
b
7% (117) 9% (150)
My employer/spouse’s employer changed health insurance companies

7% (233) 4% (133)
Had issues with the health insurance company covering my claims

2% (40) 5% (100)
Other

* small base

26 PART 5 PART 5 27
 SECTION 6: INFORMATION/EDUCATION/MEDIA SOURCES Figure 38: Health-Oriented Websites Visited

This section of the c2b Consumer Diagnostic aids in understanding where respondents with diabetes get their %
health information, which is useful for planning outreach efforts through more effective targeting and message Health-oriented Websites Visited for Health Advice Type 1 Diabetes Type 2 Diabetes
delivery. for Self or Family in the Past Three Years n = 56* n = 398
Sources of Health Care Information a b
Figure 37 lists a handful of 23 health care information sources measured in the c2b Consumer Diagnostic relied AARP.com 18% (180) 14% (140)
upon by respondents with diabetes, including the top three sources for this population. Health care professionals
are the most important information source for respondents with diabetes, as Family Physicians and Specialist Cornerstones4care.com 14% (1400) 2% (200)
Physicians represent the #1 and #2 sources, respectively. The role of the health care professional is more b
pronounced, however, for respondents with Type 2 diabetes, who are statistically more likely (95% confidence)
EverydayHealth.com 20% (400) 5% (100)
than those with Type 1 diabetes to choose these professionals as a top 3 information source/influencer. b

MayoClinic.com 14% (70) 18% (90)

Figure 37: Sources of Health Care Information
WebMD.com 36% (71) 49% (96)

Where Currently Get Information Regarding Top Three Sources that are Most
Health Care (Insurance Providers, Choosing Influential in Helping You to Become or * small base
Doctors, Clinic and Hospital Information, etc.) Stay Healthy
Information Source Type 1 Diabetes Type 2 Diabetes Type 1 Diabetes Type 2 Diabetes
n = 56* n = 398 n = 56* n = 398 CONSUMER ACCESS TO TRADITIONAL MEDIA
a b c d
34% (126) 21% (78) 16% (114) 6% (43) Print is also an important medium for reaching consumers with diabetes. Figure 39 outlines just a few of the 21
Close Friends
b d types of magazines regularly read by respondents with diabetes, as measured by the c2b Consumer Diagnostic.
66% (108) 77% (126) 46% (90) 65% (127) Respondents with Type 1 diabetes are particularly over-developed in their reading of magazines relative to the
Doctor/Family Physician
c General Population, and are statistically more likely than respondents with Type 2 diabetes to read many types
39% (115) 53% (156) 27% (108) 42% (168) of magazines.
Doctor/Specialist
c

20% (200) 13% (130) 5% (125) 4% (100)

Emails/E-newsletters
Figure 39: Types of Magazines Regularly Read
23% (100) 29% (126) 9% (90) 16% (160)
Health Insurance Company/Plan

Internet/Web sites
30% (70) 33% (77) 18% (60) 20% (67) %
Type 1 Diabetes Type 2 Diabetes
* small base Types of Magazines Regularly Read
n = 56* n = 398
a b
20% (133) 16% (107)
Cooking (e.g., Cooking Light, Food & Wine, Southern Living)
CONSUMER ACCESS TO TECHNOLOGY/MOBILE APPS/WEBSITES
18% (120) 14% (93)
As a health care provider considers the most effective and efficient ways for reaching patients with diabetes, it is Women’s Magazines (e.g., Ladies Home Journal, Good Housekeeping)
helpful to understand what technology might be leveraged in connecting with these consumers. This brief report 16% (133) 15% (125)
does not contain detailed information on consumer access to technology and mobile apps, however, that data News (e.g., Newsweek, Time, New York Magazine)
can be found in the c2b Consumer Diagnostic. 11% (138) 10% (125)
Science (e.g., Discover, Scientific American)
Two thirds of respondents with diabetes have visited health-oriented websites in the past several years, and
25% (417) 7% (117)
respondents with Type 1 diabetes are statistically more likely (95% confidence) than those with Type 2 diabetes Automobile (e.g., Car & Driver, Road & Track, Motor Trend) b
to have visited many of the sites listed in Figure 38. While the c2b Consumer Diagnostic examined the visitation
habits for respondents with diabetes among 50 types of general and health care-specific websites, the top * small batch
website for health information among these respondents is WebMD.com. However, this site is under-developed
among these respondents relative to the General Population, indicating an opportunity for this website to further
strengthen its presence among consumers with diabetes.

