Experienced stigma in Japanese outpatients with diabetes: Age and polypharmacy matter

There are three types of diabetes-related stigma (DRS): perceived, experienced, and internalized, all of which negatively impact individuals with diabetes. Over the past 2 decades, research in Japan has grown, highlighting the significant clinical effects of DRS. In this study, we focused on the least-studied form, experienced stigma investigating its prevalence, clinical correlates, and the awareness of DRS and advocacy activities among Japanese people with diabetes. We conducted a single-center, cross-sectional study from April 3 to 28, 2023, at the Ohta Nishinouchi Hospital Diabetes Center in Japan, involving 114 adults with type 1 or type 2 diabetes. Participants with severe mental or physical conditions were excluded. Each participant completed a questionnaire assessing experienced stigma, the impact of diabetes on their social life, and their familiarity with the terms "diabetes stigma" and "advocacy activities." Associations between reported stigma and demographic or clinical factors were analyzed statistically. Our findings showed that only 19.3% of participants reported a significant impact of DRS on their social life, with younger individuals and those on multiple diabetes medications more likely to report experiencing stigma. Additionally, awareness of "diabetes stigma" and "advocacy activities" was notably low among participants. In conclusion, compared to international studies, the prevalence of experienced stigma among Japanese individuals with diabetes appears lower, based on this single-center face-to-face study of outpatients. However, age and polypharmacy were identified as significant factors associated with increased reports of stigma. Despite the limitations of a single-center design, small sample size, and use of non-validated survey tools, the observed low awareness of "diabetes stigma" and "advocacy activities" underscored the need for enhanced educational initiatives by healthcare professionals and diabetes-related organizations in Japan.