A Cross-Sectional Analysis of the Stigma Surrounding Type 2 Diabetes in Colombia

Abstract

Type 2 diabetes is a global epidemic, and many people feel stigmatized for having this disease. The stigma is a relevant barrier to diabetes management. However, evidence in this regard is scarce in Latin America. This study aimed to analyze the level of stigma surrounding type 2 diabetes in the Colombian population and its relationships with sociodemographic, clinical, psychosocial variables and behaviors related to management of the disease (self-management behaviors). This cross-sectional study included 501 Colombian adults with type 2 diabetes. We estimated the relation between stigma and selected variables through linear regression models. Additionally, we analyzed the mediator role of psychosocial variables in the relationship between stigma and self-management behaviors through structural equation models. A total of 16.4% of patients showed concerning levels of stigma. The time elapsed since diagnosis (β = −0.23) and socioeconomic status (β = −0.13) were significant predictors of the level of stigma. Stigma was negatively correlated with self-efficacy (β = −0.36), self-esteem (β = −0.37), and relationship with health care provider (β = −0.46), and positively correlated with stress (β = 0.23). Self-efficacy, self-esteem, and the relationships with health care providers had a mediation role in the relationship between stigma and self-management behaviors. These variables would be part of the mechanisms through which the perception of stigma harms self-management behaviors. The stigma of type 2 diabetes is frequent in the Colombian population and negatively associated with important aspects of disease management.

Self-esteem mediates the relationship perceived stigma with self-efficacy for diabetes management in individuals with type 2 diabetes mellitus

“…While research on this topic is limited, existing studies have reported that stigma reduces the diabetes management self-efficacy levels of people with diabetes not only directly but also by lowering their selfesteem. 17,33,34 A previous study used a model to determine how self-stigma affected the self-care behaviors of people with diabetes regarding diabetes management, where both the direct effect of the variable and its effect mediated by self-esteem were investigated. The authors demonstrated that self-stigma affected the patient's activation both directly and under the mediation of self-esteem.…”

“…The authors demonstrated that self-stigma affected the patient's activation both directly and under the mediation of self-esteem. 17 In a study carried out with 501 people with T2DM, Pedrero et al 34 investigated the mediating role of psychosocial variables in the relationship between perceived stigma and self-management behaviors in people with diabetes, and they reported that self-esteem had a mediating role in this relationship. In similarity to the results of other studies, in this study, it was determined that the effect of perceived stigma in the patients on their diabetes management self-efficacy decreased when the variable of self-esteem was added to the model.…”

Diabetes-related social stigma among university students in Saudi Arabia: A cross-sectional study

“…Diabetes-related stigma was found to have both a direct [6,20] and an indirect effect [6] on patient activation; a concept that involves patient's knowledge, skills and engaging in behaviors conducive to the management of their illness. Psychologically, stigma lowers self-efficacy and self-esteem, and increases stress in diabetics , [10] which leads to engagement in less healthy behaviors, and as a result glycosylated hemoglobin, is found to be adversely affected by diabetes-related stigma. [7][8][9] There is urgent need for research in the area of stigma [19] that includes documenting the magnitude and nature of diabetesrelated stigma, comparing stigma in different settings, and identifying its determinants.…”

“…There is evidence that diabetes-related stigma affects the course and outcome of diabetes including hindering self-care , [6] having an effect on glycemic control [7][8][9] as well as psychological effects. [10] Weiss and Ramakrishna [11] have formulated a definition specific for health-related stigma: "a social process or related personal experience characterized by exclusion, rejection, blame, or devaluation that results from experience or reasonable anticipation of an adverse social judgment about a person or group identified with a particular health problem." Link and Phelan [5] characterize 3 major forms of discrimination, with varying degrees of severity; direct discrimination, structural discrimination and insidious discrimination.…”

Teste oral de tolerância à glicose alterado na gestação: comparação entre pacientes com diabetes gestacional e diabetes na gestação segundo os critérios da Organização Mundial da Saúde

“…Muitas pessoas com DM sentem-se julgadas, inclusive por profissionais de saúde, como se fossem "preguiçosas" e "responsáveis pela doença" (49,51). Esse estigma está negativamente correlacionado à autoestima, ao autocuidado e a percepção da qualidade do serviço de saúde recebido (50,52,53). Devemos, portanto, Reconhecer que a hiperglicemia na gestação tem impactos duradouros na vida da mulher, e oferecer seguimento e acompanhamento criteriosos, é essencial para melhorar a assistência à saúde.…”