Stigma in People With Type 1 or Type 2 Diabetes

Cultural Beliefs About Diabetes-Related Social Exclusion and Diabetes Distress Impact Self-Care Behaviors and HbA1c Among Patients with Type 2 Diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) disproportionally impacts Latin Americans (Latinos) in the U.S. compared to non-Latino Whites, as reflected by an increased risk for disease complications and higher mortality rates. Guided by an Integrative Model of Culture, Psychological Processes, and Health Behavior, the purpose of the present study was to examine the role of cultural beliefs and diabetes distress as determinants of self-care behaviors and HbA1c among Latino patients with T2DM.

METHODS

Participants included 109 Latino patients with T2DM recruited from a diabetes treatment center located in a region of Southern California with high diabetes mortality rates. Structural equation modeling was employed to examine the extent to which cultural beliefs about diabetes-related social exclusion and diabetes distress impact self-care behaviors and self-reported HbA1c.

RESULTS

Consistent with the study hypotheses, cultural beliefs about diabetes-related social exclusion predicted diabetes distress, which in turn predicted poor diabetes self-care.

CONCLUSIONS

Findings suggest an important need for intervention efforts that address both cultural and psychological factors in order to improve diabetes self-care behaviors and associated disease outcomes among Latino patients with T2DM. Future research could benefit from investigating protective aspects of culture that could help counter the negative implications of cultural beliefs about social exclusion and diabetes distress associated with poor self-care.

Identifying the deficiencies of currently available CGM to improve uptake and benefit

BACKGROUND AND AIMS

The use of diabetes technologies is increasing worldwide, with health systems facilitating improved access to devices. Continuous glucose monitoring is a complex intervention that provides information on glucose concentration, rate and direction of change, historical data and alerts and alarms for extremes of glucose. These data do not themselves change glycaemia and require translation to a meaningful action for impact. It is, therefore, crucial that such systems advance to better meet the needs of individuals using them.

METHODS

Narrative review of the use of, engagement with, limitations and unmet needs of continuous glucose monitoring systems.

RESULTS

CGM devices have made a significant contribution to the self-management of diabetes; however, challenges with access and user experience persist, with multiple limitations to uptake and benefit. These limitations include physical size and implementation, with associated stigma, alarm fatigue, sleep disturbance and the challenge of addressing large volumes of real-time data. Greater personalisation throughout the continuous glucose monitoring journey, with a focus on usability, may improve the benefits derived from the device and reduce the burden of self-management. Healthcare professionals may have unconscious biases that affect the provision of continuous glucose monitors due to deprivation, education, age, ethnicity and other characteristics.

CONCLUSIONS

Continuous glucose monitoring exerts a dose-dependent response; the more it is used, the more effective it is. For optimal use, continuous glucose monitors must not just reduce the burden of management in one dimension but facilitate net improvement in all domains of self-management for all users.

Understanding the Negative Effect of Stigma: A Pediatrician's Guide to Employing Anti-stigma Language/Care to Improve Engagement and Outcomes

A primer for pediatric providers on understanding stigma in health care, the terminology and types of stigma, the conditions commonly faced with stigma in pediatrics, the components of evidence-based anti-stigma initiatives, and guidance to effect change within a pediatric practice. The authors outline the negative effects of stigma in pediatrics and how to combat the problem at the source, and explore self-stigma, public stigma, and structural stigma and how it applies to weight, diabetes, disability, HIV, mental health, and substance use in pediatrics.

Physicians' stigmatizing attitudes about individuals with type 2 diabetes: Associations with communication practices and perceived barriers to care

AIMS

The stigma of type 2 diabetes (T2D) has received growing attention in the healthcare setting. However, there has been almost no research examining how healthcare professional biases about diabetes relate to patient care. This cross-sectional study examined how physicians' self-reported biases, stereotypes, and attributions about diabetes and obesity were related to their patient care practices.

METHODS

Physicians treating T2D, specializing in internal medicine or endocrinology (n=205), completed a battery of online questionnaires.

RESULTS

Physicians who attributed poor patient compliance as the primary barrier to provision of diabetes care had worse perceptions of individuals with T2D and were less likely to use person-centered approaches with their patients. Physicians' stigmatizing attitudes about T2D were associated with less use of person-first language, while more positive perceptions of individuals with T2D were associated with greater use of motivational interviewing. Weight-related stigma was associated with less use of person-centered approaches to care and less confidence in their ability to provide care.

CONCLUSIONS

Findings reiterate the associations between weight stigma and poorer physician communication and suggest that similar patterns occur in the provision of care for individuals with T2D. Physicians who treat T2D may benefit from stigma reduction interventions for both diabetes and weight-related stigmas.

"I Haven't Told Anyone but You": Experiences and Biopsychosocial Support Needs of People With Type 2 Diabetes and Binge Eating

Up to 25% of people with type 2 diabetes (T2D) may binge eat which is almost 10 times as many as in the general population. Binge eating is associated with depression, anxiety, and social isolation. Moreover, binge eating may increase the risk of obesity and high blood glucose levels, both of which can accelerate the onset of complications to diabetes and death in people with T2D. Still, little is known about the experiences, needs, and preferences of people with T2D and binge eating that can inform and develop current and future treatment efforts. The aim of the study was therefore to gain in-depth insights into the experiences and biopsychosocial support needs of women and men with T2D and binge eating. Twenty semi-structured individual interviews (65% with females) were conducted and analyzed according to the methodology of Interpretive Description. Four themes were identified: (a) T2D and binge eating: Feeling trapped in a vicious circle; (b) Unwanted outcasts: Responding to continuous criticism; (c) Biomedical relief: Blaming and adjusting the body; and, (d) Silent struggles: Wanting to cease the secrecy. Pertinent to all themes were the guilt, shame, and worries about developing complications that the participants experienced when binge eating despite having T2D. Although binge eating triggered emotional distress, binge eating was at the same time a way of coping with such distress. Implications for treatment and future research are discussed, including the need to systematically assess and address binge eating in routine T2D care.

Perception of Type 2 Diabetes Mellitus (T2DM) patients on diabetes self-care management in Fiji

INTRODUCTION

The prevalence of diabetes has increased globally where Type 2 Diabetes Mellitus (T2DM) is more common than any other type of diabetes. Self- care management education of diabetes provides skills and information for diabetic patients to effectively perform their own self diabetic self-care for optimum glycemic index control. As T2DM is a growing health issue in Fiji, promoting diabetes self manages among patients is a need, however there is lack of evidence in this regard. Therefore, the aim of this study is to explore the perception of T2DM patients on diabetic self-care management.

METHOD

This study used a qualitative method among T2DM patients regarding diabetic self-care management in Central Division, Fiji in 2022. This study was conducted in SOPD (Special Out Patient Department) clinics in the three chosen governmental health centers in the central division of Fiji. The study sample inclusion criteria were only T2DM patients, and no other types of diabetes, patients who are 18years and above, patients who are attending clinic at least for more than 6 months, self-identified as Fijian participants of any ethnicity or gender. The study settings were also purposively selected but the study sample was selected using purposive sampling. In depth interview using semi-structured open-ended questionnaires was used to collect data. Thematic analysis was done, followed by reviewing themes, defining and naming them.

