Association of perceived diabetes stigma with time below range <3.0 mmol/L and anxiety in adults with type 1 diabetes using continuous glucose monitoring

Aims: This study aimed to evaluate the association of stigma related to type 1 diabetes with CGM-derived data and psychological outcomes in adults with type 1 diabetes. Methods: In this cross-sectional study, 104 adults with type 1 diabetes undergoing continuous glucose monitoring (CGM) completed the Type 1 Diabetes Stigma Assessment Scale (DSAS-1), Patient Health Questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), and Diabetes Distress Scale (DDS). Thirty-day standard CGM data with ≥70% sensor wear time of CGM was analysed. Linear regression was used to evaluate the potential relationship between the DSAS-1 scores and CGM-derived hypoglycaemia metrics. Results: Higher DSAS-1 total score was independently associated with increased time below range <3.0 mmol/L (adjusted β = 0.011 per point; 95% CI: 0.0018,0.0202; p = 0.019) but not with <3.9 mmol/L. Elevated stigma associated with anxiety (adjusted OR, 1.086; 95% CI:, 1.035,1.152; p = 0.002) with no significant link to depression. Item-level analyses identified DSAS-1 items related to differential treatment (items 15 and 19) and blame/judgement (items 11, 14, and 17) as being significantly associated with clinically significant hypoglycaemia. Associations were consistent across subgroups, especially among participants with a longer diabetes duration and a higher coefficient of variation of CGM glucose levels, calculated as glucose standard deviation divided by mean glucose and expressed as a percentage. Conclusions: In adults with type 1 diabetes using CGM, perceived stigma was significantly correlated with more time spent in hypoglycaemia and greater anxiety. Further studies are needed to identify causal relationships between stigma and clinically significant hypoglycaemia in people with type 1 diabetes.