Diabetes stigma is an emerging determinant of behaviors and outcomes. The theoretically-informed validated Comprehensive Diabetes Stigma Scale (CDSS), evaluates diabetes stigma and includes four subscales measuring enacted, perceived and self-stigma and concealment. This study tested associations between CDSS scores, medication adherence and HbA1c in a prospective cohort. We hypothesized that greater diabetes stigma would be associated with worse diabetes medication adherence and HbA1c. Pearson’s correlations and multivariable linear regression models adjusting for age, sex, race, education, insurance, partner status, diabetes duration and insulin use quantified the association of baseline CDSS scores and with ARMS-D scores and HbA1c assessed 3-6 months after enrollment. Participants (n=254) were 60 (SD 11) years old, 53% female, 80% White, 61% used insulin, mean HbA1c 7.7% (SD 1.6), and were living with diabetes for 14 (SD 9) years. CDSS scores and bivariate correlations shown in the Table. In adjusted models, CDSS overall score was associated with worse medication adherence (β 95%CI: 0.70, 0.01 - 1.39; p=0.05), but not with HbA1c (0.21, -0.05- 0.47; p=0.45). Only concealment was associated with worse HbA1c (0.48, 0.18-0.78; p=0.01). Prospective adjusted associations underline the importance of addressing concealment as a behavioral response to stigma leading to worse clinical outcomes in diabetes.


K. Cavanaugh: None. L.B. Beach: None. A.J. Hackstadt: None. K. Wallston: None. T. Elasy: None. L.S. Mayberry: None.


National Institutes of Health (P30DK92986-09, P30DK020593, UL1TR002243, K12HL143959)

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