RESULTS

Thirty patients participated in this study. Five major themes emerged from the in-depth interview including; patient factors that affect diabetes self-care management, behavior and attitude towards T2DM self-care management, health services delivery, challenges and barriers faced by patients to perform diabetes self-care management, and recommendations to improve patient self-care management. Patients in this study have good knowledge about T2DM and the self-care management they have to perform. It is the patients' attitude and behavior towards T2DM self-care management that affects patients to perform self-care management. The study also showed patients have gained good knowledge from Health Care Workers (HCW). Socio-economic and psychological status also played a vital part in patients' self-care management. Apart from challenges, there were opportunities to learn the difficulties patients face in order to perform self-care management.

CONCLUSION

The results of this study revealed a combination of individual, cultural, and health systematic related factors as the mots influencer of diabetes self-management among patients in Fiji. Patients have to take ownership of their own health in order to improve their blood sugar reading and reduce complication of diabetes. Tailored interventions that consider patients' belief and address potential challenges would be useful. A lot is needed in terms of upgrading facilities for the comfort of patients and need to collaborate more with other multidisciplinary team and stakeholders.

Experiences and Views of Young People and Health Care Professionals of Using Social Media to Self-Manage Type 1 Diabetes Mellitus: Thematic Synthesis of Qualitative Studies

BACKGROUND

Social media have shown the potential to support type 1 diabetes self-management by providing informational, emotional, and peer-to-peer support. However, the perceptions of young people and health care professionals' (HCPs) toward the use of social media for type 1 diabetes self-management have not been systematically reviewed.

OBJECTIVE

The aim of this study is to explore and summarize the experiences and views of young people with type 1 diabetes and their HCPs on using social media for self-management across qualitative findings.

METHODS

We searched MEDLINE, Embase, PsycINFO, and CINAHL from 2012 to 2023 using Medical Subject Heading terms and text words related to type 1 diabetes and social media. We screened and selected the studies according to the inclusion and exclusion criteria. We quality appraised and characterized the included studies and conducted a thematic synthesis.

RESULTS

We included 11 studies in our synthesis. A total of 9 of them were qualitative and 2 were mixed methods studies. Ten focused on young people with type 1 diabetes and 1 on HCPs. All used content analysis and were of moderate to high quality. Thirteen descriptive themes were yielded by our thematic synthesis, contributing to five analytic themes: (1) differences in how young people interact with social media, (2) characteristics of social media platforms that influence their use and uptake for type 1 diabetes self-management, (3) social media as a source of information, (4) impact on young people's coping and emotional well-being, and (5) impact on support from and relationships with HCPs and services.

CONCLUSIONS

The synthesis suggests that we should consider leveraging social media's peer support capabilities to augment the traditional services for young people with type 1 diabetes. However, the patients may have privacy concerns about HCPs' involvement in their online activities. This warrants an update of existing guidelines to help young people use social media safely for self-managing their diabetes.

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

Diabetes stigma is a pervasive social phenomenon with significant impacts on individuals living with type 2 diabetes mellitus (T2DM). Despite the negative health impact of diabetes stigma, little is known about the experience of this phenomenon in Africa. This review aimed to synthesize existing quantitative and qualitative studies that examine the experiences and outcomes of T2DM stigma in Africa. A mixed studies review methodology was utilized to conduct this research. Relevant articles were identified by searching the Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE and PsycINFO databases. The mixed method appraisal tool was used to assess the quality of included studies. Of 2626 records identified, 10 articles met the inclusion criteria. The prevalence of diabetes stigma was as high as 70%. The results of the review indicate that individuals with T2DM in Africa are labelled as 'having HIV', 'nearing their death' and 'wasting resources'. These experiences were associated with low quality of life, disease concealment and avoidance of self-management behaviours. The findings highlight the urgent need for further stigma-centric studies to fully understand how T2DM stigma is experienced in Africa. The evidence from such studies would inform the development and evaluation of effective interventions to address this social consequence of T2DM.

Protocol of a Prospective Observational Study on Lifestyle and Quality of Life in Adults with Type 1 Diabetes in Japan

INTRODUCTION

Recent studies have shown that the quality of life (QOL) of people living with type 1 diabetes (T1D) is poor and must be improved. However, the living situation and QOL of adults living with T1D in Japan have not been fully clarified. This study will examine their lifestyle, QOL, and clinical situation, as well as the relationships between them.

METHODS

This is a prospective, 5-year follow-up observational study. Between December 2019 and September 2021, we enrolled adults in Japan who were living with T1D and receiving insulin therapy, and are acquiring longitudinal clinical data and the responses to seven questionnaires regarding lifestyle and QOL. The primary study outcomes are (1) the relationship between Problem Areas in Diabetes (PAID) scores and various factors including demographic data, clinical characteristics, medical history, lifestyle habits, treatment history, biochemical data, and the scores of questionnaires; and (2) the relationship between Beck Depression Inventory (BDI)-II scores and various factors aforementioned. The secondary outcomes are the relationships between various factors aforementioned and each of the following: (1) blood glucose control, (2) blood lipid control, (3) dietary patterns, (4) fear of hypoglycemia, (5) sleep patterns, and (6) physical activity.

PLANNED OUTCOME

We registered 352 participants. The median age was 49 (41-63) years, and the median duration of T1D was 13 (8-20) years. All the results will be available in 2026. We expect to clarify the factors associated with decreased QOL, and that this knowledge will contribute to improving QOL in adults in Japan who are living with T1D and receiving insulin therapy.

TRIAL REGISTRATION

Clinical Trials.gov identifier, UMIN000044088.

"Shame on Me": Exploring the Role of Self-Stigma in Psychological Outcomes Among Type 2 Diabetes Patients in Hong Kong

BACKGROUND

Studies have suggested that type 2 diabetes mellitus (T2DM) are at risk of self-stigmatization (i.e., internalized sense of shame about having diabetes). Self-stigma has been found to be associated with poorer psychological outcomes among chronic disease patients; relevant studies examining such an association and its psychosocial mechanisms are scarce among Chinese T2DM patients. This study aimed to examine the association between self-stigma and psychological outcomes among T2DM patients in Hong Kong. Self-stigma was hypothesized to be associated with higher psychological distress and lower quality of life (QoL). Such associations were also hypothesized to be mediated by lower perceived social support, lower self-care self-efficacy, plus higher self-perceived burden to significant others.

METHODS

T2DM patients (N = 206) recruited from hospitals and clinics in Hong Kong were invited to complete a cross-sectional survey measuring the aforementioned variables.

RESULTS

After controlling for covariates, multiple mediation analysis results indicated the indirect effects from self-stigma to psychological distress via increased self-perceived burden (β = 0.07; 95% CI = 0.02, 0.15) and decreased self-care self-efficacy (β = 0.05; 95% CI = 0.01, 0.11) were significant. Moreover, the indirect effect from self-stigma to QoL via decreased self-care self-efficacy was also significant (β = -0.07; 95% CI = -0.14, -0.02). After considering the mediators, the direct effects from self-stigma to higher psychological distress and lower QoL remained significant (βs = 0.15 and -0.15 respectively, ps < .05).

