ESPE Yearbook of Paediatric Endocrinology

Brief summary: Using data collected from 1608 adolescents and young adults (aged 10–24.9 years) with type 1 or type 2 diabetes recruited in the SEARCH for Diabetes in Youth study, this study assessed the cross-sectional association between diabetes stigma and diabetes outcomes. Diabetes stigma was more common among females and was associated with suboptimal glycemic outcomes and acute and chronic complications.

Stigma, defined as a negative social judgment that leads to unwarranted rejection or exclusion, is common in people with chronic diseases (1). Diabetes-related stigma refers to negative social attitudes towards diabetes that can lead people experiencing blame, stereotyping, rejection, exclusion, and/or discrimination (2). Previous studies have reported a high frequency of stigma among adults with diabetes, but there are limited data on this topic for younger populations (2).

In this study of the large SEARCH for Diabetes in Youth cohort of young people with type 1 and type 2 diabetes, a five-question survey, specifically designed for this study, was used to assess the frequency of perceived diabetes-related stigma, with three questions assessing perception or experience of diabetes stigma and the other two questions exploring consequences of diabetes stigma. One key finding was that diabetes stigma was more common among females. This is in line with the higher burden of other psychosocial comorbidities, such as depression, diabetes distress, and disordered eating behaviors in females. The study also showed a strong association between diabetes-related stigma and elevated HbA1c, which is a common finding in adolescents and young adults. In contrast, no association was found with education, employment status, health insurance, or use of technology. In participants with T1D, diabetes-related stigma was also independently associated with higher rates of recent episodes of hypoglycemia and ketoacidosis, as well as with retinopathy and nephropathy.

This study highlights the importance of addressing diabetes stigma in comprehensive diabetes care in adolescents and young adults with diabetes, who are particularly vulnerable due to age-specific characteristics, such as the focus on peer relationships, personal identity, and establishing autonomy (3). Stigma not only impact on the psychological well-being of young people with diabetes but represents an additional risk factor for suboptimal diabetes outcomes.

References: 1. Weiss MG, Ramakrishna J Stigma interventions and research for international health. Lancet. 2006;367(9509):536–538. 2. Liu NF, Brown AS, Folias AE, et al. Stigma in people with type 1 or type 2 diabetes. Clin Diabetes. 2017;35(1):27–34. 3. Andrews JL, Ahmed SP, Blakemore SJ. Navigating the social environment in adolescence: The role of social brain development. Biol Psychiatry. 2021;89(2):109–118.