Stigma in Type 2 diabetes: a study from Southern India

Stigma in Type 2 diabetes: a study from Southern India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Stigma in Type 2 diabetes: a study from Southern India Aruna Sri, S, Gumpeny Lakshmi, Gumpeny Ramachandra Sridhar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5354625/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Feb, 2026 Read the published version in Journal of Diabetes Mellitus → Version 1 posted You are reading this latest preprint version Abstract Among the many psychological and psychiatric disturbances in diabetes, stigma due to the disease (‘Diabetes stigma’) is one. It has been studied principally in subjects with type 1 diabetes. We report diabetes stigma in subjects with type 2 diabetes from southern India, in relation to demographic and lifestyle variables. Subjects with type 2 diabetes mellitus presenting to a tertiary care diabetes and endocrine center in southern India were recruited (n:333; 196 men, 137 women age range 25-78 years). structured interview form to provide demographic, clinical and life style related information. They completed Diabetes Stigma Assessment Scale-2 (DSAS-2) to assess diabetes stigma. ANOVA and t-test results showed that the tested demographic variables (age, gender, occupation, level of education and income), clinical and life style variables (diabetes duration, no. of stressors and exercise) had significant influence on the experience of diabetes stigma. When these associations were tested using two separate multiple regression models, only age was found to be a significant predictor of stigma in terms of total stigma experience, perception of being treated differently by others, self-stigma and blame & judgment by others. Interestingly, participants’ gender didn’t make any significant difference in this experience of stigma. Similarly, all the three tested clinical and life style variables emerged as significant predictors of various domains of diabetes stigma. Diabetes stigma is closely linked with age and life style factors such as duration of diabetes, number of stressors being experienced and physical exercise among people with Type 2 diabetes. self stigma psychological effects demographic life style factors stress distress Introduction Diabetes mellitus is best approached from a biopsychosocial perspective because of the various facets involved in its management [1]. It is associated with psychological and social difficulties that need attention. Focusing solely on clinical parameters results in suboptimal metabolic control. We documented a number of gender-based differences in people with diabetes hailing from India: these were related to quality of life, well-being, distress, psychological adjustment to diabetes, depression and social support [2,3]. Together, these contribute to stigmatization of individuals with diabetes. Stigma due to diabetes has been referred to as the ‘social burden of living with diabetes’ [4]. The concept of stigma was proposed in the early 1960’s by Goffman as an ‘attribute that is deeply discrediting’ and one that reduces a person from a whole and ‘usual’ person to a ‘tainted’ one defined primarily based on this attribute’ [5]. It has since been refined by sociologists and social psychologists as being ‘any attribute likely to put an individual at odds with societal norms, resulting in negative stereotyping, prejudice, blame, rejection, status loss and discrimination’ [6]. Link and Phelan expanded the concept of stigma to incorporate four attributes: labelling, negative stereotyping, separation and status loss and labelling [7]. This definition is commonly employed in diabetes-related stigma literature [8]. Diabetes stigma involves experienced or enacted stigma, perceived or felt stigma, anticipated stigma, internalized or self-stigma and intersectional stigma [9]. Stigma is a process, resulting from an aggregate of marking, stereotype, isolation, emotional response, loss of status and discrimination [10]. It can be compounded as intersectional stigma, when it is associated with other conditions such as obesity, smoking, mental health conditions, race, ethnicity, gender or sexual identity [4]. Diabetes stigma leads to adverse consequences in psychological well being, social well being, and physical well being and self-care [4,9]. A number of validated diabetes assessment tools are available for type 2 diabetes: Type-2 Diabetes Stigma Assessment Scale (DSAS-2), Self-Stigma Scale (SSS-J), Kanden Institute Stigma Scala (KISS) and Diabetes Self Stigma Scale [4]. The prevalence of diabetes stigma in adults with type 2 diabetes ranges between 12% and 70% [4], with a female preponderance; the latter was attributed to societal and cultural factors. In India, a few studies were published in type 1 diabetes mellitus [11,12]. Self-stigma was longitudinally assessed in type 2 diabetes using 4-item Stigma Scale for Chronic Illness (SSCI-4) as part of the INDEPENDENT Study among adults from India having mild to moderate depressive symptoms. The type 2 Diabetes Stigma Assessment Scale (DSAS-2) was developed as self-report measure of perceived and experienced stigma for use with adults with type 2 diabetes [13]. It reliably measured type 2 diabetes stigma in different ethnic populations (14). In the present study, adult subjects with type 2 diabetes presenting to a tertiary care endocrine centre from southern India (n:333; 196 men, 137 women age range 25-78 years) were administered the DSAS-2; data on demographic, clinical and lifestyle related information were collected. Methods A cross-sectional design using purposive sampling was chosen The inclusion criteria were: diagnosis of Type 2 diabetes, fasting blood glucose ≥ 120mg/dl, and HBA1c ≥ 7. The study group consisted of 333 individuals (196 males and 137 females aged 25-78 years) A structured form, developed by the researchers, was used to obtain information about demographics and clinical and lifestyle-related information.Forms were provided in English and Telugu (the local vernacular language); Data were obtained over six months, from not more than four subjects in a day. The study was approved by the ethics committee of Endocrine and Diabetes Centre; the study was performed in accordance with the ethical standards as laid down by The World Medical Association's (WMA) Declaration of Helsinki. Informed consent was obtained from all the participants who were already diagnosed with type 2 Diabetes Measures A structured form, developed by the investigator, was used to collect demographic, clinical and lifestyle-related information. Similarly, the Type 2 Diabetes Stigma Assessment Scale (DSAS-2), a standardized self-report scale developed by Browne et al. [13], was used to measure the diabetes stigma experienced. DSAS-2 is a 19-item scale with each item rated on a 5-point Likert scale (1 =strongly disagree, 2 = disagree, 3 = unsure,4 = agree, and 5 = strongly agree). This tool quantifies the extent and impact of stigma. It is a novel measure of diabetes-specific stigma featuring a simple three-factor