CONCLUSIONS

Self-stigma could be linked to poorer psychological outcomes through increased self-perceived burden and decreased self-care self-efficacy among T2DM patients. Targeting those variables when designing interventions might facilitate those patients' psychological adjustments.

Impact of Negative or Stigmatizing Messages on Diabetes Outcomes: An Integrative Review

PURPOSE

The purpose was to determine if negative or stigmatizing language and messaging have an impact on diabetes distress, outcomes, or care behaviors in people with diabetes. Since 2012, when the first language position statement was published, the way health care professionals talk to people with diabetes has been an ongoing topic of discussion. However, there have been no recent literature reviews evaluating the impact of problem language on outcomes among people with type 1 and type 2 diabetes.

METHODS

An integrative review was conducted using 4 electronic databases: CINAHL, Embase, Web of Science, and Medline (Ovid). Studies reporting on diabetes, language, stigma, diabetes distress, glycemic outcomes, and self-care behaviors were included.

RESULTS

The review included 9 studies, all of which were of high quality. The impact of negative or stigmatizing language on self-care behaviors was the most commonly addressed outcome. Whereas some studies revealed no change, others reported a decrease in self-care behaviors by people with diabetes who had negative perceptions of provider messages. Actual or perceived use of negative or stigmatizing language is linked to higher A1C. Four studies reported an association between messages and diabetes distress.

CONCLUSIONS

Negative/stigmatizing language has both an immediate and long-term effect on people with diabetes. The inconsistent approaches to studying language in diabetes makes it challenging to compare outcomes and identify themes. Future research is needed to identify effective interventions to change the messages in diabetes.

Perceptions of Beverages With Non-nutritive Sweeteners Among Indigenous Adults Living in Manitoba and Implications for Type 2 Diabetes

OBJECTIVES

The purpose of this study was to explore the perspectives of Indigenous adults on consuming beverages with non-nutritive sweeteners.

METHODS

In this work, we used a community-based, participatory design in partnership with National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W. We conducted 74 qualitative interviews with Indigenous adults living in Manitoba, including Island Lake First Nations (n=39), Flin Flon (n=15), and the North End neighbourhood of Winnipeg (n=20). Data were indexed in NVivo, and transcripts were analyzed thematically.

RESULTS

Participants exclusively discussed beverages with non-nutritive sweeteners (BNNSs) as an alternative to regular pop or sugary drinks, which were widely available, accessible, and consumed. Why or how BNNSs were viewed as an alternative comprised 3 subthemes: an alternative for health reasons; divergent taste preferences; and an alternative with mysterious but negative health effects. Participants who reported regular consumption of BNNSs largely described consuming them to manage type 2 diabetes. Fewer participants discussed BNNS as a means of weight management or as a preventive health behaviour. Participants who did not report regular BNNS consumption described not liking the taste of BNNSs. Finally, many participants described negative health impacts of consuming BNNSs, and specifically aspartame, although few articulated what those negative impacts were.

CONCLUSIONS

Divergent perspectives among Indigenous adults regarding the health implications of consuming BNNSs may reflect ongoing scholarly debates. These findings have implications for the prevention and dietary management of type 2 diabetes in Indigenous communities.

The Experiences of People Who Smoke With Type 2 Diabetes: A Qualitative Interview Study Using the Capability, Opportunity, Motivation, and Behavior Model

ABSTRACT

Few interventions to support smoking cessation include content specifically about diabetes. This is problematic, as people with diabetes face unique challenges when they stop smoking. The purpose of this study was to understand patients' needs and challenges in relation to smoking with Type 2 diabetes and assess the acceptability of a text message intervention to support smoking cessation. People who smoke and have Type 2 diabetes in the United States and the United Kingdom were recruited to participate in semistructured interviews (n = 20), guided by the Capability, Opportunity, Motivation, and Behavior model. A combination of inductive and deductive approaches with framework analysis was used to analyze the data. Results indicated that the participants' experiences related to the constructs of the Capability, Opportunity, Motivation, and Behavior model and the categories of mental health and diabetes distress were also notable parts of their experiences. Results can be used to guide intervention development in this unique group.

Psychological insulin resistance and its impact on self-management in type II diabetes mellitus patients treated with insulin therapy

AIMS

Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self-management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self-management in patients with type II diabetes mellitus treated with insulin therapy.

METHODS

We adopted a cross-sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self-management using the barriers to insulin treatment questionnaire and the partners in health scale.

RESULTS

A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self-management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin-related outcomes, no diabetes-related complications, less fear of injection and self-testing, no hypoglycaemia within the previous year, and younger age.

CONCLUSION

Insulin therapy injection by patient and no diabetes-related complications were the most common factors associated with overall self-management and with each domain of self-management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self-management.

The impact of stigma on the management of type 1 diabetes: A systematic review

AIMS

To systematically review the literature investigating the links between stigma and the management of type 1 diabetes.

METHODS

A systematic literature review was conducted in accordance with PRISMA guidelines. Both quantitative and qualitative data were considered. Included papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT), and a narrative synthesis of results was reported.

RESULTS

Nineteen articles met the inclusion criteria and were included in the final analysis. Amongst these, one study used mixed methods, nine were qualitative, and nine were quantitative. All studies found a negative relationship between stigma and type 1 diabetes management. Qualitative studies provided a further understanding of the effects observed in the quantitative studies and found that stigma can affect self-care activities, disclosure of diabetes, and the uptake of diabetes technology. Systemic causes of stigma and intersectional stigma were also observed.

CONCLUSIONS

This review highlights that people with type 1 diabetes are negatively affected by stigma, irrespective of their age, gender, culture, or use of diabetes technology. Quantitative studies were limited, in that all studies were cross-sectional, and there was a lack of standardisation across outcome measures. There is a need for interventions to target stigma on both an individual and a systemic level, particularly where people experience multiple intersecting stigmas.

Impact of Living with Stigma in Persons with Type 1 Diabetes: A Patient-Physician Perspective

Type 1 diabetes mellitus (T1D) is an autoimmune disorder characterized by a complete deficiency in insulin due to the destruction of pancreatic beta cells. Globally, T1D accounts for nearly 5-10% of the total diabetes cases. Living with this life-long condition has a significant emotional, psychological, physical, mental, and social impact. Despite extensive research characterizing the underlying physiology of T1D, additional work is needed to address the psychosocial aspects associated with the condition and its effect on the quality of life (QoL) of people living with T1D. One area that warrants further exploration is the stigma-related stereotypes and prejudice of people living with T1D experience in real-life settings. Despite the acknowledgment of stigma for conditions such as obesity, mental illness, and epilepsy, its association with T1D and ensuing psychological distress remains relatively under-investigated. Health-related stigma is a huge barrier to seeking appropriate, timely support for enhanced healthcare management and engagement in such patients. Here, we provide the perspectives of an adult with over 33 years of living with T1D and an expert endocrinologist who details their experience of T1D-related stigma. The self-reported factors explored by the person living with T1D include (but are not limited to) blame, mockery of the condition/person, diabetes-related shame, exclusion, rejection, negative judgments, fear, stereotyping, and discrimination. The lived experience supported by the clinical insights of the endocrinologist highlights the urgent need to decipher the severity, extent, nature, determinants, and consequences of stigma faced by a person living with T1D. Raising societal awareness, increasing education for caregivers, access to counseling for people living with diabetes, and engaging in shared decision-making remain the path forward.

