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Amid ongoing controversy over the cost of insulin, a new analysis finds that approximately 1.3 million people, or 16.5% of all adults with diabetes in the U.S., rationed their use of the life-saving treatment in the past year, raising the prospect of harmful and increasingly expensive health consequences.

Among all insulin users, the most common rationing tactic was to simply delay purchases, with 14.5% of people with diabetes making this decision in response to the cost. Roughly 14% of those with type 1 diabetes took less insulin than needed, compared with 9.5% of those with type 2 diabetes, according to the analysis, which was published in the Annals of Internal Medicine.

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