Diabetes stigma and its association with diabetes outcomes: a cross-sectional study of adults with type 1 diabetes

Abstract

Aims: The aim of this study was to investigate the relationship between diabetes stigma as experienced by adults with type 1 diabetes and diabetes outcomes using the novel, validated measure of the Type 1 Diabetes Stigma Assessment Scale. Methods: A total of 1594 adults with type 1 diabetes completed a questionnaire on socio-economic factors, psychosocial health, and diabetes stigma and these self-reported data were linked with data from electronic clinical records on glycaemic control, diabetes duration, age, and diabetes-related complications. Bivariate analyses and multivariate linear regressions were performed to assess the relationship between diabetes stigma as measured by three subscales, Identity concern, Blame and judgement, and Treated differently on the one hand, and patient characteristics and diabetes outcomes on the other. Results: Endorsement of the stigma statements ranged from 3.6–78.3% of respondents. Higher stigma scores in relation to Identity concern and Blame and judgement were significantly associated with being female, of lower age, lower diabetes duration, and having at least one complication. Those who reported higher levels of perceived stigma reported significantly higher levels of diabetes distress (β = 0.37 (95% CI: 0.33–0.40), 0.35 (95% CI: 0.30–0.39), 0.41 (95% CI: 0.35–0.46)), and HbA1c levels (β = 0.11 (95% CI: 0.02–0.21), 0.28 (95% CI: 0.16–0.40), 0.26 (95% CI: 0.14–0.42) for Identity concern, Blame and judgement, and Treated differently, respectively). Conclusions: The findings demonstrated that diabetes stigma is negatively associated with both diabetes distress and glycaemic control and should be considered part of the psychosocial burden of adults with type 1 diabetes.

Diabetes stigma predicts higher HbA1c levels in Australian adolescents with type 1 diabetes.

“…In summary, enacted and felt stigma is highly prevalent in adults with T1D and is associated with higher HbA1c levels (Hansen et al, 2020). However, the prevalence of diabetes stigma, and its relationship with glycemic control, has not been comprehensively investigated in adolescents with T1D.…”

State of the art: understanding and integration of the social context in diabetes care

“…They also argue that people with type 1 diabetes commonly report experiencing stigma at work [34]. The fears of being seen as less worthy as an employee and of being discriminated against force some people with diabetes to work while being sick to overcome these biases and compensate for sickness absence related to diabetes [34].…”

“…Another study, however, shows a high disclosure rate of having type 2 diabetes in the workplace [35]. Hansen et al [34] conclude that the psychosocial burden of diabetes in work life among people with type 1 diabetes should be considered to fall within the spectrum of psychosocial diabetes care and research.…”

“… stated in 2018 that work life and diabetes can be characterized as a matter of containment: ‘… the assemblage of practices and mental and emotional work required to keep diabetes at the level of a side‐involvement and maintain proper situational involvement in work life’ . They also argue that people with type 1 diabetes commonly report experiencing stigma at work . The fears of being seen as less worthy as an employee and of being discriminated against force some people with diabetes to work while being sick to overcome these biases and compensate for sickness absence related to diabetes .…”

“…Hansen et al . conclude that the psychosocial burden of diabetes in work life among people with type 1 diabetes should be considered to fall within the spectrum of psychosocial diabetes care and research.…”