28 PART 5 PART 5 29
 SECTION 7: CONSUMER INFORMATION SOURCES AND HEALTH
INSURANCE COMPANIES
This section of the c2b Consumer Diagnostic focuses on media and influence sources regarding health insurance
companies for respondents with diabetes. This information is critical for health insurance companies who seek
to engage consumers with advertising and education to attract them on the Health Insurance Exchanges. Figures
40 and 41 look at receptivity for various sources of health insurance company information among respondents
with diabetes. The c2b Consumer Diagnostic examines consumer receptivity for 50 sources of health insurance
company information.
Respondents with Type 1 diabetes are statistically more likely (95% confidence) than those with Type 2 diabetes
to actively collect or share information on health insurance companies through social media. Figure 42 provides
a sample of the social media habits measured in the c2b Consumer Diagnostic. The consumers who participate
in these activities represent potential influencers for other consumers seeking information on health insurance
companies. These companies should consider engaging such influential consumers as a means for reaching a
broader network of potential members seeking peer perspective.
Figure 42: Social Media and Health Insurance Companies

Type 1 Diabetes: Respondents with Type 1 diabetes are more attuned to health insurance company advertising %
and outreach than is the General Population, as nearly every source of information driving awareness listed in
Figure 40 is over-developed. Respondents with Type 1 diabetes seem relatively hungry for health insurance What Have You Done Related to Type 1 Diabetes Type 2 Diabetes
information and are open and willing to receiving it from a variety of sources. Health Insurance Companies? n = 56* n = 398
a b

Figure 40: Consumer Information Sources on Health Insurance – Type 1 Diabetes Posted positive or negative feedback on a health insurance company on a social networking 14% (467) 3% (100)
website (such as Facebook, Twitter, Tumblr) b
21% (233) 15% (167)
Influence Your OPEN and WILLING Asked a question on a health insurance company’s website
Make You Aware of
Choice of Health to Receiving from
Information Source Health Insurance
Insurance Health Insurance 14% (350) 4% (100)
Companies Read a blog written by a health insurance company
b
Companies Companies
Physician 25% (93) 30% (115) 38% (109) * small base
Employer/Spouse’s employer 30% (111) 21% (96) 27% (117)
Ads on radio 18% (200) 14% (467) 13% (260)
Ads on TV 23% (121) 14% (233) 23% (256)
Insurance company Web sites 18% (95) 16% (123) 18% (100)
SECTION 8: AFFORDABLE CARE ACT
n = 56 The Patient Protection and Affordable Care Act (ACA) will affect every American to some extent, including
* small base consumers with diabetes. However, whether the ACA will improve or detract from the quality of their care
has yet to be determined. This section of the c2b Consumer Diagnostic examines the attitudes of respondents
with diabetes regarding Health Care Reform and the ACA to help anticipate their expectations and needs as the
Type 2 Diabetes: The Top 2 influential sources on health insurance plan choice among respondents with Type 2 country adapts to this new legislation.
diabetes are: 1) Physician; 2) Spouse. Health care professional influence is strong with this population; while a
health insurance company may be hesitant to try cultivating ambassadors among health care professionals (who
prefer to stay impartial), these companies should at least recognize this influence and neutralize any negative
impact health care professionals can have on consumer plan choice. SUPPORT/OPPOSITION FOR THE ACA
Figure 43 shows the extent to which respondents with diabetes supported or opposed the Affordable Care Act
Figure 41: Consumer Information Sources on Health Insurance – Type 2 Diabetes
when this study was completed in early 2013. These attitudes will most likely have shifted in the intervening
time, and this will be measured when c2b solutions’ next national study is fielded in January 2015.
Influence Your OPEN and WILLING
Make You Aware of
Choice of Health to Receiving from
Information Source Health Insurance
Insurance Health Insurance
Respondents with Type 1 diabetes were more supportive of the legislation, with 50% either Fully or Somewhat
Companies Supported the ACA, compared with only 14% who Fully or Somewhat Opposed it (36% neither supported nor
Companies Companies
opposed the ACA, or did not take a stance). In contrast, respondents with Type 2 diabetes were more likely to be
Friends 29% (94) 17% (85) 26% (87)
split on the ACA, with one third supporting and one third opposing the legislation. However, 20% of respondents
Spouse/Partner 23% (100) 20% (83) 20% (80) with Type 2 diabetes Fully Opposed the ACA, which is statistically more likely (95% confidence) than those with
Physician 37% (137) 38% (146) 43% (123) Type 1 diabetes to have held this position.
Pharmacist 18% (150) 16% (160) 22% (129)
Newspaper/magazine articles 19% (127) 10% (125) 12% (100)

