Predictors of stigma perception by people with type 1 diabetes: A cross-sectional analysis of the BETTER registry

Aims: This study investigates stigma predictors across ages and genders, addressing a critical gap in understanding diverse populations to reduce related suboptimal clinical and psychosocial outcomes. Methods: Cross-sectional analysis of self-reported data from BETTER, a Canadian registry of people with type 1 diabetes. Participants (n = 709) completed the 19-item-Diabetes-Stigma Assessment-Scale (DSAS-1) categorized into treated differently, blame and judgment, and identity concerns sub-scales. Associations with diabetes distress (DDS-17-score/102), depression (PHQ-9-score/27), social-support (ESSI-score/34), fear of hypoglycemia (HFS-II-score/132), and hyperglycemia-avoidance-behaviours (HAS-score/88) were computed. Results: Perceived stigma was highest in youth aged 14-24 years (46<middle dot>0 +/- 15<middle dot>6, p < 0<middle dot>001) and women (41<middle dot>2 +/- 15<middle dot>7, p = 0<middle dot>009), compared to other age groups and men. Blame and Judgment contributed to most of stigma perception. Youth perceived significantly more blame and judgment (p < 0<middle dot>001) and identity concerns (p = 0<middle dot>001) compared to middle-aged adults and seniors. Women perceive significantly more blame and judgment compared to men (p < 0<middle dot>001). The perception of being treated differently was not reported to be an issue across ages and genders. Participants with higher scores of depression, diabetes-distress, fear of hypoglycemia, hyperglycemia-avoidance behaviours, and lesser social-support, reported increased stigma. Conclusions: Stigma varies by age and gender, underscoring the need for targeted interventions to reduce it. Challenging stereotypes and reducing stigma-related stressors are essential for better outcomes.