Experiences of diabetes stigma among adults with type 1 and type 2 diabetes: A multi‐study, multi‐country, secondary analysis
Bibliographic record
Abstract
AIMS: To conduct a multi-study, cross-country examination of diabetes stigma among adults with type 1 and type 2 diabetes (T1D, T2D). METHODS: Pre-existing, cross-sectional studies of adults (aged ≥18) completing the T1D or T2D Diabetes Stigma Assessment Scales (DSAS-1/DSAS-2) were collated. Descriptive statistics were calculated for (sub)scale and item scores. Variance-components linear random-effect multi-level modelling (nested random intercepts for country and study) estimated overall mean (sub)scale scores, 95% confidence intervals, intraclass correlation coefficients (ICC) and 95% prediction intervals. Likelihood ratio (LR) tests provided inference for country- and study-specific heterogeneity. RESULTS: Eleven studies were included from six countries (Australia k = 2, Canada k = 1, Japan k = 2, New Zealand k = 1, UAE k = 1, USA k = 4) in four languages (Arabic k = 1, English k = 7, Japanese k = 2, Spanish k = 1). Six studies included n = 3114 adults with T1D (insulin pump: 42%; 75% aged <60 years). Ten studies included n = 6586 adults with T2D (insulin-treated: 37%; 44% aged <60 years). Most reported ≥1 experience of diabetes stigma (T1D = 91%; study range: 84%-96%; T2D = 77%; 69%-89%). In 10 studies, the 'blame and judgment' subscale was most endorsed (T1D = 83%; 62%-89%, T2D = 70%; 53%-79%). Most adults with T1D reported 'identity concerns' (73%; 62%-80%), and 47% of adults with T2D reported 'self-stigma' (30-60%). Being 'treated differently' was least common (T1D = 46%; 40%-54%, T2D = 37%; 28%-47%). Low levels of heterogeneity were observed in mean [SE] total scores (DSAS-1: 54 [0.94] ICC = 0.02, p < 0.001; DSAS-2: 44 [1.1], ICC ≤0.4, p < 0.001). CONCLUSIONS: Findings suggest a high and relatively consistent prevalence of diabetes stigma across studies and within and across countries, supporting calls for local and global action.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".