The impact of diabetes on formal and informal care.

There is limited evidence on how chronic conditions affect the demand and costs for long-term care (LTC), restricting our ability to evaluate interventions. This paper estimates the causal effect of type 2 diabetes (T2D), a highly prevalent chronic condition among the elderly, on formal and informal LTC utilization. We used data from eight waves (2002-2017) of the English Longitudinal Study of Ageing (ELSA) (n = 18,166) and employed a Mendelian Randomization approach to address the endogeneity of diabetes status in LTC demand. Our results indicate that T2D increases the probability of using formal care by 6 percentage points and informal care by 27 percentage points. When adjusting for possible pleiotropy via obesity, the impact on informal care reduces to 25 percentage points. Exploration of mechanisms shows that diabetes increases the likelihood of limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). These results highlight the broader burden of T2D beyond healthcare costs and can be used in future decision analytic models to evaluate the cost-effectiveness of diabetes interventions.