Are diabetes stigma and attitudes towards insulin among people with type 2 diabetes related?

Our new study examines the negative experience of insulin use associated with diabetes stigma among people with type 2 diabetes.

by Jasmine Schipp & Dr Elizabeth Holmes-Truscott


Our previous research (1,2) has shown that for some people with insulin-treated type 2 diabetes, concerns and negative experiences of insulin therapy use are common and ongoing. These negative insulin appraisals may have consequences for their diabetes self-care and emotional wellbeing. For example, some people avoid taking insulin injections in public due to feeling embarrassed or fear of negative judgement. For others, feelings of self-blame and ‘failure’ may be a common experience when they need to start or intensify insulin treatment.

This led Dr Holmes-Truscott and colleagues to hypothesise that people with insulin-treated type 2 diabetes who report more negative insulin appraisals may report greater diabetes stigma. Diabetes stigma refers to perceived or experienced negative judgement and stereotyping from others based on an aspect of diabetes or its management.

Using data from the second Diabetes MILES – Australia study (MILES-2), they were able to examine the relationship between diabetes stigma and negative insulin appraisals among 456 Australian adults with insulin-treated type 2 diabetes. Diabetes stigma was positively and independently associated with negative insulin appraisals, in addition to diabetes-specific self-efficacy. This means that people with type 2 diabetes who experience and/or perceive more diabetes stigma are also more likely to report more negative appraisals or experience of their insulin use.

This is the first study to examine the relationship between diabetes stigma and attitudes to insulin use among adults with type 2 diabetes. Our findings suggest that one mechanism for reducing negative insulin appraisals may be minimising the stigma surrounding diabetes. For example, through public awareness campaigns about diabetes, and advocating for the use of accurate and non-judgemental language when communicating with and about people with diabetes

Holmes-Truscott E, Browne JL, Ventura AD, Pouwer F, Speight J. Diabetes stigma is associated with negative treatment appraisals among adults with insulin-treated Type 2 diabetes: results from the second Diabetes MILES – Australia (MILES-2) survey. Diabetic Medicine, 2018; Online ahead of print: doi:10.1111/dme.13598