Addressing disparities in technology use among patients with type 1 diabetes: a review

PURPOSE OF REVIEW

The benefits of continuous glucose monitors (CGMs) and insulin pumps in the management of type 1 diabetes (T1D) are widely recognized. However, glaring disparities in access exist, particularly in marginalized and economically disadvantaged groups that stand to benefit significantly from diabetes technology use. We will review recent data describing drivers of these disparities and approaches to address the disparities.

RECENT FINDINGS

Several qualitative studies were published in recent years that have investigated the drivers of disparities reported over the past decades. These studies report that in addition to typical barriers seen in the diabetes technology, marginalized patients have unique challenges that make insulin pumps and CGMs less accessible.

SUMMARY

Barriers to technology use in these groups include stigmatization, lack of support, financial constraints, provider biases, stringent insurance policies, and clinic infrastructure. To address inequities, multifaceted strategies across community, healthcare, and provider sectors are essential. Key initiatives include enhancing public awareness, refining health policies, ensuring access to high-quality care, and emphasizing patient-centered approaches. The equitable use of technology can narrow the gap in T1D outcomes. The social and economic implications of suboptimal T1D management further underscore the urgency of these efforts for both improved health outcomes and cost-efficient care.

Oral Nanomedicine: Challenges and Opportunities

Compared to injection administration, oral administration is free of discomfort, wound infection, and complications and has a higher compliance rate for patients with diverse diseases. However, oral administration reduces the bioavailability of medicines, especially biologics (e.g., peptides, proteins, and antibodies), due to harsh gastrointestinal biological barriers. In this context, the development and prosperity of nanotechnology have helped improve the bioactivity and oral availability of oral medicines. On this basis, first, the biological barriers to oral administration are discussed, and then oral nanomedicine based on organic and inorganic nanomaterials and their biomedical applications in diverse diseases are reviewed. Finally, the challenges and potential opportunities in the future development of oral nanomedicine, which may provide a vital reference for the eventual clinical transformation and standardized production of oral nanomedicine, are put forward.

Maternal responsibility and omission of complexity: an exploration of the portrayal of gestational diabetes mellitus in Danish written media

OBJECTIVES

Gestational diabetes mellitus (GDM) has implications for the future health of both mother and offspring, and there is a risk that mothers are held responsible and blamed for their own and their offspring's long-term health. The media plays a significant role in shaping public perceptions of health. Therefore, our study aimed to investigate how GDM and women with GDM are portrayed in Danish written media.

DESIGN

We identified written newspaper articles reporting on GDM from 2018 to 2019 and analysed them using thematic network analysis and elements from critical discourse analysis.

RESULTS

In total, 130 articles were included in the analysis. Four themes emerged: (1) ways of introducing GDM, (2) descriptions of causes and prevention of GDM, (3) descriptions of consequences of GDM and (4) value-laden descriptions of GDM. GDM was often mentioned in relation to other conditions or factors and with lack of differentiation. Maternal responsibility was emphasised via oversimplified descriptions of causal relations, descriptions of individual agency and no emphasis on structural causes and preventive measures. GDM was positioned as resulting in 'bad pregnancies' using value-laden wordings.

CONCLUSION

We identified various aspects of how GDM is portrayed in written media. The findings signal the importance of clear, nuanced and respectful communication on GDM, including conveying the complexity of the condition and the role of structural factors.

Diabetes-related social stigma among university students in Saudi Arabia: A cross-sectional study

Diabetes-related stigma encompasses stereotypes, discrimination, and blame, significantly influencing diabetes management and overall well-being. Despite high diabetes-related stigma prevalence in various contexts, there is limited research in Saudi Arabia, especially that perceived/enacted by non-diabetics, the so-called social stigma. This cross-sectional study aimed to assess diabetes-related social stigma (DRSS) and to identify correlates among university students in Jazan, Saudi Arabia. A convenience sampling was employed to collect responses from 536 Jazan University students using an online questionnaire. After excluding participants with diabetes mellitus (n = 17), data from 519 individuals were analyzed. The DRSS questionnaire comprised 2 scales: social distancing and negative attitudes and stereotyping. The study found mixed results regarding the student population's attitude toward diabetic patients. Most students displayed favorable answers on social distancing scale statements, with the majority of statements showing willingness to engage in different social aspects with diabetics getting a positive response from at least 96% of respondents. The study identified various types of negative attitudes and stereotyping, for example, 46% of the sample agreed that dealing with a diabetic is upsetting or tiring. Correlates of social distancing included academic year, rural residence, and nonmedical field of specialty, while predictors of negative attitude and stereotyping included female gender and higher family income. The findings indicate a need to improve attitudes related to diabetics among university students in Saudi Arabia, with a particular focus on negative attitude stereotyping. Raising awareness about DRSS, especially among future healthcare professionals, is essential. Further refinement of the DRSS measurement scales is recommended through broader testing among the general population to enhance our understanding of this important issue.

"Once I take that one bite": the consideration of harm reduction as a strategy to support dietary change for patients with diabetes

BACKGROUND

Despite well-established guidelines to treat diabetes, many people with diabetes struggle to manage their disease. For many, this struggle is related to challenges achieving nutrition-related lifestyle changes. We examined how people with diabetes describe barriers to maintaining a healthy diet and considered the benefits of using a harm reduction approach to assist patients to achieve nutrition-related goals.

METHODS

This is a secondary analysis of 89 interviews conducted with adults who had type 1 or type 2 diabetes. Interviews were analyzed using a content analysis approach. Themes regarding food or diet were initially captured in a "food" node. Data in the food node were then sub-coded for this analysis, again using a content analysis approach.

RESULTS

Participants frequently used addiction language to talk about their relationship with food, at times referring to themselves as "an addict" and describing food as "their drug." Participants perceived their unhealthy food choices either as a sign of weakness or as "cheating." They also identified food's ability to comfort them and an unwillingness to change as particular challenges to sustaining a healthier diet.

CONCLUSION

Participants often described their relationship with food through an addiction lens. A harm reduction approach has been associated with positive outcomes among those with substance abuse disorder. Patient-centered communication incorporating the harm reduction model may improve the patient-clinician relationship and thus improve patient outcomes and quality-of-life while reducing health-related stigma in diabetes care. Future work should explore the effectiveness of this approach in patients with diabetes.

TRIAL REGISTRATION

Registered on ClinicalTrials.gov, NCT02792777. Registration information submitted 02/06/2016, with the registration first posted on the ClinicalTrials.gov website 08/06/2016. Data collection began on 29/04/2016.