n = 398

30 PART 5 PART 5 31
 Figure 43: Support or Opposition for the ACA
After answering the question in the c2b Consumer Diagnostic survey about their level of understanding with
regard to Health Insurance Exchanges, respondents with diabetes were presented a description of how the
Exchanges may operate when they are activated in 2014. This description can be found in Figure 45.
Support fully with no changes

Support somewhat
Figure 45: Description of Health Insurance Exchanges

Health Insurance Exchange Scenario

Neither support nor oppose
Type 2 Diabetes n = 398
Type 1 Diabetes n = 56*
Starting January 1, 2014, the Affordable Care Act establishes Health Insurance Exchanges where consumers may
Oppose somewhat General Population n=4,184 choose from a selection of health insurance companies from an internet website managed by a governmental
agency.

Fully oppose it Consumers who are near poverty level and without health insurance will have their coverage paid for through
these Exchanges with public funding (taxes). For everyone else, an employer may choose to continue providing
health insurance to its employees. However, employers may also stop providing health insurance and require
I don't know employees to shop for health insurance on the Health Insurance Exchange. Those employers may (or may not)
provide vouchers to employees to help pay for some or all of these costs.
0% 5% 10% 15% 20% 25% 30% 35%

* small base
SECTION 9: HEALTH INSURANCE EXCHANGES
When the Health Insurance Exchanges activate in 2014, how one goes about acquiring health insurance coverage
will change for many consumers. As the preceding data/Figures in this Section of the c2b Consumer Diagnostic
show, there is not a high level of understanding about the ACA and Health Care Reform, in general, among
consumers with diabetes, although respondents with Type 1 diabetes indicate a higher level of support. Specific
to Health Insurance Exchanges, the level of understanding is also not high. The c2b Consumer Diagnostic
examines the current understanding and attitudes with regard to Health Insurance Exchanges among consumers
with diabetes.
Unless a consumer is near poverty level, the law requires that he/she will have to get health insurance from his/
her employer or purchase health insurance on the Health Insurance Exchange. If a consumer chooses not to get
health insurance, he/she must pay a penalty up to 2% of his/her household income.
After having read the description of Health Insurance Exchanges, respondents were then asked to identify how
the description made them feel, choosing from words/pictures presented in Figure 46. Respondents could choose
up to two responses or “no particular feelings.” This methodology, called the “Emoti*Scape” was developed by
Ipsos through extensive literature review, thousands of survey interviews, and multivariate analysis to produce a
list of 40 items covering a wide range of emotions that respondents could clearly differentiate.

As shown in Figure 44, 29% of respondents with Type 1 diabetes claim to Completely Understand the Exchanges, Figure 46: Ipsos Emoti*Scape Emotion Map
which is a statistically higher (95% confidence) percentage than that for respondents with Type 2 diabetes. On
the other hand, respondents with Type 2 diabetes are statistically more likely than those with Type 1 diabetes to
admit they Do not at All Understand the Exchanges (47% vs. 30%, respectively). Another 41% of respondents
with Type 1 and 40% of those with Type 2 diabetes say they Partially Understand the Exchanges. A significant
amount of public education regarding the Health Insurance Exchanges is warranted.