structure of stigma encompassing both enacted and self-stigma and can be reduced to a single domain for total score calculation. DSAS-2 is a reliable and valid measure of type 2 diabetes-specific stigma. It gives three separate scores for Treated Differently (6 items α = 0.88), Blame and Judgment (7 items, α = 0.90), and Self-stigma (6 items, α = 0.90) factors and also yields the Total Stigma score (α = 0.95). DSAS-2 demonstrated strong psychometric properties like satisfactory concurrent, convergent, and discriminant validity can facilitate much-needed research in this area. The scale has been translated into Telugu (local language), and the Linguistic validation method has been used. Permission to translate was acquired from the authorized people and organization. Statistical analysis The data were analyzed using SPSS version 23. Initial data analysis was conducted to examine how the selected demographic and selected clinical and lifestyle variables are related to diabetes stigma. ANOVA and t–tests were used. Table1 shows the spread of the sample under socio demographic variables. Table1 shows the spread of the sample under socio demographic variables. Sample distribution with respect to select demographic variables Socio demographic Variables Description Frequency&% Gender Male 196 (58.9) Female 137(41.1) Age Less than 40 59(17.7) 41-60 219(65.2) 61 & above 57(17.1) Education No education 48(14.4) Up to tenth grade 124(37.2) Intermediate & Graduation 106(31.8) PG & above 55(16.5) Occupation Homemaker 105(31.5) Self employed 113(33.9) Employee 90(27.0) Retired 25(7.5) Income No income 117(35.1) Up to three lakhs 103(30.9) Up to five lakhs 35(10.5) More than five lakhs 78(23.4) DSAS-2 total DSAS-2 1 DSAA-2 2 DSAS-2 3 SES variables Coefficient (95% CI) P value Coefficient (95% CI) P value Coefficient (95% CI) P value Coefficient (95% CI) P value Demographic variables Age -.22 (-5.33, -1.81) .001** -.108 (-1.56, .02) .05* -.17(-1.76, -.40) .005** -.25 (-2.46, -.96 .001** Gender .02 (-2.46, 3.21) .80 -.06(-1.85, .71 ) .38 .01(-.96, 1.23) .80 .09(-.40, 2.01) .19 Education -.06(-1.85, -.93) .35 -.10(-1.04, .09 ) .10 .06 (-.24, .72) .32 -.80 (-.90, .16) .18 Occupation -.01 (-1.78, 1.47) .85 -.81(-1.04 .43 ) .41 -.01(.68, -.52) .87 .04(-.49, .89) .56 Income -.01(-1.34, 1.2) .93 .99(-.87, .28 ) .31 -.01(-.53,.46) .88 .07(-.27, .82) .32 Clinical & Life-style Variables Duration of Diabetes -.18 (-2.69, -.74) .001 -.04(-.61,.28) .47 -.27(-1.35, -.61) .001** -.14(-.98, -.14) .01** Exercise -.13 (-2.94, -.33) .01** -.13(-1.36, -.16) .01** -.04(-.71, .28) .39 -.12(-1.22, -.10) .02 No. of Stressors .11 (.17, 3.38) .05* .08(-.15, 1.13) .12 .02(-.47, .75) .65 .16(.37, 1.75) .005** DSAS-2 Total DSAS-2 1- Treated differently DSAS-2 2- Blame and judgement DSAS-2 3- Self stigma R² value-0.44-DSAS total and demographics R² value-0.31-DSAS-2 1 R² value-0.22-DSAS-2 2 R² value-0.55-DSAS-2 3 R² value-0.70-DSAS-2 total and clinical & lifestyle variables R² value-0.23-DSAS-2 1 R² value-0.77-DSAS-2 2 R² value-0.65-DSAS-2 3 Results Prevalence of Diabetes Stigma The three age groups (less than 40 years, 41-60 years and above 60 years) had significant differences in total diabetes stigma (F=9.04, p≤.01), blame and judgment (F=5.68, p≤.01 ) and self-stigma (F=10.57, p≤.01 ). The four educational groups (no education, up to 10 th grade, intermediate and graduation and post-graduation) had significant difference on only treated differently subscale of diabetes stigma scale (F=2.84, p≤.05), with no-education group reporting higher scores. Significant differences were observed among the four occupation groups on various subscales of the stigma scale. The four occupation groups (homemaker, self-employed, employee and retired) had significant differences in treated differently (F=3.66, p≤.01), self-stigma (F=3.31, p≤.05) and on total stigma (F=3.07, p≤.05). Further analysis was conducted to examine if income levels are associated with the experience of diabetes stigma. It was found that the four income groups ( no income, up to 3 lakhs, 3 to 5 lakhs and above 5 lakhs) had significant differences on only treated differently subscale of DSAS2 (F=2.94, p≤.05) with the no-income group feeling strongly that they were treated differently by others due to their diabetes condition. It is interesting to note that no significant differences were observed between the male and the female participants on any of the diabetes stigma sub-scales and on total stigma. Further analysis was conducted to see how the selected clinical and lifestyle variables (diabetes duration, physical exercise and no. of stressors being experienced) are related to diabetes stigma and its subscales. It was found that having diabetes is significantly related to the experience of diabetes stigma. The four diabetes duration groups (less than one year, 1 to <5 years, 5 to 10 years and more than 10 years) had significant differences on total diabetes stigma (F= 5.95, p≤.01), blame and judgment (F=12.21, p≤.01) and self-stigma (F= 3.19, p≤.01). It was the participants with least diabetes duration (i.e. less than one year) who reported experiencing higher levels of scores on these dimensions. The three exercise groups (no exercise, up to 1 hour and more than 1 hour) differed significantly on treated differently (F=4.0, p≤.05), self-stigma (F=4.69, p≤.01) and total stigma (F= 5.30, p≤.01). Also, number of stressors currently being experienced by the participants, seemed to be related to the experience of stigma among the participants. The three groups (no stressors, one stressor and more than one stressor) had significant differences on self-stigma (F=5.45, p≤.01) and total stigma (F=3.0, p≤.05) with the more than one stressor group reported experiencing more self-stigma and total stigma. Diabetes stigma and associated factors Two separate multiple regression analyses were conducted to assess which of the demographic/clinical/life style variable(s) most contribute to the variance observed in diabetes stigma scores. Of all the five demographic variables used in the model (age, gender, education, occupation and income), only age significantly predicted score on the total diabetes stigma (β= -.22, p≤. 