Impact of Diabetes-Related Stigma on Treatment Adherence Among Young Adults with Type 1 Diabetes

Abstract

Background: Type 1 diabetes requires strict adherence to insulin therapy and self-monitoring; however, psychosocial factors such as perceived stigma may interfere with effective disease management, particularly among young adults. Objective: To evaluate the impact of diabetes-related stigma on treatment adherence and glycemic outcomes among young adults with type 1 diabetes. Methods: A descriptive mixed-methods study was conducted over four months in an urban clinical setting, enrolling 72 participants aged 18–30 years with established type 1 diabetes. Perceived stigma was assessed using the Diabetes Stigma Assessment Scale (DSAS-1), while adherence behaviors were measured through the Summary of Diabetes Self-Care Activities (SDSCA). HbA1c values were obtained from medical records. Quantitative data were analyzed using Pearson correlation and independent t-tests, while qualitative insights were explored through thematic analysis of semi-structured interviews. Results: Participants demonstrated moderate stigma levels (mean DSAS-1 score: 2.9 ± 0.6) and suboptimal adherence to insulin administration (4.1 ± 1.2 days/week) and glucose monitoring (3.5 ± 1.4 days/week). Higher stigma scores were significantly associated with lower adherence to insulin (r = -0.48, p = 0.001) and glucose monitoring (r = -0.52, p < 0.001), as well as higher HbA1c levels (r = 0.44, p = 0.002). Individuals in the high-stigma group exhibited significantly poorer adherence and glycemic control compared to those with lower stigma. Conclusion: Perceived diabetes-related stigma was a significant barrier to treatment adherence and optimal glycemic control. Addressing stigma through patient-centered and psychosocially informed interventions may enhance diabetes management outcomes.