Yamamoto Mayuko, Takashi Yuichi, Ishizu Masashi, Toyokawa Kyoko, Nagata Dai, Makihata Kensuke, Koganemaru Haruki, Sakamoto Tomoki, Teshima Kayoko, Urata Yuka, Muta Yoshimi, Yokomizo Hisashi, Sekiguchi Dan, Maeda Yasutaka, Minami Masae, Kato Asuka, Kawanami Daiji
Department of Endocrinology and Diabetes, Fukuoka University School of Medicine, Fukuoka, Japan.
Department of Endocrinology and Diabetes, Fukuoka University School of Medicine, Fukuoka, Japan
BMJ Open. 2025 Jun 17;15(6):e095698. doi: 10.1136/bmjopen-2024-095698.
To investigate the association between self-stigma evaluated using the Japanese version of the Self-Stigma Scale (SSS-J) and diabetic complications, such as diabetic retinopathy (DR) and diabetic kidney disease (DKD).
Cross-sectional study.
One university hospital and one clinic in Fukuoka, Japan.
People (age ≥20 years) with type 2 diabetes receiving outpatient care, who were treated by diabetologists, and completed the SSS-J questionnaire (n=259).
The primary outcome was the level of self-stigma assessed using the SSS-J. The presence of DR and DKD was evaluated as secondary outcomes.
A positive correlation was found between self-stigma and glycated haemoglobin (HbA1c) levels (=0.132, p=0.034). The mean SSS-J score was significantly higher in people with type 2 diabetes who had DR than in those without DR (p=0.006). There was no significant difference in the mean SSS-J scores of the patients with albuminuria (p=0.318) or a decreased kidney function (p=0.887). Additionally, the relative risk for the presence of DR, as assessed by quartiles of SSS-J scores and a logistic regression analysis, was significantly increased in the Q4 group with the highest SSS-J score after adjustment for sex, age and HbA1c (OR=3.91, 95% CI 1.49 to 10.3, p=0.006). The relative risk for the presence of albuminuria as a DKD significantly increased in the Q4 group immediately after adjustment for sex and age (OR=2.45, 95% CI 1.04 to 5.81, p=0.042). However, this association was attenuated and became non-significant after additional adjustment for HbA1c levels. In contrast, no significant association was observed between the SSS-J score quartiles and decreased kidney function.
The presence of DR was more strongly associated with self-stigma than DKD. Although the causality between self-stigma and the presence of DR could not be elucidated due to the cross-sectional nature of the study, the present study suggests that addressing self-stigma may aid in glycaemic management and the prevention of DR, emphasising the need for healthcare providers to recognise self-stigma as a barrier to optimal diabetes care.
使用日本版自我污名量表（SSS-J）评估自我污名与糖尿病并发症（如糖尿病视网膜病变（DR）和糖尿病肾病（DKD））之间的关联。
横断面研究。
日本福冈的一家大学医院和一家诊所。
年龄≥20岁、接受门诊治疗、由糖尿病专家诊治并完成SSS-J问卷的2型糖尿病患者（n = 259）。
主要结局是使用SSS-J评估的自我污名水平。DR和DKD的存在情况作为次要结局进行评估。
自我污名与糖化血红蛋白（HbA1c）水平之间存在正相关（=0.132，p = 0.034）。患有DR的2型糖尿病患者的SSS-J平均得分显著高于未患DR的患者（p = 0.006）。蛋白尿患者（p = 0.318）或肾功能下降患者（p = 0.887）的SSS-J平均得分无显著差异。此外，在对性别、年龄和HbA1c进行调整后，通过SSS-J得分四分位数和逻辑回归分析评估，DR存在的相对风险在SSS-J得分最高的Q4组中显著增加（OR = 3.91，95%CI 1.49至10.3，p = 0.006）。在对性别和年龄进行调整后，Q4组中作为DKD的蛋白尿存在的相对风险立即显著增加（OR = 2.45，95%CI 1.04至5.81，p = 0.042）。然而，在对HbA1c水平进行额外调整后，这种关联减弱且变得不显著。相比之下，SSS-J得分四分位数与肾功能下降之间未观察到显著关联。
DR的存在与自我污名的关联比DKD更强。尽管由于研究的横断面性质，无法阐明自我污名与DR存在之间的因果关系，但本研究表明，解决自我污名可能有助于血糖管理和预防DR，强调医疗保健提供者需要认识到自我污名是优化糖尿病护理的障碍。
