{"doi":"10.1111/dme.70082","title":"Experiences of diabetes stigma among adults with type 1 and type 2 diabetes: A multi‐study, multi‐country, secondary analysis","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Aims</jats:title>\n                    <jats:p>To conduct a multi‐study, cross‐country examination of diabetes stigma among adults with type 1 and type 2 diabetes (T1D, T2D).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>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.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      Eleven studies were included from six countries (Australia\n                      <jats:italic>k</jats:italic>\n                       = 2, Canada\n                      <jats:italic>k</jats:italic>\n                       = 1, Japan\n                      <jats:italic>k</jats:italic>\n                       = 2, New Zealand\n                      <jats:italic>k</jats:italic>\n                       = 1, UAE\n                      <jats:italic>k</jats:italic>\n                       = 1, USA\n                      <jats:italic>k</jats:italic>\n                       = 4) in four languages (Arabic\n                      <jats:italic>k</jats:italic>\n                       = 1, English\n                      <jats:italic>k</jats:italic>\n                       = 7, Japanese\n                      <jats:italic>k</jats:italic>\n                       = 2, Spanish\n                      <jats:italic>k</jats:italic>\n                       = 1). Six studies included\n                      <jats:italic>n</jats:italic>\n                       = 3114 adults with T1D (insulin pump: 42%; 75% aged &lt;60 years). Ten studies included\n                      <jats:italic>n</jats:italic>\n                       = 6586 adults with T2D (insulin‐treated: 37%; 44% aged &lt;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,\n                      <jats:italic>p</jats:italic>\n                       &lt; 0.001; DSAS‐2: 44 [1.1], ICC ≤0.4,\n                      <jats:italic>p</jats:italic>\n                       &lt; 0.001).\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>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.</jats:p>\n                  </jats:sec>","journal":"Diabetic Medicine","year":2025,"id":636318,"datarank":0.37273599746820013,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.0,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1651416,"name":"Eloise Litterbach","orcid":"0000-0002-4618-1068","position":1,"is_corresponding":false},{"id":1651419,"name":"Uffe Søholm","orcid":null,"position":2,"is_corresponding":false},{"id":1279700,"name":"Paul A. Agius","orcid":"0000-0002-6075-8548","position":3,"is_corresponding":false},{"id":1651421,"name":"Hamzah Alzubaidi","orcid":"0000-0001-5122-271X","position":4,"is_corresponding":false},{"id":1651422,"name":"Valery Bodziony","orcid":null,"position":5,"is_corresponding":false},{"id":1651424,"name":"Joncarl Bresolin","orcid":null,"position":6,"is_corresponding":false},{"id":1206837,"name":"Kim Fletcher","orcid":null,"position":7,"is_corresponding":false},{"id":491351,"name":"Matthew Garza","orcid":null,"position":8,"is_corresponding":false},{"id":799272,"name":"Kevin L. Joiner","orcid":"0000-0002-8356-2222","position":9,"is_corresponding":false},{"id":107043,"name":"Rebecca M. Puhl","orcid":"0000-0003-2340-2486","position":10,"is_corresponding":false},{"id":1312719,"name":"Michio Shimabukuro","orcid":"0000-0001-7835-7665","position":11,"is_corresponding":false},{"id":1651426,"name":"Laura Syron","orcid":null,"position":12,"is_corresponding":false},{"id":1651427,"name":"Hiroko Takaike","orcid":null,"position":13,"is_corresponding":false},{"id":1651428,"name":"Michael Vallis","orcid":"0000-0002-0165-5936","position":14,"is_corresponding":false},{"id":1651429,"name":"Heather Verry","orcid":null,"position":15,"is_corresponding":false},{"id":999917,"name":"Jennifer A. Halliday","orcid":"0000-0003-1156-279X","position":16,"is_corresponding":false},{"id":1651430,"name":"Sarah L. Manallack","orcid":"0009-0001-5292-2897","position":17,"is_corresponding":false},{"id":1651431,"name":"Timothy C. Skinner","orcid":null,"position":18,"is_corresponding":false},{"id":921528,"name":"Jane Speight","orcid":"0000-0002-1204-6896","position":19,"is_corresponding":false},{"id":1651413,"name":"Elizabeth Holmes‐Truscott","orcid":"0000-0001-9139-4663","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Experiences of diabetes stigma among adults with type 1 and type 2 diabetes: A multi‐study, multi‐country, secondary analysis","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Aims</jats:title>\n                    <jats:p>To conduct a multi‐study, cross‐country examination of diabetes stigma among adults with type 1 and type 2 diabetes (T1D, T2D).