DM Control

Author

Dr Samuel Blay Nguah

Reading In data

Importing and cleaning data

Code
df_glycemic_clean <- 
    df_glycemic %>% 
    janitor::clean_names() %>% 
    rename(
        caregiver_occup = primary_caregiver_s_occupation, 
        caregiver_educ = education_level_of_caregiver, 
        dura_dm = duration_of_diabetes_diagnosis,
        free_insulin = do_you_receive_free_insulin_consistently, 
        disrupt_strip = have_there_been_disruptions_in_the_supply_of_glucometers_or_test_strips, 
        diff_transport = do_you_have_difficulties_affording_transportation_to_the_clinic, 
        diff_trans_sp = if_yes_to_transportation_difficulties_specify, 
        diff_meals = do_you_have_difficulties_in_getting_regular_meals_daily,
        diff_meals_sp = if_yes_to_getting_meals_regularly_specify, 
        add_burden = are_there_any_additional_financial_burdens_related_to_diabetes_management_e_g_medication_tests, 
        supp_family = do_you_receive_support_for_diabetes_management_from_your_family,
        adm_public = have_you_faced_any_challenges_administering_insulin_at_school_workplace_or_in_public_places, 
        keep_ins = where_do_you_keep_your_insulin_at_school_work, 
        additional_concerns = do_you_have_any_additional_comments_or_concerns_regarding_your_diabetes_care,
        improve_dm = what_improvements_would_you_suggest_for_better_management_of_diabetes_in_your_community, 
        share_stigma = please_share_any_additional_comments_or_experiences_regarding_stigma_related_to_paediatric_diabetes, 
        help_stigma = what_type_of_support_do_you_believe_would_help_reduce_stigma_related_to_paediatric_diabetes_select_all_that_apply, 
        stigma_counsel = have_you_or_your_family_received_any_formal_education_or_counseling_on_how_to_cope_with_stigma_related_to_diabetes,
        strategies_stigma = what_strategies_do_you_or_your_family_use_to_cope_with_stigma_or_negative_treatment_related_to_diabetes_select_all_that_apply, 
        diff_relationship = for_adolescents_and_young_adults_have_you_experienced_difficulties_in_forming_or_maintaining_relationships_because_of_your_diabetes, 
        avoid_activities = have_you_avoided_participating_in_activities_e_g_sports_church_school_events_because_of_your_diabetes, 
        facility_avail = which_of_these_facilities_are_available_for_your_use_at_your_school_work_select_all_that_apply, 
        awareness_work = is_there_sufficient_awareness_and_support_for_diabetes_in_your_school_work,
        feel_stigma = do_you_feel_that_diabetes_is_stigmatized_in_your_community, 
        exp_discrimination = have_you_experienced_any_negative_attitudes_or_discrimination_because_of_your_diabetes, 
        worries_dm = do_you_have_any_worries_about_people_discovering_that_you_have_diabetes, 
        worries_dm_desc = description_worries_about_diabetes_status_becoming_known, 
        awareness_work_res = give_reasons_for_your_answer_about_diabetes_awareness, 
        inform_dm = who_have_you_informed_that_you_have_diabetes, 
        unpleasant_desc = please_describe_any_unpleasant_experiences, 
        desc_rel_diff = description_about_relationship_difficulties, 
        inj_school = where_place_do_you_inject_at_school_work, 
        stigma_justify = justify_your_answer_concerning_stigma, 
        visit_freq = column1
        ) %>% 
    mutate(age_of_patient = factor(
        age_of_patient, 
        levels = c(
            "0–5 years", "5–10 years", "11–17 years", 
            "18–25 years", "Above 25 years")),
        family_income_level = factor(
            family_income_level, 
