title: Stigma among workers attending a hospital specialist diabetes clinic.
abstract: BACKGROUND
  Stigma among sufferers of chronic diseases such as obesity, human immunodeficiency virus disease and mental health disorders has been studied. This study addresses stigma affecting workers with diabetes.
  
  
  OBJECTIVE
  To investigate diabetes-related stigma and associated factors in a group of workers receiving care in a Singapore diabetes outpatient clinic.
  
  
  METHODS
  Type 2 diabetes mellitus (T2DM) patients receiving subsidized care and holding full-time employment were consecutively recruited over 9 months. A questionnaire was individually administered by an interviewer.
  
  
  RESULTS
  One hundred and twenty-five participants were recruited. Fifteen, who reported experiencing stigma, had higher median hospitalizations compared with the rest of the study group (2 (interquartile range (IQR) 0-6) versus 0 (0-1.75), P < 0.05). They were more likely to report that their diabetes affected work (8 (53%) versus 25 (23%), P < 0.05); having heard others experience diabetes-related stigma (9 (60%) versus 33 (30%), P < 0.05) and that employment prospects were affected (6 (40%) versus 18 (16%), P < 0.05), as well as having higher HbA1c (9.5% versus 8.5%, P > 0.05). Fifty-three per cent (66) of respondents reported that work affected their diabetes. There was no significant difference between the stigma and non-stigma groups in age (mean 50 years), body mass index (BMI; mean 28kg/m(2)), diabetes duration (12 years) and insulin use.
  
  
  CONCLUSIONS
  Twelve percentage of employed T2DM outpatients reported experiencing stigma because of diabetes. This was associated with frequency of hospitalization (a surrogate for poorer health) and poorer diabetes control. Strategies to reduce stigma include optimizing diabetes control, patient support and educating employers to improve understanding of diabetes and its work implications.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, S119077 Singapore, Department of Medicine, Alexandra Hospital, S159964, Singapore, see_muah_lee@juronghealth.com.sg.
authors.forename: S-M
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Medicine, Alexandra Hospital, S159964, Singapore, see_muah_lee@juronghealth.com.sg.
authors.forename: L C
authors.initials: LC
authors.lastname: Lim
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, S119077 Singapore, PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam Jalan Tungku Link, Gadong, BE 1410, Brunei Darussalam. see_muah_lee@juronghealth.com.sg.
authors.forename: D
authors.initials: D
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D012846:Singapore; D057545:Social Stigma; D013038:Specialization
keywords: Employment; stigma; type 2 diabetes mellitus.