Psychosocial Facilitators and Barriers to Type 2 Diabetes Management in Adults: A Meta-Synthesis

BACKGROUND

Globally, the cases of type 2 diabetes are increasing, and this is largely attributed to lifestyle changes. Though diabetes is primarily a metabolic disease determined by biological factors, psychosocial aspects play a crucial role in its progression and management. However, the literature on psychosocial dimensions of diabetes management is minuscule and scattered.

OBJECTIVE

This synthesis sought to understand the psychosocial facilitators and barriers to type 2 diabetes management and coping among adults.

METHODS

We have adopted a meta-synthesis to review available qualitative studies using Pub- Med and Scopus databases. Based on inclusion criteria, we have chosen 24 studies published between 2010 and 2023. We have considered studies across countries, among which 63% of the studies included were from Western countries, and most have employed qualitative descriptive design. The selected studies were analyzed thematically using a deductive framework.

RESULTS

Six themes emerged as the psychosocial barriers and facilitators of managing and coping with type 2 diabetes: 1) cognitive-emotional factors, 2) faith, 3) constraints to behavioural change, 4) social constraints and support, 5) healthcare provider-patient relationship, and 6) awareness. Further, a conceptual framework was developed from the synthesis.

CONCLUSION

The patients' experiences evident from this synthesis signify the crucial role of psychosocial factors in diabetes management and coping. This evidence emphasizes the need for integrated care so that psychosocial aspects are addressed by healthcare providers and behavioural health professionals, which may lead to the promotion of facilitators and the minimization of barriers.

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.

Diabetes Care in Humanitarian Settings

Despite the increasing prevalence of diabetes in populations experiencing humanitarian crisis, along with evidence that people living with diabetes are at higher risk for poor outcomes in a crisis, diabetes care is not routinely included in humanitarian health interventions. We here describe 4 factors that have contributed to the inequities and lack of diabetes inclusion in humanitarian programmes: (1) evolving paradigms in humanitarian health care, (2) complexities of diabetes service provision in humanitarian settings, (3) social and cultural challenges, and (4) lack of financing. We also outline opportunities and possible interventions to address these challenges and improve diabetes care among crisis-affected populations.

Stigma perception and determinants among patients with type 2 diabetes mellitus in Iraq

BACKGROUND AND PURPOSE

Diabetes mellitus (DM) is a leading cause of death worldwide. Stigma is a sign of social disgrace occurring within public relations, and it is linked with many health conditions including diabetes. Stigma could worsen the disease course, reduce treatment adherence, and affect the quality of life of diabetic patients. The objective of this study was to assess the magnitude of diabetic stigma among patients with type 2 DM.

METHODS

In this analytic cross-sectional study, data collection was performed from June 1, 2022, until November 1, 2022, et al.-Najaf City, Iraq. A consecutive sample of 429 patients with type 2 DM was interviewed using the Arabic version of the type 2 Diabetes Stigma Assessment Scale (DSAS-2), which is a validated tool. The total diabetic stigma score, treated differently score, self-stigma score, and blame and judgment score were estimated.

RESULTS

The mean age of the sample was 56.6 years, and males represented 61.8% of them. The total diabetic stigma score mean was 51.72. The question regarding people's judgment of food choices showed the highest rate (53%) among patients. Problematic stigma appeared in 24.71% of DM patients. Lower educational level, being divorced or widow, age above 50 years, being unemployed or housewife, and lower income showed significantly higher diabetic stigma scores.

CONCLUSION

One-quarter of type 2 DM patients showed problematic stigma. The mean diabetic stigma score was significantly higher among patients with lower education, divorced or widow status, older age, unemployment or housewife category, and low-income status.

The relationship between psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment

BACKGROUND

Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life.

METHODS

From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis.

RESULTS

(1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life."

CONCLUSIONS

Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.

Experiences of stigma, psychological distress, and facilitative coping among pregnant people with gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) has been rising in the United States, and it poses significant health risks to pregnant individuals and their infants. Prior research has shown that individuals with GDM also experience prevalent stress and mental health issues, which can further contribute to glucose regulation difficulties. Stigma associated with GDM may contribute to these mental health challenges, yet there is a lack of focused research on GDM-related stigma, its impact on psychological health, and effective coping mechanisms. Thus, this qualitative study aims to understand individuals' experiences related to GDM stigma, mental health, and facilitative coping.

METHODS

In-depth, semi-structured interviews were conducted with 14 individuals with a current or recent (within the last year) diagnosis of GDM. Thematic analysis was employed to guide data analysis.

RESULTS

Four themes emerged from data analysis: (1) experience of distal GDM stigma including stigmatizing provider interactions, stigma from non-medical spaces, and intersecting stigma with weight, (2) internalized GDM stigma, such as shame, guilt, and self-blame, (3) psychological distress, which included experiences of stress and overwhelm, excessive worry and fear, and loneliness and isolation, and (4) facilitative coping mechanisms, which included diagnosis acceptance, internet-based GDM community, active participation in GDM management, social and familial support, and time for oneself.

CONCLUSIONS

Findings demonstrate the relevance of GDM stigma in mental health among people with GDM and the need for addressing GDM stigma and psychological health in this population. Interventions that can reduce GDM stigma, improve psychological wellness, and enhance positive coping may facilitate successful GDM management and healthy birth outcomes. Future quantitative, theory-driven research is needed to understand the prevalence of GDM stigma experiences and mechanisms identified in the current study, as well as among marginalized populations (e.g., individuals of color, sexual and gender minorities).

Person-first language in diabetes and obesity scientific publications

AIMS

We aimed to quantify the use of person-first language (PFL) among scholarly articles focusing on diabetes or obesity.

METHODS

PFL and condition-first language (CFL) terms for diabetes and obesity (e.g. diabetic, obese) were identified from existing guidelines and a review of the literature. Exact phrase literature searches were conducted between 2011 and 2020 and results were categorised as PFL, CFL or both.

RESULTS

Among diabetes articles, 43% used PFL, 40% used CFL and 17% contained both. Among obesity articles, 0.5% used PFL, 99% used CFL and 0.2% used both. The use of PFL increased by 3% per year for diabetes articles, compared to 117% for obesity articles. The rate of adoption of PFL in diabetes articles was unchanged in 2018-2020 compared to the 3 years prior.

CONCLUSIONS

While the use of person-first language in diabetes articles had increased over the review period, its rate of adoption has started to slow. Conversely, the use of PFL in obesity articles is nascent and increasing.

The relationship between stigma and psychological distress among people with diabetes: a meta-analysis

BACKGROUND & AIMS

Diabetes may perceive or experience varying degrees of stigma and psychological distress. The association between diabetes-related stigma and psychological distress has been examined in many studies, but no research has used a quantitative synthesis method to investigate the severity of this association and the moderators of the relationship. Thus, we conducted a meta-analysis to quantitatively integrate previous findings to identify the magnitude of the association between stigma and psychological distress among people with diabetes.

