Experience of stigma among persons with type 2 diabetes in Africa: a systematic review

Perceived Barriers to Healthy Lifestyle Adherence and Associated Factors Among Patients with Type 2 Diabetes Mellitus: Implications for Improved Self-Care

Background

Many patients with type 2 diabetes mellitus (T2DM) face barriers to maintain a healthy lifestyle. This study investigated the perceived barriers to healthy eating and physical activity and compared them by demographic and diabetes-related characteristics among patients with T2DM.

Methods

A cross-sectional study was conducted among 534 patients with T2DM attending primary healthcare centers in Hail City from January to June 2023. Data analyzed at a significance level of <0.05.

Results

Barriers to healthy eating and physical activity were perceived by 34.9% and 28% of patients, re-spectively. Personal and environmental barriers to healthy eating were perceived more frequently than social barriers (43.0% and 26.9%, respectively). Personal and environmental barriers to physical activity were perceived by 28.0% of patients, followed by social barriers (27.9%). The most frequently perceived barrier to healthy eating was a lack of motivation (61.6%), followed by insufficient information about healthy diets (32.2%). Regarding physical activity, a lack of motivation was the most frequently perceived personal barrier (32.0%), while a lack of a supportive work environment was the most frequently perceived social barrier (33.7%). Patients who were aged between 30 and 40 years, were highly educated, were diagnosed with DM within less than five years, and used insulin injections as a strategy to manage DM reported significantly higher levels of perceived barriers to healthy eating compared to their counterparts. In contrast, patients who were female, married, had poor financial status, and used insulin injections reported significantly higher levels of perceived barriers to physical activity compared to their counterparts.

Conclusion

Over one-third of patients with T2DM seeking medical care in Hail City perceive barriers to healthy eating, mainly a lack of motivation, insufficient diet information. Educational programs that consider the unique characteristics of patients should be developed.

The Prevalence and Determinants of Anxiety and Depressive Symptoms in Patients with Type II Diabetes Mellitus in Mogadishu, Somalia: A Cross-Sectional Study

Purpose

This study aims to determine the prevalence of depression, anxiety, and stress among TIIDM patients in Mogadishu, Somalia, and identify predicting factors, as there is limited research on these disorders in Somalia.

Methods

A hospital-based cross-sectional study was conducted on adult patients with TIIDM from November 2023 to January 2024 at Erdogan Hospital, in the capital city of Somalia. A total of 360 participants were recruited using the systematic sampling technique. Data was collected using questionnaires on sociodemographic, clinical and behavioral characteristics. The depression, anxiety, and stress scale (DASS-21) questionnaire was used to assess symptoms of depression, anxiety, and stress. Bivariate and multivariate logistic regression analyses were performed to identify variables predicted by the outcome variables.

Results

Out of the 360 participants included in this study, 44.7%, 55.0%, and 30.3% had depression, anxiety, and stress symptoms, respectively. A lack of regular exercise (AOR = 1.79; 95% CI: 1.14-2.79) and an illness duration of 4-7 years (AOR = 1.94; 95% CI: 1.16-3.23) were statistically associated with depression. Being female (AOR = 2.07; 95% CI: 1.31-3.28), having ≥9 children (AOR = 1.94; 95% CI: 1.07-3.53), and a lack of regular exercise (AOR = 1.57; 95% CI: 1.01-2.45) were statistically associated with anxiety. A lack of regular exercise (AOR = 2.07; 95% CI: 1.31-3.28), having DM complications (AOR = 2.14; 95% CI: 1.01-4.54), an illness duration of 4-7 years (AOR = 2.22; 95% CI: 1.25-3.94), and DM management non-compliance (AOR = 2.74; 95% CI: 1.20-6.26) were statistically associated with stress.

Conclusions

This study found that TIIDM patients had moderately high rates of depression, anxiety, and stress symptoms, with a lack of physical activity associated with increased odds of depression, anxiety, and stress symptoms. Healthcare workers should screen for psychological symptoms, provide interventions, monitor sedentary patients, and encourage adherence to treatment and physical exercise to reduce mental health burden.

Diabetes Stigma and Clinical Outcomes: An International Review

Diabetes stigma is the social burden of living with diabetes. People with diabetes may experience or perceive an adverse social judgment, prejudice, or stereotype about living with diabetes at work, school, in healthcare settings, popular culture, or relationships. This review describes the methods that have been used to assess diabetes stigma, and explores the prevalence of diabetes stigma, associated sociodemographic and socioeconomic factors, cultural factors, and how diabetes stigma is associated with clinical outcomes, including HbA1c levels, diabetic ketoacidosis, severe hypoglycemia, and chronic complications, in addition to psychosocial complications in youth, adolescents, and adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). The prevalence of diabetes stigma has been reported as high as 78% in adults with T1D, 70% in adults with T2D, 98% in youth and adolescents with T1D, and is unknown in youth and adolescents with T2D. Diabetes stigma has been associated with lower psychosocial functioning, decreased self-care behaviors, higher HbA1c levels, and higher frequency of diabetes complications in adults with T1D and T2D. In adolescents and young adults with T1D, diabetes stigma is associated with lower psychosocial functioning, higher HbA1c levels, and higher frequency of diabetic ketoacidosis and severe hypoglycemia episodes in addition to chronic complications. In youth and adolescents with T2D, one study demonstrated an association of diabetes stigma with lower psychosocial functioning, higher HbA1c levels, and presence of retinopathy. Gaps exist in our understanding of the mechanisms of diabetes stigma, particularly in youth and adolescents with T2D.

Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations

People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.