Association of self‐stigma with glycated hemoglobin: A single‐center, cross‐sectional study of adults with type 1 diabetes in Japan

Abstract

Aims/Introduction There has been an increase in research on diabetes‐related stigma and its association with glycated hemoglobin (HbA1c) over the past years. However, little is known about the association of self‐stigma with HbA1c in persons with type 1 diabetes. This study aims to examine the association between self‐stigma and HbA1c in Japanese people with type 1 diabetes. Materials and Methods This cross‐sectional study was conducted at a clinic in Tokyo. Questionnaires using nine items from the Japanese version of the Self‐Stigma Scale was distributed to outpatients with type 1 diabetes, aged ≥18 years. We excluded outpatients with serious mental disorder, those who required urgent medical treatment or received hemodialysis. Adjusted linear regression analyses tested the association between the score of the 9‐item Self‐Stigma Scale and HbA1c. Results Questionnaires were distributed to 166 eligible participants. A total of 109 participants were included in the final analysis after excluding participants with incomplete answers and laboratory data. After adjusting for age, sex, employment status, body mass index, duration of diabetes and insulin secretion, there was a significant positive association between self‐stigma and HbA1c (β = 0.05, 95% confidence interval 0.01 to 0.08). Conclusions This cross‐sectional study showed a significant association between self‐stigma and HbA1c in persons with type 1 diabetes. Addressing self‐stigma might be as equally essential as measuring HbA1c in evaluating glycemic outcome among individuals with type 1 diabetes.

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

“…One area of concern regarded the appropriateness of measures. Four of the nine studies were marked as ‘no’ regarding the appropriateness of measures 1,17,20,21 . In two studies, 1,20 measures were created specifically for the study which, to the knowledge of the authors, had not been validated prior to the study.…”

“…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.…”

“…Four of the nine studies were marked as 'no' regarding the appropriateness of measures. 1,17,20,21 In two studies, 1,20 measures were created specifically for the study which, to the knowledge of the authors, had not been validated prior to the study. In another two studies, 17,21 measures were used that had been validated within populations of people with type 2 diabetes only.…”

“…1,17,20,21 In two studies, 1,20 measures were created specifically for the study which, to the knowledge of the authors, had not been validated prior to the study. In another two studies, 17,21 measures were used that had been validated within populations of people with type 2 diabetes only. The second area of concern identified by the MMAT was the risk of nonresponse bias.…”

“…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.…”