REVIEW METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we systematically searched four English academic databases (PubMed, Embase, Web of Science, and PsycINFO) and three Chinese databases (China National Knowledge Infrastructure [CNKI], WANFANG Data, China Science and Technology Journal Database [VIP]). The databases were searched from the inception of each database to the end of March 2023. The pooled correlation coefficient of the association between stigma and psychological distress among people with diabetes was calculated by a random effects model using Stata software (version 17.0), and several moderators that impacted this relationship were identified.

RESULTS

Eligible studies (N = 19) with a total of 12,777 participants were analysed. The pooled correlation was high between diabetes-related stigma and psychological distress (r = 0.50, 95% CI: [0.43-0.57]). Moreover, the association was moderated by the diabetes stigma measurement tools and diabetes distress measurement tools used. However, the relationship was not moderated by type of diabetes, age, gender, geographical location, or type of stigma.

CONCLUSIONS

The results of the meta-analysis showed that stigma is strongly related to psychological distress among people with diabetes. Longitudinal or experimental research should be expanded in the future to further identify the causal pathways in the relationship between diabetes stigma and diabetes distress.

Identification of Sociodemographic and Clinical Factors Influencing the Feeling of Stigmatization in People with Type 1 Diabetes

BACKGROUND

A large percentage of people with type 1 diabetes experience stigma, which may directly affect diabetes management. Moreover, it may adversely influence the acceptance of the disease and, thus, the treatment process, including compliance with medical and dietary recommendations. Therefore, it is important to seek adequate forms of counteracting the phenomenon of stigmatization. Thus, the aim of the study was to determine the factors influencing the level of perceived stigma by T1D patients, with particular emphasis on sociodemographic factors (including sex, place of residence, and education) and clinical factors related to the course of the disease.

METHODS

An observational cross-sectional online questionnaire was conducted in a group of 339 people with T1D. The link to the questionnaire was shared via social media. The DSAS-1 questionnaire translated into Polish was used as the research tool.

RESULTS

A moderate level of stigmatization was found (49.78 ± 14.54 points). It was significantly lower in people living in small towns compared to rural residents (ß = -0.121, p = 0.038), lower in people in relationships compared to those who are single (ß = -0.175, p = 0.001), in people diagnosed with T1D at an older age (ß = -0.107, p = 0.048), and in those who rated their financial situation as very good vs. bad (ß = -0.314, p < 0.001). It was also found that the level of stigma significantly decreased with age (ß = -0.181, p = 0.001). In addition, a significantly higher stigma perception was uncovered in the group of people with HbA1C > 7% than in the group ≤ 7% (ß = 0.118, p = 0.030).

CONCLUSIONS

Due to the occurrence of stigma among people with T1D, which can directly affect the management of diabetes, effective and comprehensive efforts should be made to provide support to people with diabetes. It is also necessary to raise awareness among the general public and disseminate knowledge about diabetes, which can reduce stigmatization as a result. Anti-stigma messages should be included in the prevention programs about the potential side effects and risks associated with mistreating people with T1D.

Interventions to address global inequity in diabetes: international progress

Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis.

Diabetes stigma and weight stigma among physicians treating type 2 diabetes: Overlapping patterns of bias

AIMS

Adults with type 2 diabetes (T2D) report experiencing stigma across multiple settings, including stigmatizing interactions with their healthcare providers. However, research examining physician biases toward patients with T2D is scarce. Identifying stigma-related barriers in diabetes care is essential to prevent providers' biases from impairing health care delivery. This study assessed attitudes towards individuals with T2D and obesity among physicians who treat T2D.

METHODS

Physicians specializing in internal medicine or endocrinology (n=205) completed a series of online questionnaires assessing their attitudes towards patients with T2D and obesity, and their attributions of controllability and blame of individuals with T2D and obesity.

RESULTS

While 85% of physicians felt professionally prepared and confident to treat patients with T2D, 1/3 reported being repulsed by patients with T2D and view them as lazy (39%), lacking motivation (44%), and non-compliant with treatment (44%). Many witnessed professionals in their field making negative comments about patients with T2D (44%). Physicians endorsed worse levels of bias towards patients with obesity than T2D, but differences were small.

CONCLUSIONS

Findings highlight the need for stigma reduction interventions for physicians addressing both T2D and obesity. Research assessing the effects of T2D stigma on quality of patient care and health outcomes is needed.

Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward

Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.

The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

OBJECTIVE

The language used to describe people with substance use disorder impacts stigma and influences clinical decision making. This study evaluates the presence of stigmatizing language (SL) in clinical notes and detects patient- and provider-level differences.

METHODS

All free-text notes generated in a large health system for patients with substance-related diagnoses between December 2020 and November 2021 were included. A natural language processing algorithm using the National Institute on Drug Abuse's "Words Matter" list was developed to identify use of SL in context.

RESULTS

There were 546,309 notes for 30,391 patients, of which 100,792 (18.4%) contained SL. A total of 18,727 patients (61.6%) had at least one note with SL. The most common SLs used were "abuse" and "substance abuse." Nurses were least likely to use SL (4.1%) while physician assistants were most likely (46.9%). Male patients were more likely than female patients to have SL in their notes (adjusted odds ratio [aOR], 1.17; 95% confidence internal [CI], 1.11-1.23), younger patients aged 18 to 24 were less likely to have SL than patients 45 to 54 years (aOR, 0.55; 95% CI, 0.50-0.61), Asian patients were less likely to have SL than White patients (aOR, 0.45; 95% CI, 0.36-0.56), and Hispanic patients were less likely to have SL than non-Hispanic patients (aOR, 0.88; 95% CI, 0.80-0.98).

CONCLUSIONS

The majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed.

Type 2 diabetes stigma and its association with clinical, psychological, and behavioral outcomes: a systematic review and meta-analysis

AIM

To synthesize quantitative research evidence on the association between type 2 diabetes (T2D) stigma and psychological, behavioral, and clinical outcomes.

METHODS

We searched APA PyschInfo, Cochrane Central, Scopus, Web of Science, Medline, CINAHL and EMBASE through November 2022. Peer-reviewed observational studies examining the association between T2D stigma and psychological, behavioral, and/or clinical outcomes were eligible for inclusion. Risk of bias was assessed with the JBI critical appraisal checklist. Correlation coefficients were pooled in random effect meta-analyses.

RESULTS

Our search produced 9642 citations, 29 met the inclusion criteria. Included articles were published between 2014 and 2022. We found a weak positive correlation between T2D stigma and HbA1C (r=0.16, 95% CI:0.08 to 025, I²=70%, N=7 studies), a moderate positive correlation between T2D stigma and depressive symptoms (r=0.49, 95% CI: 0.44 to 0.54, I²=26.9%, n=5 studies) and diabetes distress (r=0.54, 95% CI: 0.35 to 0.72, I²=96.9%, n=7studies). Persons with T2D stigma who experienced stigma tended to have less engagement in diabetes self-management, though this association was weak (r=-0.17, 95% CI: -0.25 to -0.08, I²=79.8%, n=7studies).

