Association between stigma and treatment satisfaction in patients with type 2 diabetes: a cross-sectional study

To investigate the comprehensive association between diabetes stigma, treatment satisfaction, and clinical parameters in patients with type 2 diabetes.

This cross-sectional study included 307 Japanese outpatients. Diabetes stigma was assessed using the Kanden Institute Stigma Scale (KISS). Treatment satisfaction and perceived hyperglycemia were evaluated via the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Data regarding patient demographics, comorbidities, and antidiabetic treatments were also collected. We investigated independent factors associated with the continuous KISS score using multivariable linear regression models to prevent information loss.

The median age of the participants was 69 years, median body mass index (BMI) was 24.9 kg/m2, and median HbA1c was 7.1%. The median continuous KISS score was 11. In the multivariable linear regression model, after adjusting for prespecified confounders, including age, sex, duration of diabetes, and the number of antidiabetic agents, higher body mass index (BMI), the use of injection therapy, lower treatment satisfaction, and a higher perceived frequency of hyperglycemia were independently associated with higher continuous KISS scores (all P < 0.05). Conversely, objective HbA1c lacked a significant independent association with diabetes stigma.

In patients with type 2 diabetes, a higher burden of diabetes stigma is independently associated with comorbid obesity, the use of injection therapy, lower treatment satisfaction, and the subjective perception of hyperglycemia, but not independently with objective HbA1c. This highlights the necessity of addressing patient experiences and psychosocial burden beyond objective glycemic targets.

The online version contains supplementary material available at https://doi.org/10.1007/s13340-026-00935-0.