American Diabetes Association
20191125_Holmes-Truscott_Stigma_X_outcomes._Supplementary_Files2.pdf (367.31 kB)

Psychosocial moderators of the impact of diabetes stigma: results from the second Diabetes MILES – Australia (MILES-2) study

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Version 2 2020-10-07, 22:59
Version 1 2020-09-04, 14:17
posted on 2020-10-07, 22:59 authored by Elizabeth Holmes-Truscott, Adriana D Ventura, Sharmala Thuraisingam, Frans Pouwer, Jane Speight

To examine the association between diabetes stigma, psychological, behavioural, and Hba1c outcomes and to investigate moderation effects of self-esteem, self-efficacy and/or social support.

Research Design and Methods

Second national Diabetes MILES–Australia (MILES-2) survey: adults with type 1 diabetes (n=959, 41% male; mean±SD age: 44±15 years), insulin-treated (n=487, 60% male; age: 61±9), and non-insulin treated type 2 diabetes (n=642, 55% male; age: 61±10). (Un)adjusted linear regression analyses tested the association between diabetes stigma (DSAS) and psychological outcomes (depressive symptoms: PHQ-8; anxiety symptoms: GAD-7; diabetes-specific distress: PAID), behavioural outcomes (healthy diet and physical activity: SDSCA), and self-reported HbA1c. Interaction effects tested whether associations varied by self-esteem (RSE), self-efficacy (CIDS) and/or diabetes-specific social support (DSS).


Significant positive associations were observed between DSAS and PHQ-8, GAD-7 and PAID across diabetes type/treatment groups (all p<.001), whereby each standard deviation increase in DSAS scores was associated with an approximate half standard deviation deterioration in emotional well-being. Associations between DSAS and SDSCA and HbA1c were non-meaningful. Self-esteem moderated psychological outcomes among participants with type 1 and non-insulin treated type 2 diabetes, and diabetes distress among those with insulin-treated type 2 diabetes. Interaction effects were partially observed for social support but not for self-efficacy.


This study provides evidence of the association between diabetes stigma and depressive/anxiety symptoms and diabetes distress, and for the moderating effects of self-esteem and social support, among adults with type 1 and type 2 diabetes. Further research is needed to examine associations with objectively-measured behavioural and clinical outcomes.


Key researchers on this study were supported by core funding provided to the Australian Centre for Behavioural Research in Diabetes by Diabetes Victoria and Deakin University. EHT is funded by Deakin University Deans Postdoctoral Research fellowship. An unrestricted educational grant from Sanofi ANZ supported recruitment activities and the development of the study website. Sanofi ANZ was not involved in the study design, data collection or data analysis and had no input on the preparation of this manuscript.


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