CONCLUSIONS

T2D stigma was associated with negative health outcomes. Further studies are required to disentangle the underlying causal mechanisms to inform the development of appropriate stigma-reduction interventions.

The Emotional Impact of Negative Language in People With Diabetes: A Descriptive Study Using a Semantic Differential Scale

PURPOSE

Explore the emotional experience of people with diabetes as they encounter words and phrases that have been previously identified as problematic and evaluate potential differences in their emotional impact based on type of diabetes and demographic characteristics.

METHODS

A cross-sectional descriptive study employing an online survey of 107 adults with type 1 diabetes and 110 adults with type 2 diabetes. A semantic differential scale was used to examine feeling states associated with negative diabetes language. Descriptive statistics including means, standard deviations, and frequencies were calculated for all study variables. For each target word, frequencies of participants who endorsed a positive, neutral, or negative affective response on the sematic differential scale are reported.

RESULTS

People with diabetes reported feeling blamed, misunderstood, hopeless, judged, not motivated, and not trusting in response to "noncompliant," "unmotivated," "in denial," "preventable," "failed," "should," "uncontrolled," "what did you do wrong," and "you could end up blind or on dialysis." Participants who have type 1 diabetes and are female, White, more educated, and younger reported more negative feelings about the target words.

CONCLUSION

People with diabetes experience highly negative affective responses when they read and hear previously identified words and phrases considered to be judgmental and unhelpful.

Evidence-based European recommendations for the dietary management of diabetes

Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes.

New Caregiver Diagnoses of Severe Depression and Child Asthma Controller Medication Adherence

BACKGROUND AND OBJECTIVES

Children with asthma who have depressed caregivers are known to be less adherent to medication regimes. However, it is less clear how adherence responds to a caregiver's new diagnosis of severe depression or whether there is a similar relationship with other serious caregiver diagnoses. The hypothesis is that adherence worsens both with new diagnoses of depression and possibly with new diagnoses of other serious conditions.

METHODS

This study follows a cohort of 341,444 continuously insured children with asthma before and after a caregiver's new diagnosis of severe depression or another serious health condition. The effect of a new depression diagnosis on a child's medication adherence is compared to the effect of new diagnoses of other common caregiver chronic conditions including diabetes, cancer, congestive heart failure, coronary artery disease, and chronic obstructive pulmonary disease.

RESULTS

Results show that children's medication adherence declines following a caregiver's new diagnosis of severe depression, but that it also declines following a caregiver's new diagnosis of diabetes. There is no association with new diagnoses of the other caregiver chronic conditions examined.

CONCLUSIONS

Children whose caregivers have a new diagnosis of depression or diabetes may be at increased risk of deterioration in their medication adherence. These caregivers may benefit from additional support and follow-up. The relationship between caregivers' health and children's medication adherence is complex and deserves further study.

Relationship between the insulin use and stigma in type 2 diabetes mellitus

AIMS

This study aimed to investigate the relationship between insulin use and stigma in Type 2 Diabetes Mellitus (T2DM).

METHODS

The study was carried out in the endocrinology and metabolic disorders outpatient clinic of a state hospital between February and October 2022. The study was carried out with 154 patients, 77 of them were treated with insulin while 77 were treated with peroral antidiabetic drugs (PAD). The patient identification form and Type 2 Diabetes Stigma Assessment Scale (DSAS-2) were used for data collection. The data were analyzed by using IBM SPSS 26.0 software.

RESULTS

DSAS-2 total score, treated differently, blame and judgment, and self-stigma subscales were higher in insulin-treated T2DM patients compared to the patients treated with PAD. There was a positive relationship between the number of daily injections and the DSAS-2 total score (r = 0.554). Multiple linear regression showed that type of the treatment, treatment duration, number of daily injections and perceived level of health were the determinants of the DSAS-2 score.

CONCLUSIONS

Stigma was high in insulin-treated T2DM patients and as the number of daily injections increased, the level of the perceived stigma increased. We recommend considering the high level of perceived stigma in insulin-treated T2DM patients while preparing nursing investigations.

Social exclusion in people with diabetes: cross-sectional and longitudinal results from the German Ageing Survey (DEAS)

As social exclusion can be linked to worse health and overall reduced quality of life, we describe social exclusion in people with diabetes and assess whether diabetes can be considered as a risk factor for social exclusion. We analyzed two waves (2014, 2017, N = 6604) from a survey of community-dwelling people aged > 40 using linear regression, group comparison and generalized estimating equations to explore the association between diabetes, social exclusion, socioeconomic, physical and psychosocial variables. In the entire cohort, diabetes was cross-sectionally associated with social exclusion after adjusting for covariates (p = 0.001). In people with diabetes, social exclusion was further associated with self-esteem (p < 0.001), loneliness (p =  < 0.001), income (p = 0.017), depression (p = 0.001), physical diseases (p = 0.04), and network size (p = 0.043). Longitudinal data revealed that higher levels of social exclusion were already present before the diagnosis of diabetes, and future social exclusion was predicted by self-esteem, loneliness, depression, and income, but not by diabetes (p = .221). We conclude that diabetes is not a driver of social exclusion. Instead, both seem to co-occur as a consequence of health-related and psychosocial variables.

The influence of weight on psychosocial well-being in diabetes

BACKGROUND

Individuals with diabetes experience a wide variety of psychosocial responses to their illness due, in part, to the nature of type 1 and type 2 diabetes. Variation in patient weight may play a central role in these differences, yet its influence on psychosocial variation is largely unknown. The current study investigates the relationship between patients' perceived weight status and aspects of psychosocial well-being among individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D).

METHODS

Individuals who were diagnosed with type 1 or type 2 diabetes were assessed via an online survey from the Diabetes, Identity, Attributions, and Health Study. Participants were categorized into a lower v. higher weight status group based on their self-reported perceived weight. Analyses of covariance were conducted to assess differences in measures of disease onset blame, diabetes stigma, and identity concerns among diabetes type and perceived weight status. Covariates included in our models were gender, age, education, and time since diagnosis. Bonferroni correction was used for post-hoc tests to assess any significant interactions found in our models.

RESULTS

Findings indicated that weight moderates multiple psychosocial outcomes pertinent to illness experience. Those with T2D and lower weight blamed themselves less for their disease onset, while those with higher weight felt blamed more for their disease onset by others, regardless of diabetes type. Individuals with T1D and higher weight were more frequently and more concerned about being mistaken for having the other disease type (i.e., T2D) compared to those with lower weight.

CONCLUSIONS

Weight is a key influence on the psychosocial outcomes for people with diabetes, but it operates differently in type 1 versus type 2 diabetes. By further examining the unique interaction between disease type and weight status we may be able to improve psychological well-being among affected individuals of all sizes.

