{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:46:36Z","timestamp":1790279196649,"version":"4.1.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"11","license":[{"start":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T00:00:00Z","timestamp":1603152000000},"content-version":"vor","delay-in-days":46,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"name":"Sanofi ANZ"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To examine the association of diabetes stigma with psychological, behavioral, and HbA1c outcomes and to investigate moderation effects of self-esteem, self-efficacy, and\/or social support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>The national Second Diabetes MILES \u2013 Australia (MILES-2) survey included adults with type 1 diabetes (n = 959, 41% of whom were male, with mean \u00b1 SD age 44 \u00b1 15 years), insulin-treated type 2 diabetes (n = 487, 60% male, age 61 \u00b1 9 years), and non\u2013insulin-treated type 2 diabetes (n = 642, 55% male, age 61 \u00b1 10 years). (Un)adjusted linear regression analyses tested the association between diabetes stigma (Diabetes Stigma Assessment Scale [DSAS]) and psychological outcomes (depressive symptoms [eight-item version of the Patient Health Questionnaire (PHQ-8)], anxiety symptoms [Generalized Anxiety Disorder 7-item (GAD-7) questionnaire], and diabetes-specific distress [20-item Problem Areas In Diabetes (PAID) scale]), behavioral outcomes (healthy diet and physical activity [Summary of Diabetes Self-Care Activities (SDSCA)]), and self-reported HbA1c. Interaction effects tested whether associations varied by self-esteem (Rosenberg Self-Esteem Scale [RSES]), self-efficacy (Confidence in Diabetes Self-Care [CIDS] scale), or diabetes-specific social support (Diabetes Support Scale [DSS]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Significant positive associations were observed between DSAS and PHQ-8, GAD-7, and PAID across diabetes type\/treatment groups (all P &amp;lt; 0.001), whereby each SD increase in DSAS scores was associated with approximately one-half SD deterioration in emotional well-being. Associations between DSAS and SDSCA and HbA1c were nonmeaningful. Self-esteem moderated psychological outcomes among participants with type 1 and non\u2013insulin-treated type 2 diabetes and diabetes distress among those with insulin-treated type 2 diabetes. Interaction effects were partially observed for social support but not for self-efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study provides evidence of the association between diabetes stigma and depressive\/anxiety symptoms and diabetes distress and for the moderating effects of self-esteem and social support among adults with type 1 and type 2 diabetes. Further research is needed to examine associations with objectively measured behavioral and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc19-2447","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T15:10:15Z","timestamp":1599232215000},"page":"2651-2659","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":72,"title":["Psychosocial Moderators of the Impact of Diabetes Stigma: Results From the Second Diabetes MILES \u2013 Australia (MILES-2) Study"],"prefix":"10.2337","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9139-4663","authenticated-orcid":false,"given":"Elizabeth","family":"Holmes-Truscott","sequence":"first","affiliation":[{"name":"School of Psychology, Deakin University, Geelong, Victoria, Australia"},{"name":"The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, 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