001 ), treated differently (β= -.11, p≤.05), self-stigma (β= -.17, p≤.05) and blame & judgment (β=-.22p≤.001). Multiple regression analysis with selected clinical and selected lifestyle variables as predictor variables showed that total diabetes stigma was significantly predicted by all the three variables: diabetes duration (β= -.18, p≤.001), exercise (β= -.13, p≤.01 ), and number of stressors (β=.11, p≤.05). Scores on blame & judgment were significantly predicted by diabetes duration (β= -.14, p≤.01), exercise (β= -.12, p≤.05) and no. of stressors (β=.16, p≤.005). Scores on treated differently were significantly associated with only exercise (β=-.13, p≤.01), and scores on self-stigma were significantly associated with only diabetes duration (β= -.27, p≤.001). Discussion Diabetes stigma was observed across the age spectrum, without any difference in gender. We observed that the primary components underlying diabetes stigma were related to perceived stigma and self-stigma. Those under the age of forty attributed high stigma on blame and judgment. During clinical observations, individuals in this age range stated concerns about not marrying (among the unmarried) and that their partner may perceive them as weak and sexually less potent owing to diabetes if they share the diagnosis with their partners (among the married). The considerable disparity between the no-education group and diabetes stigma might be attributed to perceived stigma due to lack of awareness of the disease and unfavorable expectations about how they would be treated a. Earlier studies showed that higher level of education was linked with perceived diabetes stigma and non-disclosure of their diabetes [15,16]. In our study we observed that stigma was associated with low education levels, similar to the observations of Kato et al [17]. The differences in diabetes-specific stigma related to occupation suggests that those who socialize face greater diabetes stigma, whereas those who are retired (aged) are less socialized and have a high acceptance of their illness. The impact of income on diabetes stigma domain could be related to poor self-esteem and a lack of resources. In relation to duration of diabetes persons with a recent diagnosis (less than one year) feel stigmatized about type 2 diabetes, may blame themselves for their disease, and believe that others are judging them adversely for having type 2 diabetes. The low scores on the domains of blame and judgment, as well as self-stigma, among individuals who have been suffering for more than ten years suggest that they may not feel considerably stigmatized to reveal that they have diabetes since, as they get older, people may ascribe the diagnosis to their age and accept it. The no- exercise group had high stigma scores while the exercise group has low stigma scores in the areas of being treated differently, self-stigma, and overall stigma. Although existing diabetes studies have not directly examined the impact of exercise on diabetes stigma, exercise is seen to generally help individuals feel good, which may lead to enhanced self-perceptions, less stigmatization, and a greater perceived ability to manage their condition by following a healthy lifestyle. On the contrary, those who experience stigma may not have been exercising The variations in the experience of diabetes-specific stigma in relation to the number of stressors shows that stress has an effect on the perception and experience of stigma; it may potentially have a negative impact on seeking support and self-disclosure about the disease. We are not aware of studies of diabetes investigating the relationship between stressors and diabetes-specific stigma. Studies in other chronic health conditions showed that functional limitations and stressors are associated with stigma across chronic health conditions. In adults with type 1 diabetes, exposure to stressors provided a greater sense of mastery over the stressor may be associated with less stigma [18]. In multivariate regression analysis, age was the most significant predictor of diabetes stigma. The younger age group experienced both experienced stigma and self stigma. They may also see their family members or friends reminding them of their dietary and other life changes needed to be implemented. All three tested lifestyle variables (duration of diabetes, no. of stressors and exercise) emerged as significant predictors of various domains of diabetes-specific stigma. Total diabetes stigma was significantly predicted by all three clinical and lifestyle variables. Similarly, scores on blame and judgment were significantly predicted by diabetes duration, exercise and number of stressors (β=.16, p≤.005). Scores on treated differently were significantly associated with only exercise and scores on self-stigma were significantly associated with only diabetes duration. Conclusions Differences in the manifestation of diabetes stigma may be due to cultural factors and \ the medical payment security systems (10). The broad areas of stigma were related to perceived stigma and self-stigma. An international consensus statement published in 2024 paved a roadmap to end diabetes stigma and discrimination globally (9). Our study adds to the growing international evidence to reach the goal; many problems must be overcome such as insufficient funding by global agencies and performance of longitudinal studies to identify drivers of stigma to prevent it (9). Lifestyle variables are closely linked with the various domains of diabetes stigma. The findings must be replicated in other geographical regions, and by including more variables that may influence diabetes stigma. Declarations Acknowledgements ASS is grateful to Late Prof. K Madhu, Former Professor and Head, Department of Psychology &Para psychology, Andhra University, for his guidance and unwavering motivation and wishes to place on record to all the study participants for their co-operation and patience. Were it not for our loss to the pandemic, he would have been the corresponding author. References Sridhar GR, Madhu K. Psychosocial and cultural issues in diabetes mellitus. Current Science. 2002 Dec 25:1556-64. Sridhar GR, Madhu K, Veena S, Madhavi R, Sangeetha BS, Rani A. Living with diabetes: Indian experience. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2007 Sep 1;1(3):181-7. Sridhar GR. On psychology and psychiatry in diabetes. Indian Journal of Endocrinology and Metabolism. 2020 Sep 1;24(5):387-95. Kelsey B Eitel, Catherine Pihoker, Catherine E Barrett, Alissa J Roberts, Diabetes Stigma and Clinical Outcomes: An International Review, Journal of the Endocrine Society, Volume 8, Issue 9, September 2024, bvae136, https://doi.org/10.1210/jendso/bvae136 Goffrnan E. Stigma notes on the management of spoiled identity. New York, NY: Simon Schuster, 1963 Kato A, Fujimaki Y, Fujimori S, Isogawa A, Onishi Y, Suzuki R, Ueki K, Yamauchi T, Kadowaki T, Hashimoto H. Associations between diabetes duration and self-stigma development in Japanese people with type 2 diabetes: a secondary analysis of cross-sectional data. BMJ open. 2021 Dec 1;11(12):e055013. Link BG, Phelan JC. Conceptualizing stigma. Annual review of Sociology. 2001 Aug;27(1):363-85. Schabert J, Browne JL, Mosely K, Speight J. Social stigma in diabetes: a framework to understand a growing problem for an increasing epidemic. The Patient-Patient-Centered Outcomes Research. 2013 Mar;6:1-0. Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Deschênes S, Guzman SJ, Joiner KL, Liu S, Willaing I, Babbott KM, Cleal B, Dickinson JK, Halliday JA, Morrissey EC, Nefs G, O'Donnell S, Serlachius A, Winterdijk P, Alzubaidi H, Arifin B, Cambron-Kopco L, Santa Ana C, Davidsen E, de Groot M, de Wit M, Deroze P, Haack S, Holt RIG, Jensen W, Khunti K, Kragelund Nielsen K, Lathia T, Lee CJ, McNulty B, Naranjo D, Pearl RL, Prinjha S, Puhl RM, Sabidi A, Selvan C, Sethi J, Seyam M, Sturt J, Subramaniam M, Terkildsen Maindal H, Valentine V, Vallis M, Skinner TC. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol. 2024 Jan;12(1):61-82. doi: 10.1016/S2213-8587(23)00347-9. PMID: 38128969. Li X, Wu L, Yun J, Sun Q. The status of stigma in patients with type 2 diabetes mellitus and its association with medication adherence and quality of life in China: A cross-sectional study. Medicine (Baltimore). 2023 Jun 30;102(26):e34242. doi: 10.1097/MD.0000000000034242. PMID: 37390244; PMCID: PMC10313242. Verloo H, Meenakumari M, Abraham EJ, Malarvizhi G. A qualitative study of perceptions of determinants of disease burden among young patients with type 1 diabetes and their parents in South India. Diabetes Metab Syndr Obes. 2016 May 19;9:169-76. doi: 10.2147/DMSO.S102435. PMID: 27274298; PMCID: PMC4876838. Kesavadev J, Sadikot SM, Saboo B, Shrestha D, Jawad F, Azad K, Wijesuriya MA, Latt TS, Kalra S. Challenges in Type 1 diabetes management in South East Asia: Descriptive situational assessment. Indian J Endocrinol Metab. 2014 Sep;18(5):600-7. doi: 10.4103/2230-8210.139210. PMID: 25285274; PMCID: PMC4171880. Browne JL, Ventura AD, Mosely K, Speight J. Measuring the Stigma Surrounding Type 2 Diabetes: Development and Validation of the Type 2 Diabetes Stigma Assessment Scale (DSAS-2). Diabetes Care. 2016 Dec;39(12):2141-2148. doi: 10.2337/dc16-0117. Epub 2016 Aug 11. Erratum in: Diabetes Care. 2017 Jun;40(6):808. doi: 10.2337/dc17-er06. PMID: 27515964. Taher TMJ, Ahmed HA, Abutiheen AA, Alfadhul SA, Ghazi HF. Stigma perception and determinants among patients with type 2 diabetes mellitus in Iraq. J Egypt Public Health Assoc. 2023 Nov 29;98(1):20. doi: 10.1186/s42506-023-00145-5. PMID: 38017311; PMCID: PMC10684431. Liu NF, Brown AS, Folias AE, Younge MF, Guzman SJ, Close KL, Wood R. Stigma in People With Type 1 or Type 2 Diabetes. Clin Diabetes. 2017 Jan;35(1):27-34. doi: 10.2337/cd16-0020. Erratum in: Clin Diabetes. 2017;35(4):262. Folias AE [added]. PMID: 28144043; PMCID: PMC5241772. Olesen K, Cleal B, Skinner T, Willaing I. Characteristics associated with non-disclosure of Type 2 diabetes at work. Diabet Med. 2017;34(8):1116-1119. doi: 10.1111/dme.13386. Epub 2017 Jun 6. PMID: 28523854. Kato A, Yamauchi T, Kadowaki T. A closer inspection of diabetes-related stigma: why more research is needed. Diabetol Int. 2019;11(2):73-75. doi: 10.1007/s13340-019-00421-w. PMID: 32206476; PMCID: PMC7082436. Browne JL, Ventura A, Mosely K, Speight J. 'I'm not a druggie, I'm just a diabetic': a qualitative study of stigma from the perspective of adults with type 1 diabetes. BMJ Open. 2014;4(7):e005625. doi: 10.1136/bmjopen-2014-005625. PMID: 25056982; PMCID: PMC4120421. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Feb, 2026 Read the published version in Journal of Diabetes Mellitus → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5354625","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":383816625,"identity":"90ce604a-2715-4799-9d4b-d0da4f620430","order_by":0,"name":"Aruna Sri, S","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"S","middleName":"Aruna","lastName":"Sri","suffix":""},{"id":383816626,"identity":"506acbf1-7091-4f21-9b4e-3975b2924134","order_by":1,"name":"Gumpeny Lakshmi","email":"","orcid":"","institution":"Gayatri Vidya Parishad Institute of Healthcare \u0026 Medical Technology","correspondingAuthor":false,"prefix":"","firstName":"Gumpeny","middleName":"","lastName":"Lakshmi","suffix":""},{"id":383816627,"identity":"df726187-72fe-4ce3-957f-ef5acad7940f","order_by":2,"name":"Gumpeny Ramachandra Sridhar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYFACxgZpEMUGIj6AGOykaGGcAWIwE2GPNIzBzAMmCSiXn3248XZBzb3EPv7Dj1/b/Nomz8fMwPjhYw5uLQbnEputZxwrTmxjOGZmndt327CNmYFZcuY2PFp4GNukedgSjNkYG8yMc3tuMwK1sDHz4tEi3wPS8g+ohZn9m7Flz217gloYzgC18LYlyLGx8Rg/ZvhxO5GgFoMzjM3WvH1ALTw8ZYy9DbeT25gZm/H6Rb6H/eFtnm8JPPL9xzd/+PHntu389uaDHz7icxgSYJNgbAPRjA3EqQcC5g8Mf4hWPApGwSgYBSMIAADvS0gdcZ9CXgAAAABJRU5ErkJggg==","orcid":"","institution":"Visakhapatnam Andhra Pradesh","correspondingAuthor":true,"prefix":"","firstName":"Gumpeny","middleName":"Ramachandra","lastName":"Sridhar","suffix":""}],"badges":[],"createdAt":"2024-10-29 13:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5354625/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5354625/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.4236/jdm.2026.161001","type":"published","date":"2026-02-09T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104834885,"identity":"b7e75a64-8ca8-404e-92a2-71afe9a074fe","added_by":"auto","created_at":"2026-03-17 17:34:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":498979,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5354625/v1/0c84c6f2-3d84-4aa2-b747-d3f8bf2b2c00.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Stigma in Type 2 diabetes: a study from Southern India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus is best approached from a biopsychosocial perspective because of the various facets involved in its management [1]. It is associated with psychological and social difficulties that need attention. Focusing solely on clinical parameters results in suboptimal metabolic control. We documented a number of gender-based differences in people with diabetes hailing from India: these were related to quality of life, well-being, distress, psychological adjustment to diabetes, depression and social support [2,3].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTogether, these contribute to stigmatization of individuals with diabetes. Stigma due to diabetes has been referred to as the ‘social burden of living with diabetes’ [4]. The concept of stigma was proposed in the early 1960’s by Goffman as an ‘attribute that is deeply discrediting’ and one that reduces a person from a whole and ‘usual’ person to a ‘tainted’ one defined primarily based on this attribute’ [5]. It has since been refined by sociologists and social psychologists as being ‘any attribute likely to put an individual at odds with societal norms, resulting in negative stereotyping, prejudice, blame, rejection, status loss and discrimination’ [6]. Link and Phelan expanded the concept of stigma to incorporate four attributes: labelling, negative stereotyping, separation and status loss and labelling [7]. This definition is commonly employed in diabetes-related stigma literature [8]. Diabetes stigma involves experienced or enacted stigma, perceived or felt stigma, anticipated stigma, internalized or self-stigma and intersectional stigma [9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStigma is a process, resulting from an aggregate of marking, stereotype, isolation, emotional response, loss of status and discrimination [10]. It can be compounded as intersectional stigma, when it is associated with other conditions such as obesity, smoking, mental health conditions, race, ethnicity, gender or sexual identity [4]. Diabetes stigma leads to adverse consequences in psychological well being, social well being, and physical well being and self-care [4,9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA number of validated diabetes assessment tools are