            levels = c("Low", "Medium", "High")),
        avail_health_p = case_when(
            str_detect(facility_avail, "(H|h)ealth") ~ "Yes", 
            TRUE ~ "No"), 
        avail_health_clinic = case_when(
            str_detect(facility_avail, "(Sick|Pharm|Clinic)") ~ "Yes", 
            TRUE ~ "No"), 
        avail_health_fridge = case_when(
            str_detect(facility_avail, "(F|f)ridge") ~ "Yes", 
            TRUE ~ "No"), 
        inj_p_private = case_when(
            str_detect(inj_school, "PRIVATE") ~ "Yes", 
            TRUE ~ "No"),
        inj_p_classroom = case_when(
            str_detect(inj_school, "(CLASSROOM|SCIENCE LAB)") ~ "Yes", 
            TRUE ~ "No"),
        inj_p_bathroom = case_when(
            str_detect(inj_school, "BATHROOM") ~ "Yes", 
            TRUE ~ "No"), 
        inj_p_home = case_when(
            str_detect(inj_school, "HOME") ~ "Yes", 
            TRUE ~ "No"), 
        inj_p_office = case_when(
            str_detect(inj_school, "OFFICE") ~ "Yes", 
            TRUE ~ "No"), 
        inj_p_house = case_when(
            str_detect(inj_school, "HOUSE") ~ "Yes", 
            TRUE ~ "No"), 
        inj_p_sickbay = case_when(
            str_detect(inj_school, "(SICK|HOSPITAL)") ~ "Yes", 
            TRUE ~ "No"),
        inj_p_dorm = case_when(
            str_detect(inj_school, "(DORM|HOSTEL|PREFECT)") ~ "Yes", 
            TRUE ~ "No"), 
        inj_p_teacher_house = case_when(
            str_detect(inj_school, "TEACHER'S HOUSE") ~ "Yes", 
            TRUE ~ "No"), 
        inj_p_others = case_when(
            str_detect(
                inj_school, 
                "(INCOMPLETE|SHOP|UNCOMPLETED|WORKPLACE)") ~ "Yes",
            TRUE ~ "No"), 
        str_talk_family = case_when(
            str_detect(strategies_stigma, "All of the above") ~"Yes", 
            str_detect(
                strategies_stigma, "Talking to family members") ~ "Yes", 
            TRUE ~ "no"), 
        str_talk_friends = case_when(
            str_detect(strategies_stigma, "All of the above") ~"Yes", 
            str_detect(
                strategies_stigma, 
                "Talking to friends") ~ "Yes", 
            TRUE ~ "no"), 
        str_talk_healthp = case_when(
            str_detect(strategies_stigma, "All of the above") ~"Yes", 
            str_detect(
                strategies_stigma, 
                "Talking to health professionals") ~ "Yes", 
            TRUE ~ "no"), 
        str_join_supp_grp = case_when(
            str_detect(strategies_stigma, "All of the above") ~"Yes", 
            str_detect(
                strategies_stigma, 
                "Joining a support group") ~ "Yes", 
            TRUE ~ "no"),
        str_avoid_stigma = case_when(
            str_detect(strategies_stigma, "All of the above") ~"Yes", 
            str_detect(
                strategies_stigma, 
                "Avoiding situations where stigma might occur") ~ "Yes", 
            TRUE ~ "no"), 
        need_sch_dm_educ = case_when(
            str_detect(help_stigma, "All of the above") ~"Yes", 
            str_detect(
                help_stigma, 
                "More education about diabetes in schools") ~ "Yes", 
            TRUE ~ "no"), 
        need_sup_caregiver = case_when(
            str_detect(help_stigma, "All of the above") ~"Yes", 
            str_detect(
                help_stigma, 
                "Support groups for caregivers") ~ "Yes", 
            TRUE ~ "no"),
        need_sup_children = case_when(
            str_detect(help_stigma, "All of the above") ~"Yes", 
            str_detect(
                help_stigma, 
