Background: People with type 1 diabetes (PWT1D) perceiving high diabetes-related stigma are less likely to report in-target A1c levels. We hypothesized that people with higher levels of stigma have suboptimal psychosocial outcomes and that stigma would be perceived differently across age groups. Methods: Cross-sectional analysis of 709 PWT1D aged ≥14 years in the BETTER T1D registry (Quebec, Canada) who completed the T1D Stigma Assessment Scale (DSAS-1). The DSAS-1 (/95) includes 3 subscales; Blame & Judgment (6 items), Identity Concern (7 items), and Treated Differently (6 items). Individuals who perceived more stigma compared to the total cohort (DSAS-1 mean score +1 standard deviation), were stratified into groups by age to determine associations with diabetes self-management behaviours and outcomes. Results: Across groups, youth (n=105; 14-24 years) had the highest stigma perception (20%), followed by 18% in middle-aged adults (n=401; 35-64 years), then 15% for both young adults (n=130; 25-34 years) and seniors (n=73; 65+ years). The majority of youth, young and middle-aged adults, and seniors perceived stigma as Blame & Judgment (51%, 44%, 33%, and 19%, respectively). Stigma related to Identity Concern was highest among seniors (15%). In an age- and diabetes duration-adjusted models, 40% of adjusted variance in stigma score was explained by increased diabetes distress (p<0.001), depression (p=0.005), hyperglycemia avoidance behaviours (p<0.001), fear of hypoglycemia (p<0.001) and decreased social support (p<0.001). Conclusion: Interventions targeting diabetes-related stigma need to be tailored for different age groups to target suboptimal diabetes self-management behaviours and improve psychosocial outcomes. Disclosure A.Housni: None. A.Katz: None. J.C.Kichler: None. M.Nakhla: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé. Funding JDRF (4-SRA-2018-651-Q-R); Canadian Institutes of Health Research (JT1-157204)
T1DX-QI is a network of over 40 pediatric and adult centers that share best practices to improve outcomes for people with T1D. Guidelines for comprehensive diabetes care recommend integration of psychosocial screening; however, variable resources and clinical structures influence the degree to which practices can implement these recommendations. A 22-item survey was administered to T1DX-QI sites in 2021 (n= 25 pediatric and 8 adult) . Data from items relevant to psychosocial screening were analyzed with Rstudio. Fisher tests were used to compare the percentage of psychosocial domains assessed by pediatric vs. adult clinics. Overall, 96% of pediatric centers report using at least one screening tool, 79% report > 2; 43% of adult centers use one or more screening tools. The most common psychosocial domain in both settings is depression; pediatric (96%) , adult (38%) (Figure) . Screening for social determinants of health and diabetes-related distress were reported in both settings, and unique to pediatric is assessment of readiness to transition to adult care. Varying degrees of psychosocial screening is present in the T1DX-QI network. Centers endorse benefits, as well as common challenges, including time constraints, integration into workflow, and how best to follow up responses. T1DX-QI sites are working together to overcome barriers that contribute to gaps between guidelines and practice. Disclosure S.Corathers: None. J.C.Kichler: None. O.Ebekozien: None. E.L.Ospelt: None. S.Rompicherla: None. P.Prahalad: None. A.J.Roberts: None. C.E.Muñoz: None. M.Basina: None. L.B.Smith: None. D.N.Williford: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust
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