Figure 44: Level of Understanding the Health Insurance Exchanges

50%  

45%  

40%  

35%  

30%  
General Population n=4,184
25%  
Type 1 Diabetes n = 56*
20%   Type 2 Diabetes n = 398

15%  

10%  

5%  

0%  
Completely  Understand   Par8ally  Understand   Do  not  Understand  at  All  

* small base

32 PART 5 PART 5 33
 %
Figure 47 captures the range of emotions expressed by respondents with diabetes after having read the description Type 1 Diabetes Type 2 Diabetes
of Health Insurance Exchanges. After having read the description, emotions tended toward the negative. While Emotion Groupings/Clusters
n = 56* n = 398
half of respondents with diabetes supported the ACA in Figure 43 and another 20% neither supported nor
a b
opposed, after reading the description of the Exchanges, only 41% of emotions were positive for this population
in Figure 47. However, the percentage of respondents with Type 1 diabetes who have positive feelings about 30% (77) 39% (100)
Upsetting/Dislike
the ACA is statistically higher (95% confidence) than that of respondents with Type 2 diabetes. One out of five
respondents with Type 1 diabetes report feelings associated with being energized and eager after reading the 25% (109) 21% (91)
Skeptical/Confused
description of the Exchanges.
4% (80) 4% (80)
Unengaged/Bored
Among respondents with Type 2 diabetes, the percentage of negative feelings was double that of positive feelings.
13% (118) 11% (100)
A statistically higher percentage of respondents with Type 2 diabetes indicate they feel Angry/Furious/Outraged Engaged/Curious
after reading the description of the Exchanges. Note, because respondents were allowed to select up to two
7% (58) 7% (58)
emotions, the percentages do not add up to 100%. Relaxed/Calm

11% (220) 7% (140)

Warm/Trust/Happy

21% (233) 10% (111)

Turned-On/Eager
b
Figure 47: Emotional Response to Health Insurance Exchanges
20% (91) 28% (127)
No particular feeling
% %
* small base
Type 1 Type 2
Type 1 Diabetes Type 2 Diabetes
Positive Emotions Diabetes Diabetes Negative Emotions
n = 56* n = 398 n = 56* n = 398
CONSUMER ATTITUDES AND BELIEFS ABOUT THE ACA
a b a b
Surprised/Amazed 5% 3% Sad/Depressed 2% 2% The c2b Consumer Diagnostic asked respondents a range of questions regarding their perceptions of the impact
Curious/Interested 7% 9% Lonely/Ignored 0% 0% the Affordable Care Act would have on different aspects of health care, including:
Gratitude/Relieved 2% 2% Apathetic/Unmoved 2% 2%
At Peace/Normal 5% 3% Tired/Worn Out 0% 1%
• Its costs on consumers, employers and the Government
• Uninsured consumers’ – and their own – access to health care
Jealous/Wishful 0% 0% Shy 0% -
• Its effect on quality of care
Inspired/Encouraged 0% 2% Disappointed 0% 4% • Whether it would affect appointment wait times
Cool/Calm 0% 2% Worried/Concerned 13% 10% • How it would affect physicians, including their own
Entertained/Pleased 0% 2% Bored 2% 2%
Trust 4% 2% Confused 13% 9% The c2b Consumer Diagnostic also asked respondents the degree to which they agreed or disagreed with
Happy 5% 3% Negative/Passive 27% 25%
30 attitudinal statements regarding the Affordable Care Act. Figure 49 provides a sample of these responses,
highlighting the differences among respondents with Type 1 and Type 2 diabetes and the General Population.
Warm/Fuzzy 0% 1%
Positive/Passive 25% 21% Embarrassed 0% 1%
Ashamed/Guilt 0% 0% Figure 48: Consumer Attitudes and Beliefs About the ACA
Harmony/A Connection 4% 2% Aloof/Feel Superior 2% -
Free/Unrestricted 4% 1% Hate/Repulsed 0% 6% Strongly Agree/Agree
Turned-On 5%b - Intimidated 2% 1% Type 1 Diabetes Type 2 Diabetes
Statement about Affordable Care Act/Health Care Reform
Confidence 5% 2% Irritated 5% 7% n = 56* n = 398
Attraction/Charmed 2% 1% Shocked 5% 3% a b
Proud/Self-Respect 2% 1% Skeptical 14% 14%
I’m happy with the Affordable Care Act/Health Care Reform, because I believe people with pre-existing 57% (133) 41% (95)
Eager/Enthusiastic 4% 2% Exploited/Ripped-Off 5% 7% health conditions will not be denied health care insurance b
Love 2% - Angry/Furious/Outraged 0% 9%a 50% (152) 42% (127)
I’m concerned that my prescriptions won’t be covered under the Affordable Care Act/Health Care Reform
Appreciated/Special 2% 1% Upset/Hurt 0% -
Positive/Active 21%b 9% Dislike 7% 6% 50% (125) 38% (95)
Health care is a right, and the government should ensure everyone is provided care
Negative/Active 36% 40%
I’m happy because the Affordable Care Act/Health Care Reform will increase access to health care for 48% (120) 38% (95)
more people
Positive 41%b 26% Negative 50% 52%
I’m angry because I supported the idea of Health Care Reform, but I don’t like how the Affordable Care 46% (177) 30% (115)
Act is turning out b
29% (161) 18% (100)
I trust the government to make good decisions that affect my health care