                "Support groups for children with diabetes") ~ "Yes", 
            TRUE ~ "No"), 
        need_counselling = case_when(
            str_detect(help_stigma, "All of the above") ~"Yes", 
            str_detect(
                help_stigma, 
                "Counseling services") ~ "Yes", 
            TRUE ~ "No"), 
        need_aware_comm = case_when(
            str_detect(help_stigma, "All of the above") ~"Yes", 
            str_detect(
                help_stigma, 
                "Awareness campaigns in the community") ~ "Yes", 
            TRUE ~ "No"), 
        hba1c_cat = case_when(
            most_recent_hb_a1c < 7.5 ~ "Good Control", 
            most_recent_hb_a1c <= 9 ~ "Suboptimal",
            most_recent_hb_a1c > 9 ~ "Poor control") %>% 
            factor(
                ordered = T, 
                levels = c("Good Control", "Suboptimal", "Poor control")),
        glycemic_control = case_when(
            most_recent_hb_a1c < 7.5 ~  "Yes", TRUE ~ "No") %>% 
            factor(),
        low_fam_income = case_when(
            family_income_level == "Low" ~ "Yes", TRUE ~ "No"), 
        rec_fam_supp = case_when(
            supp_family == "No" ~ "No", 
            supp_family !="" ~ "Yes"), 
        dura_dm = factor(
            dura_dm, 
            levels = c(
                "Less than 1 year", 
                "1–3 years", 
                "More than 3 years"), 
            labels = c("<1 year ", "1–3 years", ">3 years")), 
        visit_freq = case_when(
            visit_freq %in% c(
                "DIAGNOSED A MONTH AGO", 
                "JUST STARTED",
                "Every 1–3 months") ~ "1–3 months", 
             visit_freq %in% c("Every 4–6 months") ~ "4–6 months", 
             visit_freq %in% c("Less frequently") ~ "Less frequently") %>% 
            factor(
                levels = c("1–3 months", "4–6 months", "Less frequently")), 
        free_insulin = case_when(
            free_insulin == "Non applicable" ~ NA, 
            TRUE ~ free_insulin) %>% 
            factor(), 
        awareness_work = case_when(
            awareness_work == "UNSURE" ~ "Unsure", 
            awareness_work == "Non applicable" ~ NA, 
            TRUE ~ awareness_work), 
        awareness_work_2 = case_when(
          awareness_work == "No" ~ "No", 
          awareness_work %in% c("Partially","Unsure", "Yes") ~ "Yes") %>% 
          factor(),
        feel_stigma = case_when(
            feel_stigma == "No" ~ "No", 
            feel_stigma == "Yes" ~ "Yes"), 
        avoid_activities = case_when(
            str_detect(avoid_activities, "Yes") ~ "Yes",
            avoid_activities == "No" ~ "No"), 
        age_grp = case_when(
            age_of_patient %in% 
                c("0–5 years", "5–10 years") ~ "0 to 10 years", 
            age_of_patient %in% 
                c("18–25 years", "Above 25 years") ~ ">= 18 years",
            TRUE ~ age_of_patient) %>% 
            factor(
                levels = 
                    c(">= 18 years", "11–17 years", "0 to 10 years")), 
        caregiver_occup2 = case_when(
            caregiver_occup == "TRADER/SELF-EMPLOYED" ~ "Self-Employed", 
            caregiver_occup == 
                "PROFESSIONALS/TECHNICAL WORKERS" ~ "Professional", 
            caregiver_occup %in% c(
                "CLERICAL/SERVICE WORKERS", 
                "MANAGER/SENIOR OFFICIAL",
                "ORPHANED",
                "SKILLED MANUAL WORKER",
                "UNEMPLOYED", 
                "UNSKILLED MANUAL WORKER") ~ "Others") %>% 
            factor(levels = c("Self-Employed", "Others", "Professional")), 
