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

Abstract

Adolescents with Type 1 diabetes (T1D) often need to undertake self-management tasks in public or disclose their diagnosis to others. Therefore, they may be subjected to negative reactions from the public, known as enacted stigma. Adolescents with T1D may also be concerned about experiencing stigma, even without being directly subjected to it, known as felt stigma. Both types of stigma could negatively impact psychological well-being and engagement with treatment regimens. This cross-sectional study had three aims: (a) to explore the prevalence of diabetes stigma in adolescents with T1D, (b) to explore differences in adolescent reports of diabetes stigma compared to adults, and (c) to investigate if diabetes stigma is associated with glycemic control in adolescents. Seventy-six Australian adolescents with T1D completed an online questionnaire that included the Type 1 Diabetes Stigma Assessment Scale, which measures enacted and felt diabetes stigma. Their latest glycated hemoglobin (HbA1c) level was obtained from medical records. Nearly, all participants (98.7%) reported experiencing diabetes stigma, most commonly through blame and judgment from others (a form of enacted stigma). Adolescents also reported more felt stigma compared to a sample of Australian adults. After controlling for confounders, regression models showed that enacted and felt stigma predicted higher HbA1c levels. These novel results indicate that adolescents who report experiencing high levels of diabetes stigma are more likely to have higher HbA1c levels, which can place them at risk of long-term health complications. These findings should inform public health initiatives to address the misconceptions that lead to diabetes stigma.

The impact of stigma on the management of type 1 diabetes: A systematic review

“…Sample sizes for the identified studies ranged from 10 to 1572. Age groups of participants varied; two studies focused specifically on young adults, 23,28 six focused specifically on the experience of adolescents, 15,17,19,25,29,30 and one study focused on the experience of children. 26 The remainder of studies (n = 10) covered the lifespan or did not specify a target age group.…”

“…HbA 1c can be influenced by various factors, including the length of time since diagnosis, time spent having hypoglycaemia, and any infections or illnesses the person may have experienced in the previous 3 months. 32,33 Three studies focused solely on the measurement of HbA 1c 16,19,29 and did not use any additional outcomes to measure diabetes management. Only two quantitative studies recorded the number of hypoglycaemic episodes in their participant groups.…”

“…Measures for stigma also varied between studies and included the stigma subscales within the Barriers to Diabetes Adherence Scale 15 (n = 1), the Barriers to Insulin Treatment scale 17 (n = 1), the Type 1 Diabetes Stigma Assessment Scale 16,19,21,34 (n = 4), SEARCH 4 Diabetesrelated Stigma Survey 20 (n = 1), and the Universal Measure of Bias, Negative Attitudes, and Distancing Subscales 18 (n = 1). One study 1 developed its own online survey to measure stigma.…”

“…3.5.1 | Quantitative studies All nine of the quantitative studies found a correlation between reported stigma and diabetes management, whereby stigma negatively impacts diabetes management. All four studies 16,19,21,34 that utilised the Diabetes Stigma Assessment Scale (DSAS-1) and HbA 1c found a significant positive relationship. The DSAS-1 consists of three subscales: being treated differently, blame and judgement, and identity concerns, which represent different elements of felt and enacted stigma.…”

“…The DSAS-1 consists of three subscales: being treated differently, blame and judgement, and identity concerns, which represent different elements of felt and enacted stigma. Two of the four studies 16,19 that used this measure found that higher subscale scores were associated with higher HbA 1c .…”