Insulin pricing and other major diabetes-related concerns in the USA: A study of 46,400 Tweets between 2017 and 2019

Objective Little is known about the concerns of people living with diabetes. This study aims to identify key diabetes-related concerns in the USA and primary emotions associated with those concerns using information shared on Twitter. Research Design and Methods A total of 11.7 million diabetes-related tweets in English were collected between April 2017 and July 2019. Machine learning methods were used to filter tweets with personal content, to geolocate (to the US) and to identify clusters of tweets with emotional elements. A sentiment analysis was then applied to each cluster. Results We identified 46,400 tweets with emotional elements in the USA from which 30 clusters were identified; five clusters (18% of tweets) were related to insulin pricing with both positive emotions (joy, love) referring to advocacy for affordable insulin and sadness emotions related to the frustration of insulin prices, five clusters (12% of tweets) to solidarity and support with a majority of joy and love emotions expressed. The most negative topics (10% of tweets) were related to diabetes distress (24% sadness, 27% anger, 21% fear elements), to diabetic and insulin shocks (45% anger, 46% fear) and comorbidities (40% sadness). Conclusions Our work has enabled us to describe the main topics of interest about diabetes and their associated emotions. Insulin pricing is a central diabetes-related concern and is associated with feelings of sadness. Social media data are complementary to traditional diabetes epidemiology and can contribute to public decision making around key topics of interest around diabetes.