        educational_level_2 = case_when(
            educational_level %in% c("None", "Primary") ~ "Primary or less",
            TRUE ~ educational_level), 
        worries_dm = case_when(
          worries_dm == "Not applicable" ~ NA, 
          worries_dm == "Yes (please describe)" ~ "Yes", 
          TRUE ~ worries_dm),
        exp_discrimination = case_when(
          exp_discrimination == 
              "My diabetes status is generally unknown" ~ "No", 
          TRUE ~ exp_discrimination), 
        free_insulin_2 = case_when(free_insulin == "Sometimes" ~ "Yes", 
                                   TRUE ~ free_insulin), 
        disrupt_strip_2 = case_when(disrupt_strip == "Sometimes" ~ "Yes",
                                    TRUE ~ disrupt_strip), 
        diff_meals_2 = case_when(diff_meals == "Sometimes" ~ "Yes", 
                                 TRUE ~ diff_meals), 
        diff_transport_2 = case_when(
            diff_transport == "Sometimes" ~ "Yes", TRUE ~ diff_transport), 
        inj_place = case_when(
            inj_school %in% 
                c("BATHROOM", "BATHROOM/CLASSROOM", "CLASSROOM", 
                  "INCOMPLETE BUILDING", "UNCOMPLETED BUILDING") ~ 
                "Bath/Class/Building",
            inj_school == "HOME" ~ "Home", 
            inj_school %in% 
                c("NOT IN SCHOOL CURRENTLY", "NOT ON INSULIN","NA") ~ "NA", 
            TRUE ~ "Others") %>% 
            factor(
                levels = c("Bath/Class/Building", "Others", "Home")), 
        inform_dm = case_when(
            inform_dm %in% c(
                "Only family member(s)", "Only family member", 
                "ONLY FAMILY MEMBERS") ~ "Only immediate family member(s)",
            inform_dm %in% c(
                "INNER CIRCLE AND DORMITORY MEMBERS", 
                "Inner circle and acquaintances") ~ 
                "Inner circle and acquaintances", 
            TRUE ~ inform_dm) %>% 
            factor(
                levels = c(
                    "Only close friends and immediate family members (inner circle)", 
                    "Inner circle and school/work authorities", 
                    "Only immediate family member(s)", 
                    "Inner circle and acquaintances")),
        inner_circle = case_when(
            inform_dm %in% 
                c("Only close friends and immediate family members (inner circle)", "Inner circle and school/work authorities") ~ "Yes",
           inform_dm %in%  
               c("Only immediate family member(s)", 
                 "Inner circle and acquaintances")~ "No"), 
        exp_diff_rela = case_when(
            diff_relationship == "Yes (specify)" ~ "Yes",
            diff_relationship == "I HAVE A BOYFRIEND WHO KNOWS I HAVE DIABETES AND HE IS OK WITH THAT" ~ "Yes",
            diff_relationship %in% 
                c("No",
                  "DIDNOT INFORM PARTNER ABOUT HER DIABETES. HAD A CHILD WITH HIM BUT ARE NOW SEPARATED", 
                  "I HAVE A BOYFRIEND BUT I HAVE NOT DISCLOSED MY DIABETES STATUS TO HIM")  ~ "No") %>% 
                factor())
  
labelled::var_label(df_glycemic_clean) <-
    list(
        age_of_patient = "Age of Patient", 
        gender = "Sex", 
        educational_level = "Educational Level", 
        educational_level_2 = "Educational Level", 
        family_income_level = "Family Income Level", 
        caregiver_educ = "Caregiver's Educational Level", 
        caregiver_occup = "Caregiver's Occupation", 
        caregiver_occup2 = "Caregiver's Occupation", 
        type_of_diabetes = "Type of Diabetes", 
        dura_dm = "Duration of diabetes", 