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>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.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      Eleven studies were included from six countries (Australia\n                      <jats:italic>k</jats:italic>\n                       = 2, Canada\n                      <jats:italic>k</jats:italic>\n                       = 1, Japan\n                      <jats:italic>k</jats:italic>\n                       = 2, New Zealand\n                      <jats:italic>k</jats:italic>\n                       = 1, UAE\n                      <jats:italic>k</jats:italic>\n                       = 1, USA\n                      <jats:italic>k</jats:italic>\n                       = 4) in four languages (Arabic\n                      <jats:italic>k</jats:italic>\n                       = 1, English\n                      <jats:italic>k</jats:italic>\n                       = 7, Japanese\n                      <jats:italic>k</jats:italic>\n                       = 2, Spanish\n                      <jats:italic>k</jats:italic>\n                       = 1). Six studies included\n                      <jats:italic>n</jats:italic>\n                       = 3114 adults with T1D (insulin pump: 42%; 75% aged &lt;60 years). Ten studies included\n                      <jats:italic>n</jats:italic>\n                       = 6586 adults with T2D (insulin‐treated: 37%; 44% aged &lt;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,\n                      <jats:italic>p</jats:italic>\n                       &lt; 0.001; DSAS‐2: 44 [1.1], ICC ≤0.4,\n                      <jats:italic>p</jats:italic>\n                       &lt; 0.001).\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>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.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40483539","pmcid":null,"openalex_id":"https://openalex.org/W4411117883","authors":[],"funders":[{"funder_name":"Diabetes Canada","grant_id":"","title":null}],"total_grants":1,"fwci":7.2397,"citation_percentile":0.97671701,"influential_citations":0,"citation_trend":[{"year":2025,"count":4},{"year":2026,"count":7}],"oa_status":"hybrid","license":"cc-by-nc-nd","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dme.70082","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dme.70082","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/dme.70082","host_type":"publisher"},{"url":"https://doi.org/10.1111/dme.70082","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40483539","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12257424","host_type":"repository"},{"url":"https://figshare.com/articles/journal_contribution/Experiences_of_diabetes_stigma_among_adults_with_type_1_and_type_2_diabetes_A_multi_study_multi_country_secondary_analysis/29335256","host_type":"repository"}],"fields_of_study":["Diabetes Management and Education","Diabetes Management and Research","Diabetes, Cardiovascular Risks, and Lipoproteins","Humans","Diabetes Mellitus, Type 2","Diabetes Mellitus, Type 1","Social Stigma","Adult","Cross-Sectional Studies","Male","Female","Middle Aged","Canada","Australia","New Zealand","Japan","United States"],"mesh_terms":["Adult","Australia","Canada","Cross-Sectional Studies","Diabetes Mellitus, Type 1","Diabetes Mellitus, Type 2","Female","Humans","Japan","Male","Middle Aged","New Zealand","United States","Social Stigma"],"keywords":["Medicine","Type 2 diabetes","Stigma (botany)","Type 1 diabetes","Diabetes mellitus","Social stigma","Gerontology","Psychiatry","Family medicine","Endocrinology","Human immunodeficiency virus (HIV)","diabetes","diabetes stigma","psychology","psychosocial","questionnaire"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T16:48:24.764923Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}