available for type 2 diabetes: Type-2 Diabetes Stigma Assessment Scale (DSAS-2), Self-Stigma Scale (SSS-J), Kanden Institute Stigma Scala (KISS) and Diabetes Self Stigma Scale [4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of diabetes stigma in adults with type 2 diabetes ranges between 12% and 70% [4], with a female preponderance; the latter was attributed to societal and cultural factors. In India, a few studies were published in type 1 diabetes mellitus [11,12]. Self-stigma was longitudinally assessed in type 2 diabetes using 4-item Stigma Scale for Chronic Illness (SSCI-4) as part of the INDEPENDENT Study among adults from India having mild to moderate depressive symptoms. The type 2 Diabetes Stigma Assessment Scale (DSAS-2) was developed as self-report measure of perceived and experienced stigma for use with adults with type 2 diabetes [13]. It reliably measured type 2 diabetes stigma in different ethnic populations (14). In the present study, adult subjects with type 2 diabetes presenting to a tertiary care endocrine centre from southern India (n:333; 196 men, 137 women age range 25-78 years) were administered the DSAS-2; data on demographic, clinical and lifestyle related information were collected.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA cross-sectional design using purposive sampling was chosen The inclusion criteria were: diagnosis of Type 2 diabetes, fasting blood glucose \u0026ge; 120mg/dl, and HBA1c \u0026ge; 7. The study group consisted of 333 individuals (196 males and 137 females aged 25-78 years)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA structured form, developed by the researchers, was used to obtain information about demographics and clinical and lifestyle-related information.Forms were provided in English and Telugu (the local vernacular language); \u0026nbsp; Data were obtained over six months, from not more than four subjects in a day.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of Endocrine and Diabetes Centre; the study was performed \u0026nbsp;in accordance with the ethical standards as laid down by The World Medical Association\u0026apos;s (WMA) Declaration of Helsinki.\u0026nbsp;Informed consent was obtained from all the participants who were already diagnosed with type 2 Diabetes\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured form, developed by the investigator, was used to collect demographic, clinical and lifestyle-related information. Similarly, the Type 2 Diabetes Stigma Assessment Scale (DSAS-2), a standardized self-report scale developed by Browne et al. [13], was used to measure the diabetes stigma experienced. DSAS-2 is a 19-item scale with each item rated on a 5-point Likert scale (1 =strongly disagree, 2 = disagree, 3 = unsure,4 = agree, and 5 = strongly agree). This tool quantifies the extent and impact of stigma. It is a novel measure of diabetes-specific stigma featuring a simple three-factor structure of stigma encompassing both enacted and self-stigma and can be reduced to a single domain for total score calculation. \u0026nbsp;DSAS-2 is a reliable and valid measure of type 2 diabetes-specific stigma. It gives three separate scores for Treated Differently (6 items \u0026alpha; = 0.88), Blame and Judgment (7 items, \u0026alpha; = 0.90), and Self-stigma (6 items, \u0026alpha; = 0.90) factors and also yields the Total Stigma score (\u0026alpha; = 0.95). DSAS-2 demonstrated strong psychometric properties like satisfactory concurrent, convergent, and discriminant validity can facilitate much-needed research in this area. The scale has been translated into Telugu (local language), and the Linguistic validation method has been used. Permission to translate was acquired from the authorized people and organization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using SPSS version 23.\u0026nbsp;Initial data analysis was conducted to examine how the selected demographic and selected clinical and lifestyle variables are related to diabetes stigma. ANOVA and t\u0026ndash;tests were used.\u003c/p\u003e\n\u003cp\u003eTable1 shows the spread of the sample under socio demographic variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable1 shows the spread of the sample under socio demographic variables.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample distribution with respect to select demographic variables\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSocio demographic\u003c/p\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency\u0026amp;%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e196 (58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e137(41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLess than 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59(17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e219(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61 \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUp to tenth grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124(37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntermediate \u0026amp; Graduation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e106(31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePG \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55(16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHomemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105(31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e113(33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90(27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25(7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e117(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUp to three lakhs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e103(30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUp to five lakhs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMore than five lakhs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e78(23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDSAS-2 total\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDSAS-2 1\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDSAA-2 2\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDSAS-2 3\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSES variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCoefficient (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCoefficient (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCoefficient (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCoefficient (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographic variables\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.22 (-5.33, -1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.108 (-1.56, .02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.17(-1.76, -.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.005**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.25 (-2.46, -.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.02 (-2.46, 3.