        most_recent_hb_a1c = "Most recent HbA1c (%)", 
        visit_freq = "Clinic visit frequency",
        free_insulin = "Consistent access to free insulin", 
        disrupt_strip = "Disruption of glucometer/test strips", 
        diff_transport = "Difficulty affording transport to clinic", 
        diff_meals = "Difficulty obtaining regular meals", 
        add_burden = "Additional diabetes-related financial burden", 
        adm_public = "Challenges administering insulin at school/work", 
        avail_health_p = "Health professional available", 
        avail_health_clinic = "Sick bay/clinic/pharmacy available", 
        avail_health_fridge = "Refrigerator for insulin available", 
        inj_p_private = "Private space for injection available", 
        inj_p_classroom = "Place of Injection: Classroom", 
        inj_p_bathroom = "Place of Injection: Bathroom",
        inj_p_home  = "Place of Injection: Home", 
        inj_p_office = "Place of Injection: Office",
        inj_p_house  = "Place of Injection: House",
        inj_p_sickbay = "Place of Injection: Sickbay", 
        inj_p_dorm  = "Place of Injection: Dormitory", 
        inj_p_teacher_house = "Place of Injection: Teacher's House",
        inj_p_others  = "Place of Injection: Others",
        awareness_work = "Awareness/support for diabetes at work/school", 
        str_talk_family = "Talking to family members",
        str_talk_friends = "Talking to friends",
        str_talk_healthp = "Talking to health professionals",
        str_join_supp_grp = "Joining a support group",
        str_avoid_stigma = "Avoiding stigma-prone situations",
        stigma_counsel = "Received formal stigma counselling",
        need_sch_dm_educ = "Need for school-based diabetes education",
        need_sup_caregiver = "Need for caregiver support groups",
        need_counselling = "Need for counselling services",
        need_aware_comm = "Need for community awareness campaigns", 
        rec_fam_supp = "Receive family support for DM management", 
        low_fam_income = "Low family income", 
        age_grp = "Age in years", 
        glycemic_control = "Good glycaemic control", 
        inform_dm = "Who informed of Diabetes", 
        feel_stigma = "Feel DM is stigmatized in community", 
        worries_dm = "Worry people will discover your DM", 
        exp_discrimination = "Experienced discrimination because of DM", 
        avoid_activities = "Avoided activities because of DM", 
        diff_relationship = 
            "Experienced difficult relationship because of DM?", 
        free_insulin_2 = "Consistent access to free insulin",
        disrupt_strip_2 = "Disruption of glucometer/test strips", 
        diff_meals_2 = "Difficulty obtaining regular meals", 
        diff_transport_2 = "Difficulty affording transport to clinic", 
        awareness_work_2 = "Awareness/support for diabetes at work/school", 
        inj_place = "Place of insulin injection", 
        inner_circle = "Informed inner circle about DM", 
        exp_diff_rela = "Strained relationships because of DM")

# df_glycemic_clean %>% count(inform_dm) %>% print(n = 30)

Table 0: Summary of all variables

Code
gtsummary::theme_gtsummary_eda()
Setting theme "Exploratory Data Analysis"
Code
gtsummary::theme_gtsummary_compact()
Setting theme "Compact"
Code
df_glycemic_clean %>% 
    select(age_of_patient, gender, educational_level, family_income_level, 
        caregiver_educ, caregiver_occup, type_of_diabetes, dura_dm, 
        most_recent_hb_a1c, hba1c_cat, visit_freq, free_insulin, 
        disrupt_strip, diff_transport, diff_meals, add_burden, adm_public, 
