IMPE2023 Free Communications Diabetes and Insulin 2 (4 abstracts)
Diabetes Stigma, Clinical Outcomes, and Substance Use in Adolescents and Young Adults: the SEARCH for Diabetes in Youth Study
Kelsey B. Eitel 1 , Alissa J. Roberts 1 , Ralph D’Agostino , Jr. 2 , Catherine E. Barrett 3 , Ronny A. Bell 2 , Anna Bellatorre 4 , Angelica Cristello 5 , Dana Dabelea 4 , Lawrence M. Dolan 6 , Elizabeth T. Jensen 2 , Angela D. Liese 7 , Elizabeth J. Mayer-Davis 5 , Kristi Reynolds 8 , Santica M. Marcovina 9 & Catherine Pihoker 1
1University of Washington, Seattle, USA. 2Wake Forest University School of Medicine, Winston-Salem, USA. 3Centers for Disease Control and Prevention, Atlanta, USA. 4University of Colorado Denver, Aurora, USA. 5University of North Carolina at Chapel Hill, Chapel Hill, USA. 6University of Cincinnati College of Medicine, Cincinnati, USA. 7University of South Carolina, Columbia, USA. 8Kaiser Permanente Southern California, Pasadena, USA. 9Medpace Reference Laboratories, Cincinnati, USA
Perceived diabetes stigma (PDS) has been associated with worse clinical and psychosocial outcomes in adults. Our objective was to examine the associations between PDS, glycemic control, diabetes complications, psychosocial variables, and substance use in adolescents and young adults (AYAs) with type 1 diabetes (T1D) and type 2 diabetes (T2D) in the SEARCH for Diabetes in Youth study, 2016-2019. We hypothesized that greater PDS was associated with worse glycemic control, greater frequency of complications, lower use of diabetes technologies, and increased substance use. A 5-question survey was scored on a 6-point Likert scale to generate a total PDS score ranging 5-30. We used diabetes type stratified multivariable modeling to examine variables of interest, adjusting for sex, race/ethnicity, age, location, diabetes duration, education level, health insurance type, treatment regimen, and HbA1c. Of the 1,608 AYAs who completed the PDS survey, 78% had T1D, 56% were female, and 48% were non-Hispanic White people. Mean (SD) HbA1c level was 9.2% (2.3). Mean age at study visit was 21.7 (5.1) years. Mean PDS score was 10.7 (5.5). As previously described, a higher PDS score in all participants was associated with female sex (P< 0.01), higher HbA1c (P<0.01), increased disordered eating behaviors (P< 0.0001), increased depressive symptoms (P< 0.0001), and decreased health-related (P<0.0001) and diabetes-specific quality of life (P< 0.0001). Independent of HbA1c, higher PDS scores were associated with experiencing a diabetic ketoacidosis episode (P= 0.0003) and/or a severe hypoglycemic episode (P= 0.002) in the last year, in addition to developing retinopathy (P= 0.0002) and/or nephropathy (P= 0.04) in AYAs with T1D. There was no association between PDS and technology use for any participants. For those with T2D, the PDS score was associated with insulin use (P= 0.04) and developing retinopathy (P= 0.02). There were 516 participants who completed the PDS and substance use surveys. PDS scores were positively associated with current tobacco use (P= 0.01) and negatively associated with alcohol use (P=0.009) in AYAs with T1D. There was no significant association between PDS score and tobacco or alcohol use for those with T2D. Marijuana use was not associated with PDS scores for all participants. PDS was associated with suboptimal care, worse glycemic control, and both acute and chronic complications, in addition to decreased psychosocial functioning and substance use, and, therefore, may be important to address in providing comprehensive diabetes care.
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