* small base

34 PART 5 PART 5 35
 APPENDIX

The following provides a listing of all the data included in charts and tables within the c2b Consumer Diagnostic chapter on
consumers with diabetes. This same set of data can be found in the supplemental PowerPoint presentation on consumers
with diabetes offered on the c2bsolutions.com website.

Figure 5.1: Among Respondents with Diabetes, Percentage by Type Figure 5.50: Source of Filled Prescriptions
Figure 5.2: Gender Figure 5.51: Sourch of OTC, Personal Care Products, and Vitamins/Minerals/Supplements
Figure 5.3: Age Figure 5.52: Use of Retail Clinics
Figure 5.4: Racial/Ethnic Background Figure 5.53: Frequency of Respondent Visits to Health Clinic in Retail Store
Figure 5.5: Size of Household Figure 5.54: Provier of Current Health Insurance/Coverage
Figure 5.6: Children in the Household Figure 5.55: Household Members Covered by Respondent’s Plan
Figure 5.7: Marital Status Figure 5.56: Type of Health Insurance Coverage
Figure 5.8: Education Figure 5.57: Satisfaction with Health Insurance Coverage
Figure 5.9: Employment Status Figure 5.58: Likelihood to Recommend Current Health Insurance/Coverage
Figure 5.10: Annual Household Income Figure 5.59: Satisfaction/Likelihood to Recommend Health Insurance Coverage
Figure 5.11: Employer Size Figure 5.60: Perceived Value of Current Health Insurance Coverage
Figure 5.12: Home Status/Living Arrangements Figure 5.61: Health Insurance Coverage Price Sensitivity Analysis
Figure 5.13: Types of Communities Figure 5.62: Importance – Options or Costs
Figure 5.14: Political Views Figure 5.63: Type of Deduction Preferred
Figure 5.15: Self-Reported Health Status Figure 5.64: Preferred Health Insurance Company Attibutes
Figure 5.16: Managing a Healthy Lifestyle Figure 5.65: Health Insurance Switching Behavior
Figure 5.17: Attitudes Toward Proactive Behavior Figure 5.66: Reason for Switching Health Insurance Plan/Company
Figure 5.18: Attitudes Toward Disengaged Behavior Figure 5.67: Health Behavior Incentives & Penalties
Figure 5.19: Attitudes Regarding Family History Figure 5.68: Purchasing Health Insurance Online
Figure 5.20: Family Role/Relationships Figure 5.69: Whether Would Consider Purchasing Health Insurance Online
Figure 5.21: Peer Influence Figure 5.70: Sources of Health Care Information
Figure 5.22: Attitudes on Nutrition and Diet Figure 5.71: Technology Devices Currently Own and Use
Figure 5.23: Frequency of Exercise Figure 5.72: Types of Apps Downloaded
Figure 5.24: Attitudes on Exercise and Fitness Figure 5.73: Websites Visited on a Regular Basis
Figure 5.25: Body Mass Index Indicators Figure 5.74: Health-Oriented Websites Visited
Figure 5.26: Body Mass Index Figure 5.75: Types of Magazines Regularly Read
Figure 5.27: Sleep Habits Figure 5.76: Consumer Information Sources on Health Insurance – Type 1 Diabetes
Figure 5.28: Importance & Satisfaction – Physical Appearance Figure 5.77: Consumer Information Sources on Health Insurance – Type 2 Diabetes
Figure 5.29: Attitudes on Appearance Figure 5.78: Effective Ways to Leverage Magazines to Reach Consumers
Figure 5.30: Attitudes on Emotional Health Figure 5.79: Social Media and Health Insurance Companies
Figure 5.31: Current Stress Level Figure 5.80: Consumer Awareness & Understanding of the ACA
