Diabetes Stigma and Clinical Outcomes in Adolescents and Young Adults: the SEARCH for Diabetes in Youth Study

Objective: To examine the association between diabetes stigma and HbA1c, treatment plan, and acute and chronic complications in adolescents and young adults (AYAs) with type 1 or type 2 diabetes. 

Research Design and Methods: The SEARCH for Diabetes in Youth study is a multicenter cohort study that collected questionnaire, laboratory, and physical exam data in AYAs with diabetes diagnosed in childhood. A 5-question survey assessed frequency of perceived diabetes-related stigma, generating a total diabetes stigma score. We used multivariable linear modeling, stratified by diabetes type, to examine the association of diabetes stigma with clinical factors, adjusting for sociodemographic characteristics, clinic site, diabetes duration, health insurance, treatment plan, and HbA1c.

Results: Of 1,608 respondents, 78% had type 1 diabetes, 56% were female, and 48% were non-Hispanic white. Mean (SD) age at study visit was 21.7 (5.1) years (range 10 – 24.9). Mean HbA1c was 9.2% (2.3%) or 77 mmol/mol (2.0 mmol/mol). Higher diabetes stigma scores were associated with female sex and higher HbA1c (p <0.01) for all participants. No significant association between diabetes stigma score and technology use was observed. In participants with type 2 diabetes, higher diabetes stigma scores were associated with insulin use (p = 0.04). Independent of HbA1c, higher diabetes stigma scores were associated with some acute complications for AYAs with type 1 diabetes and some chronic complications for AYAs with type 1 or type 2 diabetes. 

Conclusion: Diabetes stigma in AYAs is associated with worse diabetes outcomes and is important to address in providing comprehensive diabetes care.