Impact of diabetes stigma in diabetes distress and diabetes self-care: The moderating role of diabetes social support and general self-esteem in Arabic-speaking adults with type 2 diabetes

Aims: There is increasing evidence that diabetes stigma has negative impacts on behavioural and psychological outcomes among people with type 2 diabetes (T2D). However, research has focused largely on Caucasian and certain Asian groups. The aim of this study was to examine associations of diabetes stigma with diabetes distress and self-care, and investigate the moderating effects of self-esteem and social support, in Arabic-speaking communities. Methods: A cross-sectional study was conducted at 21 outpatient clinics and diabetes-specialist centres in the United Arab Emirates. Besides the Arabic Type-2 Diabetes Stigma Assessment Scale, participants completed other validated questionnaires assessing distress, self-care, social support, and self-esteem. General linear models were used to estimate the mean difference in diabetes-specific distress and self-care for every 1-point increase in diabetes stigma total score. Results: Among 327 adults with T2D, the mean total score of diabetes stigma was 43.55 +/- 13.95. Every 1-point increase in diabetes stigma was associated with significantly increased diabetes distress (beta = 0.113, 95% CI: 0.078 to 0.147; p = 0.003) and decreased self-care behaviours: diet (beta = -0.029, 95% CI: -0.048 to -0.009; p = 0.008), physical activity (beta = -0.022, 95% CI: -0.038 to -0.006; p = 0.013) and foot care (beta = -0.043, 95% CI: -0.059 to -0.026; p < 0.001). Self-esteem mitigated the effect of diabetes stigma on diabetes distress. Conclusions: Perceived and experienced diabetes stigma was independently associated with increased diabetes distress and decreased engagement in diabetes self-care among Arabic-speaking adults with T2D. These findings are crucial to help clinicians provide more effective assessment and counselling and guide public health interventions to decrease diabetes stigma in these communities.