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.06(-1.85, .71 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.01(-.96, 1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.09(-.40, 2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.06(-1.85, -.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.10(-1.04, .09 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.06 (-.24, .72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.80 (-.90, .16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.01 (-1.78, 1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.81(-1.04 .43 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.01(.68, -.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.04(-.49, .89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.01(-1.34, 1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.99(-.87, .28 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.01(-.53,.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.07(-.27, .82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical \u0026amp; Life-style\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDuration of Diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.18 (-2.69, -.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.04(-.61,.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.27(-1.35, -.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.14(-.98, -.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eExercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.13 (-2.94, -.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.13(-1.36, -.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.04(-.71, .28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.12(-1.22, -.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo. of Stressors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.11 (.17, 3.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.08(-.15, 1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.02(-.47, .75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.16(.37, 1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.005**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDSAS-2 Total\u003c/p\u003e\n\u003cp\u003eDSAS-2 1- Treated differently\u003c/p\u003e\n\u003cp\u003eDSAS-2 2- Blame and judgement\u003c/p\u003e\n\u003cp\u003eDSAS-2 3- Self stigma\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.44-DSAS total and demographics\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.31-DSAS-2 1\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.22-DSAS-2 2\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.55-DSAS-2 3\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.70-DSAS-2 total and clinical \u0026amp; lifestyle variables\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.23-DSAS-2 1\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.77-DSAS-2 2\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; value-0.65-DSAS-2 3\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePrevalence of Diabetes Stigma\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe three age groups (less than 40 years, 41-60 years and above 60 years) had significant differences in total diabetes stigma (F=9.04, p≤.01), blame and judgment (F=5.68, p≤.01 ) and self-stigma (F=10.57, p≤.01 ). The four educational groups (no education, up to 10\u003csup\u003eth\u003c/sup\u003e grade, intermediate and graduation and post-graduation) had significant difference on only \u003cem\u003etreated differently\u003c/em\u003e subscale of \u003cem\u003ediabetes stigma\u0026nbsp;\u003c/em\u003escale (F=2.84, p≤.05), with no-education group reporting higher scores. Significant differences were observed among the four occupation groups on various subscales of the stigma scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe four occupation groups (homemaker, self-employed, employee and retired) had significant differences in treated differently (F=3.66, p≤.01), self-stigma (F=3.31, p≤.05) and on total stigma (F=3.07, p≤.05). Further analysis was conducted to examine if income levels are associated with the experience of diabetes stigma. It was found that the four income groups ( no income, up to 3 lakhs, 3 to 5 lakhs and above 5 lakhs) had significant differences on only treated differently subscale of DSAS2 (F=2.94, p≤.05) with the no-income group feeling strongly that they were treated differently by others due to their diabetes condition. It is interesting to note that no significant differences were observed between the male and the female participants on any of the diabetes stigma sub-scales and on total stigma.\u003c/p\u003e\n\u003cp\u003eFurther analysis was conducted to see how the selected clinical and lifestyle variables (diabetes duration, physical exercise and no. of stressors being experienced) are related to diabetes stigma and its subscales. It was found that having diabetes is significantly related to the experience of diabetes stigma. The four diabetes duration groups (less than one year, 1 to \u0026lt;5 years, 5 to 10 years and more than 10 years) had significant differences on total diabetes stigma (F= 5.95, p≤.01), blame and judgment (F=12.21, p≤.01) and self-stigma (F= 3.19, p≤.01). It was the participants with least diabetes duration (i.e. less than one year) who reported experiencing higher levels of scores on these dimensions. The three exercise groups (no exercise, up to 1 hour and more than 1 hour) differed significantly on treated differently (F=4.0, p≤.05), self-stigma (F=4.69, p≤.01) and total stigma (F= 5.30, p≤.01). Also, number of stressors currently being experienced by the participants, seemed to be related to the experience of stigma among the participants. The three groups (no stressors, one stressor and more than one stressor) had significant differences on self-stigma (F=5.45, p≤.01) and total stigma (F=3.0, p≤.05) with the more than one stressor group reported experiencing more self-stigma and total stigma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiabetes stigma and associated factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo separate multiple regression analyses were conducted to assess which of the demographic/clinical/life style variable(s) most contribute to the variance observed in diabetes stigma scores. Of all the five demographic variables used in the model (age, gender, education, occupation and income), only age significantly predicted score on the total diabetes stigma (β=\u003cem\u003e-.22,\u0026nbsp;\u003c/em\u003ep≤.\u003cem\u003e001\u003c/em\u003e), treated differently (β=\u003cem\u003e-.11,\u0026nbsp;\u003c/em\u003ep≤.05), self-stigma (β=\u003cem\u003e-.17,\u0026nbsp;\u003c/em\u003ep≤.05) and blame \u0026amp; judgment (β=-.22p≤.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultiple regression analysis with selected clinical and selected lifestyle variables as predictor variables showed that total diabetes stigma was significantly predicted by all the three variables: diabetes duration (β= -.18, p≤.001), exercise (β= -.13, p≤.01 ), \u0026nbsp;and number of stressors (β=.11, p≤.05). Scores on blame \u0026amp; judgment were significantly predicted by diabetes duration (β= -.14, p≤.01), exercise (β= -.12, p≤.05) and no. of stressors (β=.16, p≤.005). Scores on treated differently were significantly associated with only exercise (β=-.13, p≤.01), and scores on self-stigma were significantly associated with only diabetes duration (β= -.27, p≤.001).