Figure 5.32: Importance & Satisfaction – Work/Life Balance (Among Respondence Who Work) Figure 5.81: Awareness of ACA Impact on Health Care Stakeholders
Figure 5.33: Financial Considerations Figure 5.82: Perceived Personal Impact of ACA on Personal Time & Finances
Figure 5.34: Personal and Social Responsibility Figure 5.83: Perceived Personal Impact of ACA on Uninsured Patients
Figure 5.35: Attitudes on Change Figure 5.84: Perceived Personal Impact of ACA on Personal Access to Health Care
Figure 5.36: Ever Filed a Lawsuit against a Health Care Provider Figure 5.85: Perceived Personal Impact of ACA on Timely Doctor Appointments
Figure 5.37: Litigation Risk Figure 5.86: Perceived Personal Impact of ACA on Quality of Care
Figure 5.38: Impact of Illness Figure 5.87: Perceived Personal Impact of ACA on Medical Expenses
Figure 5.39: Comorbidities with Diabetes Figure 5.88: Perceived Personal Impact of ACA on Personal Health Behaviors
Figure 5.40: Health Conditions Treated with Prescription Medication Figure 5.89: Perceived Personal Impact of ACA on Physical Relationship
Figure 5.41: Number of Prescriptions Taken Figure 5.90: Perceived Personal Impact of ACA on Total Doctors Available
Figure 5.42: Compliance & Persistency Figure 5.91: Perceived Personal Impact of ACA on Personal Physician’s Intent to Practice
Figure 5.43: Brand vs. Generic Prescription Preference Figure 5.92: Support of Opposition for the ACA
Figure 5.44: Non-Prescription Remedies Used in Treating Types of Diabetes Figure 5.93: Likelihood of Initiating Conversation of the ACA
Figure 5.45: Average Use of Vitamins, Minerals, Supplements Figure 5.94: Level of Understanding the Health Insurance Exchanges
Figure 5.46: Attitudes Toward Types of Medicine Figure 5.95: Description of Health Insurance Exchanges
Figure 5.47: Attitudes Toward Health Care Professionals Figure 5.96: Ipsos Emoti*Scape Emotion Map
Figure 5.48: Importance of a Personal Relationship with Health Care Professionals Figure 5.97: Emotional Response to Health Insurance Exchanges
Figure 5.49: Frequency of Physician Visits by Specialty Figure 5.98: Consumer Attitudes and Beliefs About the ACA

36 PART 5 PART 5 37
This whitepaper provided a sample of the comprehensive data on consumers with diabetes found in the c2b Consumer
Diagnostic and its supplement PowerPoint slidedeck. The c2b Consumer Diagnostic also includes chapters on the
following populations:

• The General Population of U.S. health care consumers

• Consumers with:
o Anxiety or Depression
o Cancer
o Cardiovascular conditions
o Obesity or are overweight
• The c2b Psychographic Segments

The study from which the c2b Consumer Diagnostic was developed included 44 health conditions and can be analyzed
according to any demographic, socioeconomic or geographic consumer segment. The c2b Insights Accelerator is a data
analytics tool that allows for custom queries of more than 15 million data points from c2b solutions’ market research.

c2b solutions’ next national study will be fielded in January 2015, from which the second edition of the c2b Consumer
Diagnostic will be developed.

For more information, please contact:

Brent Walker
VP & CMO

brent@c2bsolutions.com
844-c2b-data (844-222-3282) ext. 702

c2bsolutions.com