The impact of diabetes on formal and informal care

This paper estimates the causal effect of type 2 diabetes on formal and informal long-term care (LTC) utilization among older adults in England. Using data from eight waves of the English Longitudinal Study of Ageing (ELSA), we employ a Mendelian Randomization approach to address the endogeneity of diabetes status in LTC demand. Our results indicate that type 2 diabetes 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 findings highlight the broader burden of type 2 diabetes beyond healthcare costs and have implications for evaluating the cost-effectiveness of diabetes interventions.