Comprehensive Diabetes Stigma Scale—Associations with Patient Characteristics and Outcomes

Abstract

Stigma related to health conditions has been linked to poor medication adherence and health outcomes. With input from patients living with diabetes, diabetes clinicians, and stigma researchers, we designed the Comprehensive Diabetes Stigma Scale (CDSS). We hypothesized that higher diabetes stigma would be associated with worse medication adherence, younger age, insulin use, and higher HbA1c values. We recruited adults with diabetes on ≥1 diabetes medication in person from one academic practice and online via ResearchMatch. Participants completed the 15-item CDSS and measures of perceived diabetes stigma from family members, psychological and behavioral consequences of diabetes stigma, and medication adherence. Participants self-reported the range of their most recent HbA1c lab value. Spearman correlations and multiple linear regression were used to assess associations between variables. Participants (n=311) were on average 61 ± 11 years; 56% female and 86% white. Most (69%) participants endorsed at least 1 CDSS-15 item, 34% reported HbA1c >7.0%, and 49% reported insulin use. CDSS-15 scores correlated with diabetes family perceived stigma (ρ=0.51, p<0.01) and consequences of diabetes stigma (ρ =0.63, p<0.01). Higher diabetes stigma correlated with worse medication adherence (ρ =0.40, p<0.01). This association remained significant after adjusting for age, sex, race, diabetes duration, insulin use, and marital, employment, and insurance status (β=0.17, p<0.01). By age, younger participants had higher CDSS-15 scores (ρ =-0.35, p<0.01). CDSS-15 scores did not differ by insulin use status (ρ =0.03, p=0.59). The mean CDSS-15 score of participants with HbA1c <6.4% (23; 95% CI 21-25) was lower than those with HbA1c >9.0% (30; 95% CI 19-41), but this difference was not significant (p=0.06). These findings reinforce that diabetes stigma is prevalent and show for the first time that diabetes stigma may be a unique factor contributing to suboptimal diabetes medication adherence. Disclosure L.B. Beach: None. S. Kankotia: None. C.U. Dinh: None. T. Elasy: None. L.S. Mayberry: None. K. Wallston: Advisory Panel; Self; EdLogics Inc.. G. Phillips: None. P. Janulis: None. K. Cavanaugh: None.