Diabetes stigma is associated with high glycosylated hemoglobin (HbA1c) levels and diabetes complications, as shown in study published online April 1, 2023 in the journal Diabetes Care.¹

To examine the impact of diabetes stigma on diabetes care in adolescents and young adults with type 1 or type 2 diabetes, researchers recruited 1608 participants from the SEARCH for Diabetes in Youth study, a multicenter study of diabetes among children and young adults in the United States. Most of the selected study subjects () had type 1 diabetes and more than half (56%) were female. Their mean age was 21.7 years; the mean HbA1c was 9.2%. A questionnaire (with 5 questions) based on perceived diabetes-related stigma was used to calculate the total diabetes stigma score.

Patients who had higher HbA1c levels had higher diabetes stigma scores. Likewise, the score tended to be higher among female patients. Among patients with type 2 diabetes, the diabetes stigma score was higher in those on insulin therapy. Higher diabetes stigma scores were associated with acute complications like diabetic ketoacidosis (DKA) and severe hypoglycemia episode in the last year among children and young adults with type 1 diabetes and some chronic complications like retinopathy among those with either type 1 or type 2 diabetes and nephropathy for those with type 1 diabetes.

This study shows that children and young adults who experienced higher diabetes stigma had less than optimal glycemic control and higher frequency of complications, both acute and chronic. Insulin users were more likely to face stigma. Diabetes stigma is a significant factor impacting effective diabetes care, which is often ignored. Patients must be enquired about experiencing any kind of stigma and discrimination.

The CDC has defined diabetes stigma as “negative attitudes, judgment, discrimination, or prejudice against someone because of their diabetes”. People who are overweight or obese are especially more likely to experience diabetes stigma. Patients may themselves experience feelings of guilt or shame about their disease. This is internal stigma. External stigma is being judged by other people in the society.² Words like noncompliant, failure, adherence, diabetic, control, responsibility etc. have become commonplace in diabetes care but they carry a negative connotation and are deemed judgemental.³ Use of a diabetes-friendly language when conversing with the patient, which does not have a negative emotional impact, is the need of the hour.

References

1. Kelsey B Eitel, et al. Diabetes stigma and clinical outcomes in adolescents and young adults: The SEARCH for Diabetes in Youth Study. Diabetes Care. 2023 Apr 1;46(4):811-818.  doi: 10.2337/dc22-1749.
2. Diabetes stigma: learn about it, recognize it, reduce it. Available at: https://www.cdc.gov/diabetes/library/features/diabetes_stigma.html. Accessed on April 12, 2023.
3. Stigma is a significant, often overlooked obstacle in diabetes management. Available at: https://www.adameetingnews.org/live-updates/session-coverage/stigma-is-a-significant-often-overlooked-obstacle-in-diabetes-management/. Accessed on April 12, 2023.