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion ","content":"\u003cp\u003eDiabetes stigma was observed across the age spectrum, without any difference in gender. We observed that the primary components underlying diabetes stigma were related to perceived stigma and self-stigma. Those under the age of forty attributed high stigma on blame and judgment. During clinical observations, individuals in this age range stated concerns about not marrying (among the unmarried) and that their partner may perceive them as weak and sexually less potent owing to diabetes if they share the diagnosis with their partners (among the married).\u003c/p\u003e\n\u003cp\u003eThe considerable disparity between the no-education group and diabetes stigma might be attributed to perceived stigma due to lack of awareness of the disease and unfavorable expectations about how they would be treated a. \u0026nbsp;Earlier studies showed that higher level of education was linked with perceived diabetes stigma and non-disclosure of their diabetes [15,16]. In our study we observed that stigma was associated with low education levels, similar to the observations of Kato et al [17]. The differences in diabetes-specific stigma related to occupation suggests that those who socialize face greater diabetes stigma, whereas those who are retired (aged) are less socialized and have a high acceptance of their illness. The impact of income on diabetes stigma domain could be related to poor self-esteem and a lack of resources. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn relation to duration of diabetes persons with a recent diagnosis (less than one year) feel stigmatized about type 2 diabetes, may blame themselves for their disease, and believe that others are judging them adversely for having type 2 diabetes. The low scores on the domains of blame and judgment, as well as self-stigma, among individuals who have been suffering for more than ten years suggest that they may not feel considerably stigmatized to reveal that they have diabetes since, as they get older, people may ascribe the diagnosis to their age and accept it.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe no- exercise group had high stigma scores while the exercise group has low stigma scores in the areas of being treated differently, self-stigma, and overall stigma. \u0026nbsp;Although existing diabetes studies have not directly examined the impact of exercise on diabetes stigma, exercise is seen to generally help individuals feel good, which may lead to enhanced self-perceptions, less stigmatization, and a greater perceived ability to manage their condition by following a healthy lifestyle. On the contrary, those who experience stigma may not have been exercising\u003c/p\u003e\n\u003cp\u003eThe variations in the experience of diabetes-specific stigma in relation to the number of stressors shows that stress has an effect on the perception and experience of stigma; it may potentially have a negative impact on seeking support and self-disclosure about the disease. \u0026nbsp;We are not aware of studies of diabetes investigating the relationship between stressors and diabetes-specific stigma. Studies in other chronic health conditions showed that functional limitations and stressors are associated with stigma across chronic health conditions. \u0026nbsp;In adults with type 1 diabetes, exposure to stressors provided a greater sense of mastery over the stressor may be associated with less stigma [18].\u003c/p\u003e\n\u003cp\u003eIn multivariate regression analysis, age was the most significant predictor of diabetes stigma. The younger age group experienced both experienced stigma and self stigma. They may also see their family members or friends reminding them of their dietary and other life changes needed to be implemented. All three tested lifestyle variables (duration of diabetes, no. of stressors and exercise) emerged as significant predictors of various domains of diabetes-specific stigma.\u003c/p\u003e\n\u003cp\u003eTotal diabetes stigma was significantly predicted by all three clinical and lifestyle variables. Similarly, scores on blame and judgment were significantly predicted by diabetes duration, exercise and number of stressors (β=.16, p≤.005). Scores on treated differently were significantly associated with only exercise and scores on self-stigma were significantly associated with only diabetes duration. \u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDifferences in the manifestation of diabetes stigma may be due to cultural factors and \\ the medical payment security systems (10). The broad areas of stigma were related to perceived stigma and self-stigma. An international consensus statement published in 2024 paved a roadmap to end diabetes stigma and discrimination globally (9). Our study adds to the growing international evidence to reach the goal; many problems must be overcome such as insufficient funding by global agencies and performance of longitudinal studies to identify drivers of stigma to prevent it (9). Lifestyle variables are closely linked with the various domains of diabetes stigma. The findings must be replicated in other geographical regions, and by including more variables that may influence diabetes stigma.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eASS is grateful to Late Prof. K Madhu, Former Professor and Head, Department of Psychology \u0026amp;Para psychology, Andhra University, for his guidance and unwavering motivation and wishes to place on record to all the study participants for their co-operation and patience. Were it not for our loss to the pandemic, he would have been the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSridhar GR, Madhu K. Psychosocial and cultural issues in diabetes mellitus. Current Science. 2002 Dec 25:1556-64.\u003c/li\u003e\n\u003cli\u003eSridhar GR, Madhu K, Veena S, Madhavi R, Sangeetha BS, Rani A. Living with diabetes: Indian experience. Diabetes \u0026amp; Metabolic Syndrome: Clinical Research \u0026amp; Reviews. 2007 Sep 1;1(3):181-7.\u003c/li\u003e\n\u003cli\u003eSridhar GR. On psychology and psychiatry in diabetes. Indian Journal of Endocrinology and Metabolism. 2020 Sep 1;24(5):387-95.\u003c/li\u003e\n\u003cli\u003eKelsey B Eitel, Catherine Pihoker, Catherine E Barrett, Alissa J Roberts, Diabetes Stigma and Clinical Outcomes: An International Review, Journal of the Endocrine Society, Volume 8, Issue 9, September 2024, bvae136, https://doi.org/10.1210/jendso/bvae136\u003c/li\u003e\n\u003cli\u003eGoffrnan E. Stigma notes on the management of spoiled identity. New York, NY: Simon Schuster, 1963\u003c/li\u003e\n\u003cli\u003eKato A, Fujimaki Y, Fujimori S, Isogawa A, Onishi Y, Suzuki R, Ueki K, Yamauchi T, Kadowaki T, Hashimoto H. Associations between diabetes duration and self-stigma development in Japanese people with type 2 diabetes: a secondary analysis of cross-sectional data. BMJ open. 2021 Dec 1;11(12):e055013.