Diabetes-related stigma among individuals with type 1 diabetes in Jazan, Saudi Arabia: sociodemographic and clinical correlates

Abstract

Background Diabetes-related stigma can negatively affect self-management, psychological well-being, and health outcomes among people living with diabetes; however, its correlates in Middle Eastern populations remain insufficiently explored. Type 1 diabetes (T1D) is highly prevalent in Saudi Arabia and imposes substantial clinical, emotional, and social burdens, including stigma that may interfere with optimal care. Limited evidence from the Eastern Mediterranean Region highlights the need for context-specific research. Objective This study assessed the prevalence of stigma among adults with T1D in Jazan, Saudi Arabia, and examined associated sociodemographic and clinical factors. Methods A cross-sectional survey was conducted among 299 adults attending the Endocrinology and Diabetes Centre. Participants completed a structured questionnaire on sociodemographic and clinical characteristics and the Arabic Diabetes Type 1 Stigma Assessment Scale (DSAS-1), covering Treated Differently, Blame and Judgment, and Identity Concerns domains. Items were rated on a five-point Likert scale. Associations were examined using Spearman correlations, Mann-Whitney U, and Kruskal-Wallis tests, and hierarchical linear regression with sociodemographic factors entered first and clinical variables added in the second model. Results Participants had a mean age of 30.4 ± 13.4 years (range: 18–87 years); most were females (59.2%) and urban residents (52.8%). Problematic stigma was observed across DSAS-1 domains, particularly Treated Differently and overall stigma. Higher stigma was associated with more recent diagnosis, poorer glycemic control and with more frequent episodes of hypoglycemia, hyperglycemia, and ketoacidosis. Stigma was also more common among females, urban residents, unemployed participants, and those with lower income or education. Regression models showed that clinical factors substantially improved explained variance of stigma. Conclusion Diabetes-related stigma is common among adults with T1D in Jazan and is closely linked to adverse glycemic outcomes and sociodemographic disadvantage. Integrating strategies that reduce stigma into routine T1D care, particularly for individuals with poor glycemic control or recent diagnosis, may improve psychosocial well-being and clinical outcomes overall.