Diabetes Distress and Treatment Adherence in Individuals with Type 2 Diabetes Mellitus: The Mediating Effect of Diabetes Stigma, and The Moderating Role of Social Support

Abstract

 Diabetes mellitus is a persistent physiological disorder that carries significant psychological and psychosocial implications. Diabetes distress and medication adherence are significant psychological and behavioral factor for achieving optimal diabetes management, yet different psychological and social elements can substantially affect diabetes distress and treatement related adherence among individuals having type II diabetes mellitus (T2DM). The aim of the present study was to asses the co-relationship between diabetic distress, diabetes stigma, perceived social support, and medication adherence, emphasizing the mediating and moderating dynamics of these associations. We employed cross-sectional methodology utilizing a sample of 409 individuals diagnosed with T2DM. Participants filled out self-assessment tools for diabetes distress (DDS), diabetes stigma (DSAS), perceived social support (MSS), and medication compliance (HBMAS). Data were examined from SPSS, Pearson product-moment correlations, and PROCESS for mediation and moderated analyses employing bootstrapping. Diabetes distress exhibited a positive correlation with diabetes stigma (r = .704, p < .001), while demonstrating a significant and negative correlation with medication adherence (r = −.673, p < .001). The stigma associated with diabetes had a negative correlation with adherence to medication (r=−.633, p<.001). Mediation analysis revealed that diabetes stigma notably mediated the relationship between diabetic distress and medication adherence, exhibiting a substantial indirect effect (B = −0.117, 95% CI [−0.155, −0.080]). The moderation analysis shows that social support act as buffer as the model was significant, F(3, 405) = 151.21, p < .001, and accounted for 52.8% of the variance in medication adherence. The relationship between diabetes related distress and social support was notable, B = .020, SE = .003, t = 7.38, p < .001, 95% CI [0.014, 0.025], contributing an additional 6.3% to the variance.. The results highlight the significance of psychological elements such as diabetic distress, diabetes-related stigma, in elucidating medication compliance among individuals with T2DM. The findings suggest that interventions aimed at enhancing adherence must take into account psychological distress and stigma, alongside medication-related behaviors.