Remote Digital Technologies for the Early Detection and Monitoring of Cognitive Decline in Patients With Type 2 Diabetes: Insights From Studies of Neurodegenerative Diseases

Type 2 diabetes (T2D) is a risk factor for cognitive decline. In neurodegenerative disease research, remote digital cognitive assessments and unobtrusive sensors are gaining traction for their potential to improve early detection and monitoring of cognitive impairment. Given the high prevalence of cognitive impairments in T2D, these digital tools are highly relevant. Further research incorporating remote digital biomarkers of cognition, behavior, and motor functioning may enable comprehensive characterizations of patients with T2D and may ultimately improve clinical care and equitable access to research participation. The aim of this commentary article is to review the feasibility, validity, and limitations of using remote digital cognitive tests and unobtrusive detection methods to identify and monitor cognitive decline in neurodegenerative conditions and apply these insights to patients with T2D.

Diabetes Stigma and Clinical Outcomes in Adolescents and Young Adults: The SEARCH for Diabetes in Youth Study

OBJECTIVE

To examine the association between diabetes stigma and HbA1c, treatment plan and acute and chronic complications in adolescents and young adults (AYAs) with type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS

The SEARCH for Diabetes in Youth study is a multicenter cohort study that collected questionnaire, laboratory, and physical examination data about AYAs with diabetes diagnosed in childhood. A five-question survey assessed frequency of perceived diabetes-related stigma, generating a total diabetes stigma score. We used multivariable linear modeling, stratified by diabetes type, to examine the association of diabetes stigma with clinical factors, adjusting for sociodemographic characteristics, clinic site, diabetes duration, health insurance, treatment plan, and HbA1c.

RESULTS

Of 1,608 respondents, 78% had type 1 diabetes, 56% were female, and 48% were non-Hispanic White. The mean (SD) age at study visit was 21.7 (5.1) years (range, 10-24.9). The mean (SD) HbA1c was 9.2% (2.3%; 77 mmol/mol [2.0 mmol/mol]). Higher diabetes stigma scores were associated with female sex and higher HbA1c (P < 0.01) for all participants. No significant association between diabetes stigma score and technology use was observed. In participants with type 2 diabetes, higher diabetes stigma scores were associated with insulin use (P = 0.04). Independent of HbA1c, higher diabetes stigma scores were associated with some acute complications for AYAs with type 1 diabetes and some chronic complications for AYAs with type 1 or type 2 diabetes.

CONCLUSIONS

Diabetes stigma in AYAs is associated with worse diabetes outcomes and is important to address when providing comprehensive diabetes care.

SNAC for Enhanced Oral Bioavailability: An Updated Review

The delivery of proteins and peptides via an oral route poses numerous challenges to improve the oral bioavailability and patient compliance. To overcome these challenges, as well as to improve the permeation of proteins and peptides via intestinal mucosa, several chemicals have been studied such as surfactants, fatty acids, bile salts, pH modifiers, and chelating agents, amongst these medium chain fatty acid like C10 (sodium caprate) and Sodium N-[8-(2-hydroxybenzoyl) amino] caprylate (SNAC) and its derivatives that have been well studied from a clinical perspective. This current review enumerates the challenges involved in protein and peptide delivery via the oral route, i.e., non-invasive routes of protein and peptide administration. This review also covers the chemistry behind SNAC and toxicity as well as mechanisms to enhance the oral delivery of clinically proven molecules like simaglutide and other small molecules under clinical development, as well as other permeation enhancers for efficient delivery of proteins and peptides.

Development and Validation of a Diabetes Questionnaire for Middle School Students

OBJECTIVE

To develop and validate a questionnaire to assess diabetes knowledge, attitudes, beliefs, and intent to change among middle school students.

DESIGN

A cross-sectional validation analysis.

SETTING

Students in 3 urban middle schools in Utah participated in this study.

PARTICIPANTS

The 25-item questionnaire was validated in independent samples of 277 and 304 students in the seventh and eighth grades.

VARIABLES MEASURED

The questionnaire includes the following variables: diabetes knowledge, attitudes, beliefs, and intent to change dietary and physical activity behaviors.

ANALYSIS

Rigorous statistical approaches, including Cronbach's α (goodness of fit) calculation, test-retest reliability, and exploratory and confirmatory factor analyses, were employed to examine the reliability and construct validity.

RESULTS

The Cronbach's α coefficients were 0.7 for both subscales demonstrating acceptable internal consistency. All factor loadings were > 0.4, revealing close relations between factors and items. The confirmatory factor analysis model fit was 0.9 for the comparative fit index and Tucker-Lewis Index, indicating a reasonable model-data fit.

CONCLUSIONS AND IMPLICATIONS

This study demonstrated the validity of a diabetes questionnaire for middle school students. Future work is needed to validate its use in a diabetes prevention program, given the growing need for diabetes education among young adolescents.

Comprehensive review: Frailty in pancreas transplant candidates and recipients

Well-selected patients with kidney disease and diabetes mellitus who undergo simultaneous kidney-pancreas transplantation often experience dramatic improvements in quality of life and long-term survival compared to those who remain on medical therapy. Over the past several years the importance of frailty in the pancreas transplant candidate and recipient populations has grown. More patients with advanced age have entered the waitlist, and complications from prolonged diabetes, even in younger patients, have created increased evidence of risk for frailty. Given these concerns, and the broad challenges facing pancreas transplantation volumes overall, we generated this review to help establish the impact and implications. We summarize the interplay of immunological factors, aging, environmental factors, diabetes mellitus, and chronic kidney disease that put these patients at risk for frailty. We discuss its measurement and recommend a combination of two instruments (both well-validated and one entirely objective). We describe the outcomes for patients before and after pancreas transplantation who may have frailty, and what interventions can be taken to mitigate its effects. Broader investigation into frailty in the pancreas transplant population is needed to better understand how to select patients for pancreas transplantation and to how manage its consequences thereafter.

Association of self-stigma with glycated hemoglobin: A single-center, cross-sectional study of adults with type 1 diabetes in Japan

AIMS/INTRODUCTION

There has been an increase in research on diabetes-related stigma and its association with glycated hemoglobin (HbA1c) over the past years. However, little is known about the association of self-stigma with HbA1c in persons with type 1 diabetes. This study aims to examine the association between self-stigma and HbA1c in Japanese people with type 1 diabetes.

MATERIALS AND METHODS

This cross-sectional study was conducted at a clinic in Tokyo. Questionnaires using nine items from the Japanese version of the Self-Stigma Scale was distributed to outpatients with type 1 diabetes, aged ≥18 years. We excluded outpatients with serious mental disorder, those who required urgent medical treatment or received hemodialysis. Adjusted linear regression analyses tested the association between the score of the 9-item Self-Stigma Scale and HbA1c.

RESULTS

Questionnaires were distributed to 166 eligible participants. A total of 109 participants were included in the final analysis after excluding participants with incomplete answers and laboratory data. After adjusting for age, sex, employment status, body mass index, duration of diabetes and insulin secretion, there was a significant positive association between self-stigma and HbA1c (β = 0.05, 95% confidence interval 0.01 to 0.08).

CONCLUSIONS

This cross-sectional study showed a significant association between self-stigma and HbA1c in persons with type 1 diabetes. Addressing self-stigma might be as equally essential as measuring HbA1c in evaluating glycemic outcome among individuals with type 1 diabetes.