\u003c/li\u003e\n\u003cli\u003eLink BG, Phelan JC. Conceptualizing stigma. Annual review of Sociology. 2001 Aug;27(1):363-85.\u003c/li\u003e\n\u003cli\u003eSchabert J, Browne JL, Mosely K, Speight J. Social stigma in diabetes: a framework to understand a growing problem for an increasing epidemic. The Patient-Patient-Centered Outcomes Research. 2013 Mar;6:1-0.\u003c/li\u003e\n\u003cli\u003eSpeight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Desch\u0026ecirc;nes S, Guzman SJ, Joiner KL, Liu S, Willaing I, Babbott KM, Cleal B, Dickinson JK, Halliday JA, Morrissey EC, Nefs G, O\u0026apos;Donnell S, Serlachius A, Winterdijk P, Alzubaidi H, Arifin B, Cambron-Kopco L, Santa Ana C, Davidsen E, de Groot M, de Wit M, Deroze P, Haack S, Holt RIG, Jensen W, Khunti K, Kragelund Nielsen K, Lathia T, Lee CJ, McNulty B, Naranjo D, Pearl RL, Prinjha S, Puhl RM, Sabidi A, Selvan C, Sethi J, Seyam M, Sturt J, Subramaniam M, Terkildsen Maindal H, Valentine V, Vallis M, Skinner TC. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol. 2024 Jan;12(1):61-82. doi: 10.1016/S2213-8587(23)00347-9. PMID: 38128969.\u003c/li\u003e\n\u003cli\u003eLi X, Wu L, Yun J, Sun Q. The status of stigma in patients with type 2 diabetes mellitus and its association with medication adherence and quality of life in China: A cross-sectional study. Medicine (Baltimore). 2023 Jun 30;102(26):e34242. doi: 10.1097/MD.0000000000034242. PMID: 37390244; PMCID: PMC10313242.\u003c/li\u003e\n\u003cli\u003eVerloo H, Meenakumari M, Abraham EJ, Malarvizhi G. A qualitative study of perceptions of determinants of disease burden among young patients with type 1 diabetes and their parents in South India. Diabetes Metab Syndr Obes. 2016 May 19;9:169-76. doi: 10.2147/DMSO.S102435. PMID: 27274298; PMCID: PMC4876838.\u003c/li\u003e\n\u003cli\u003eKesavadev J, Sadikot SM, Saboo B, Shrestha D, Jawad F, Azad K, Wijesuriya MA, Latt TS, Kalra S. Challenges in Type 1 diabetes management in South East Asia: Descriptive situational assessment. Indian J Endocrinol Metab. 2014 Sep;18(5):600-7. doi: 10.4103/2230-8210.139210. PMID: 25285274; PMCID: PMC4171880.\u003c/li\u003e\n\u003cli\u003eBrowne JL, Ventura AD, Mosely K, Speight J. Measuring the Stigma Surrounding Type 2 Diabetes: Development and Validation of the Type 2 Diabetes Stigma Assessment Scale (DSAS-2). Diabetes Care. 2016 Dec;39(12):2141-2148. doi: 10.2337/dc16-0117. Epub 2016 Aug 11. Erratum in: Diabetes Care. 2017 Jun;40(6):808. doi: 10.2337/dc17-er06. PMID: 27515964.\u003c/li\u003e\n\u003cli\u003eTaher TMJ, Ahmed HA, Abutiheen AA, Alfadhul SA, Ghazi HF. Stigma perception and determinants among patients with type 2 diabetes mellitus in Iraq. J Egypt Public Health Assoc. 2023 Nov 29;98(1):20. doi: 10.1186/s42506-023-00145-5. PMID: 38017311; PMCID: PMC10684431.\u003c/li\u003e\n\u003cli\u003eLiu NF, Brown AS, Folias AE, Younge MF, Guzman SJ, Close KL, Wood R. Stigma in People With Type 1 or Type 2 Diabetes. Clin Diabetes. 2017 Jan;35(1):27-34. doi: 10.2337/cd16-0020. Erratum in: Clin Diabetes. 2017;35(4):262. Folias AE [added]. PMID: 28144043; PMCID: PMC5241772.\u003c/li\u003e\n\u003cli\u003eOlesen K, Cleal B, Skinner T, Willaing I. Characteristics associated with non-disclosure of Type 2 diabetes at work. Diabet Med. 2017;34(8):1116-1119. doi: 10.1111/dme.13386. Epub 2017 Jun 6. PMID: 28523854.\u003c/li\u003e\n\u003cli\u003eKato A, Yamauchi T, Kadowaki T. A closer inspection of diabetes-related stigma: why more research is needed. Diabetol Int. 2019;11(2):73-75. doi: 10.1007/s13340-019-00421-w. PMID: 32206476; PMCID: PMC7082436. \u003c/li\u003e\n\u003cli\u003eBrowne JL, Ventura A, Mosely K, Speight J. \u0026apos;I\u0026apos;m not a druggie, I\u0026apos;m just a diabetic\u0026apos;: a qualitative study of stigma from the perspective of adults with type 1 diabetes. BMJ Open. 2014;4(7):e005625. doi: 10.1136/bmjopen-2014-005625. PMID: 25056982; PMCID: PMC4120421.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"self stigma, psychological effects, demographic, life style factors, stress, distress","lastPublishedDoi":"10.21203/rs.3.rs-5354625/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5354625/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAmong the many psychological and psychiatric disturbances in diabetes, stigma due to the disease (‘Diabetes stigma’) is one. It has been studied principally in subjects with type 1 diabetes. We report diabetes stigma in subjects with type 2 diabetes from southern India, in relation to demographic and lifestyle variables.\u003c/p\u003e\n\u003cp\u003eSubjects with type 2 diabetes mellitus presenting to a tertiary care diabetes and endocrine center in southern India were recruited (n:333; 196 men, 137 women age range 25-78 years). structured interview form to provide demographic, clinical and life style related information. They completed Diabetes Stigma Assessment Scale-2 (DSAS-2) to assess diabetes stigma.\u003c/p\u003e\n\u003cp\u003eANOVA and t-test results showed that the tested demographic variables (age, gender, occupation, level of education and income), clinical and life style variables (diabetes duration, no. of stressors and exercise) had significant influence on the experience of diabetes stigma. When these associations were tested using two separate multiple regression models, only age was found to be a significant predictor of stigma in terms of total stigma experience, perception of being treated differently by others, self-stigma and blame \u0026amp; judgment by others. Interestingly, participants’ gender didn’t make any significant difference in this experience of stigma. Similarly, all the three tested clinical and life style variables emerged as significant predictors of various domains of diabetes stigma.\u003c/p\u003e\n\u003cp\u003eDiabetes stigma is closely linked with age and life style factors such as duration of diabetes, number of stressors being experienced and physical exercise among people with Type 2 diabetes.\u003c/p\u003e","manuscriptTitle":"Stigma in Type 2 diabetes: a study from Southern India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-29 09:35:31","doi":"10.21203/rs.3.rs-5354625/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b9cee3ae-ad06-4b56-b76b-ff33d8c5d463","owner":[],"postedDate":"November 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T15:01:45+00:00","versionOfRecord":{"articleIdentity":"rs-5354625","link":"https://doi.org/10.4236/jdm.2026.161001","journal":{"identity":"journal-of-diabetes-mellitus","isVorOnly":true,"title":"Journal of Diabetes Mellitus"},"publishedOn":"2026-02-09 00:00:00","publishedOnDateReadable":"February 9th, 2026"},"versionCreatedAt":"2024-11-29 09:35:31","video":"","vorDoi":"10.4236/jdm.2026.161001","vorDoiUrl":"https://doi.org/10.4236/jdm.2026.161001","workflowStages":[]},"version":"v1","identity":"rs-5354625","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5354625","identity":"rs-5354625","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}