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. 2025 Aug;42(8):e70082.
doi: 10.1111/dme.70082. Epub 2025 Jun 7.

Experiences of diabetes stigma among adults with type 1 and type 2 diabetes: A multi-study, multi-country, secondary analysis

Elizabeth Holmes-Truscott  1   2 , Eloise Litterbach  1   2 , Uffe Søholm  1   2 , Paul A Agius  3 , Hamzah Alzubaidi  4   5   6 , Valery Bodziony  7 , Joncarl Bresolin  8 , Kim Fletcher  8 , Matthew Garza  9 , Kevin L Joiner  10 , Rebecca M Puhl  11 , Michio Shimabukuro  12 , Laura Syron  8 , Hiroko Takaike  13 , Michael Vallis  14 , Heather Verry  15 , Jennifer A Halliday  1   2 , Sarah L Manallack  1   2 , Timothy C Skinner  1   2 , Jane Speight  1   2
Affiliations

Experiences of diabetes stigma among adults with type 1 and type 2 diabetes: A multi-study, multi-country, secondary analysis

Elizabeth Holmes-Truscott et al. Diabet Med. 2025 Aug.

Abstract

Aims: To conduct a multi-study, cross-country examination of diabetes stigma among adults with type 1 and type 2 diabetes (T1D, T2D).

Methods: Pre-existing, cross-sectional studies of adults (aged ≥18) completing the T1D or T2D Diabetes Stigma Assessment Scales (DSAS-1/DSAS-2) were collated. Descriptive statistics were calculated for (sub)scale and item scores. Variance-components linear random-effect multi-level modelling (nested random intercepts for country and study) estimated overall mean (sub)scale scores, 95% confidence intervals, intraclass correlation coefficients (ICC) and 95% prediction intervals. Likelihood ratio (LR) tests provided inference for country- and study-specific heterogeneity.

Results: Eleven studies were included from six countries (Australia k = 2, Canada k = 1, Japan k = 2, New Zealand k = 1, UAE k = 1, USA k = 4) in four languages (Arabic k = 1, English k = 7, Japanese k = 2, Spanish k = 1). Six studies included n = 3114 adults with T1D (insulin pump: 42%; 75% aged <60 years). Ten studies included n = 6586 adults with T2D (insulin-treated: 37%; 44% aged <60 years). Most reported ≥1 experience of diabetes stigma (T1D = 91%; study range: 84%-96%; T2D = 77%; 69%-89%). In 10 studies, the 'blame and judgment' subscale was most endorsed (T1D = 83%; 62%-89%, T2D = 70%; 53%-79%). Most adults with T1D reported 'identity concerns' (73%; 62%-80%), and 47% of adults with T2D reported 'self-stigma' (30-60%). Being 'treated differently' was least common (T1D = 46%; 40%-54%, T2D = 37%; 28%-47%). Low levels of heterogeneity were observed in mean [SE] total scores (DSAS-1: 54 [0.94] ICC = 0.02, p < 0.001; DSAS-2: 44 [1.1], ICC ≤0.4, p < 0.001).

Conclusions: Findings suggest a high and relatively consistent prevalence of diabetes stigma across studies and within and across countries, supporting calls for local and global action.

Keywords: diabetes; diabetes stigma; psychology; psychosocial; questionnaire.

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Conflict of interest statement

EHT has received unrestricted educational grants paid to her institution from AstraZeneca and Diabetes Australia, and an investigator‐initiated grant from Sanofi Diabetes; has received speaker fees from Novo Nordisk and Roche Diabetes Care Australia Pty Ltd.; and has served on an advisory board for AstraZeneca. US has previously been employed by Novo Nordisk A/S. RMP has received grant support from WW International and consulting fees from Eli Lilly and Company, outside of this study. MV has received speaking and consultation fees from Abbott, Abbvie, Bausch Health, Boehringer Ingelheim, Lilly, Novo Nordisk, Roche, and Sanofi, and investigator‐driven research funding from Abbott, Bausch Health, and Novo Nordisk. JAH reports speaker honoraria from Roche Diabetes Care, paid to her institution, for a one‐off presentation unrelated to the HypoPAST protocol. TCS reports that he has received funding from Roche Diagnostics for research projects and been CI on grants with Roche as a co‐funder. TCS has sat on Advisory Boards for Novo Nordisk, AstraZeneca, Eli Lilly, and Sanofi. JS has served on advisory boards for Janssen, Medtronic, Omnipod, Roche Diabetes Care and Sanofi Diabetes; received unrestricted educational grants and in‐kind support from Abbott Diabetes Care, AstraZeneca, Medtronic, Roche Diabetes Care, and Sanofi Diabetes; received sponsorship to attend educational meetings from Medtronic, Roche Diabetes Care and Sanofi Diabetes; and consultancy income or speaker fees from Abbott Diabetes Care, AstraZeneca, Insulet, Medtronic, Novo Nordisk, Roche Diabetes Care, and Sanofi Diabetes. All honoraria paid to her institution. JSp is also the copyright holder of the type 1 and type 2 Diabetes Stigma Assessment Scales (DSAS‐1/DSAS‐2) used in this study. All other authors declare no conflicts.

Figures

FIGURE 1
FIGURE 1
Proportion (%) of adults with type 1 diabetes endorsing (‘agree’ or ‘strongly agree’) DSAS‐1 items overall and by study, presented within subscale in descending order of endorsement.
FIGURE 2
FIGURE 2
Proportion (%) of adults with type 2 diabetes endorsing (‘agree’ or ‘strongly agree’) DSAS‐2 items overall and by study, presented within subscale in descending order of endorsement.
See this image and copyright information in PMC

References

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