Validation of the Short Type 1 Diabetes Stigma Assessment Scale (DSAS-1) and Its Association with Affective States, Diabetes Distress, Diabetes Self-Management, and Glycemic Control

Introduction: We validated an 8-item version of the DSAS-1 and examined its relationship with momentary ratings of affective states, diabetes distress, diabetes self-care, and glycemic control over time. Methods: We recruited 184 adults with T1D from Los Angeles, California, and the Bronx, New York. Participants completed a short version of the DSAS-1, other validated questionnaires, and 10-14 days of intensive longitudinal data collection using blinded continuous glucose monitoring and Ecological Momentary Assessment (EMA) via smartphone. Psychometric validation included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and internal consistency reliability assessment. We used Spearman's rho correlations to explore the convergent validity using EMA data. Results: EFA indicated an acceptable fit of a 3-factor model (Bartlett's = 0.000; KMO = 0.774). This was corroborated with CFA, which demonstrated a reasonable three-factor fit (chi-squared = 36.44; RMSEA = 0.079; SRMR = 0.036; TLI = 0.985; CFI = 0.991); less so for a single-factor model. Satisfactory convergent and discriminant validity was demonstrated. The DSAS-1 was significantly correlated with momentary ratings of negative emotions (0.30, p = <0.001), diabetes distress (0.32, p = <0.001), insulin regimen adherence (-0.20, p = 0.007), diabetes self-care (-0.24, p = 0.002), mean blood glucose (0.20, p = 0.008) and time in range (-0.21, p = 0.006), but was not significantly associated with positive emotions. Conclusions: The 8-item DSAS-1 is a valid and reliable measure of T1D stigma. Convergent validity confirms the importance of diabetes-related stigma in relation to psychosocial and blood glucose outcomes, and underscores the need for further examination of stigma in diabetes, which may be facilitated by this shorter scale. Disclosure G.Crespo-ramos: None. H.Jin: None. E.Pyatak: Research Support; Abbott Diabetes. D.Spruijt-metz: None. J.S.Gonzalez: Consultant; Virta Health Corp. C.J.Hoogendoorn: None. S.Schneider: None. R.Hernandez: None. L.T.Pham: None. A.L.Peters: Advisory Panel; Abbott Diabetes, Medscape, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Stock/Shareholder; Omada Health, Inc., Livongo. V.F.Ruelas: None. J.P.Crandall: Research Support; Abbott. P.Lee: None. Funding National Institutes of Health (R01DK121298)