        avail_health_p, avail_health_clinic, avail_health_fridge, 
        inj_p_private, inj_p_classroom, inj_p_bathroom, inj_p_home, 
        inj_p_office, inj_p_house, inj_p_sickbay, inj_p_dorm, 
        inj_p_teacher_house, inj_p_others, awareness_work, 
        feel_stigma, worries_dm, exp_discrimination, inform_dm, 
        avoid_activities, diff_relationship, str_talk_family,
        str_talk_friends, str_talk_healthp, str_join_supp_grp,
        str_avoid_stigma, stigma_counsel, need_sch_dm_educ, 
        need_sup_caregiver, need_counselling, need_aware_comm, 
        glycemic_control, age_grp, gender, educational_level_2, 
        family_income_level, free_insulin_2, caregiver_educ, 
        disrupt_strip_2, diff_meals_2, caregiver_occup2, diff_transport_2,
        type_of_diabetes, dura_dm, rec_fam_supp, feel_stigma,
        awareness_work_2, inj_place, worries_dm, exp_discrimination,
        inner_circle, avoid_activities, avoid_activities, 
        diff_relationship,hba1c_cat, age_grp, gender, educational_level_2, 
        family_income_level, free_insulin_2, disrupt_strip_2, 
        caregiver_educ, diff_meals_2, caregiver_occup2, 
        diff_transport_2, type_of_diabetes, dura_dm, rec_fam_supp,
        feel_stigma, awareness_work_2, inj_place, worries_dm, 
        exp_discrimination, inner_circle, avoid_activities, 
        avoid_activities, diff_relationship, exp_diff_rela, 
        inner_circle) %>% 
    gtsummary::tbl_summary() %>% 
    gtsummary::bold_labels()
Characteristic N = 1611
Age of Patient
    0–5 years 3 (1.86%)
    5–10 years 15 (9.32%)
    11–17 years 67 (41.6%)
    18–25 years 58 (36.0%)
    Above 25 years 18 (11.2%)
Sex
    Female 107 (66.5%)
    Male 54 (33.5%)
Educational Level
    None 2 (1.24%)
    Primary 70 (43.5%)
    Secondary 60 (37.3%)
    Tertiary 29 (18.0%)
Family Income Level
    Low 68 (42.2%)
    Medium 88 (54.7%)
    High 5 (3.11%)
Caregiver's Educational Level
    None 23 (14.4%)
    Primary 50 (31.3%)
    Secondary 48 (30.0%)
    Tertiary 39 (24.4%)
    Unknown 1
Caregiver's Occupation
    CLERICAL/SERVICE WORKERS 10 (6.21%)
    MANAGER/SENIOR OFFICIAL 3 (1.86%)
    ORPHANED 1 (0.62%)
    PROFESSIONALS/TECHNICAL WORKERS 28 (17.4%)
    SKILLED MANUAL WORKER 13 (8.07%)
    TRADER/SELF-EMPLOYED 99 (61.5%)
    UNEMPLOYED 6 (3.73%)
    UNSKILLED MANUAL WORKER 1 (0.62%)
Type of Diabetes
    Type 1 131 (81.4%)
    Type 2 30 (18.6%)
Duration of diabetes
    <1 year 31 (19.3%)
    1–3 years 31 (19.3%)
    >3 years 99 (61.5%)
Most recent HbA1c (%)
    Median (Q1, Q3) 9.70 (8.20, 11.50)
    Mean (SD) 9.97 (2.45)
    Min, Max 4.90, 15.10
hba1c_cat
    Good Control 23 (14.3%)
    Suboptimal 36 (22.4%)
    Poor control 102 (63.4%)
Clinic visit frequency
    1–3 months 127 (78.9%)
    4–6 months 23 (14.3%)
    Less frequently 11 (6.83%)
Consistent access to free insulin
    No 5 (3.21%)
    Sometimes 5 (3.21%)
    Yes 146 (93.6%)
    Unknown 5
Disruption of glucometer/test strips
    No 124 (78.0%)
    Sometimes 7 (4.40%)
    Yes 28 (17.6%)
    Unknown 2
Difficulty affording transport to clinic
    No 112 (69.6%)
    Sometimes 33 (20.5%)
    Yes 16 (9.94%)
Difficulty obtaining regular meals
    No 122 (76.3%)
    Sometimes 32 (20.0%)
    Yes 6 (3.75%)
    Unknown 1
Additional diabetes-related financial burden
    No 104 (64.6%)
    Sometimes 40 (24.8%)
    Yes 17 (10.6%)
Challenges administering insulin at school/work
    No 39 (24.2%)
    Non applicable 4 (2.48%)
    Sometimes 14 (8.70%)
    Yes 104 (64.6%)
Health professional available 24 (14.9%)
Sick bay/clinic/pharmacy available 41 (25.5%)
Refrigerator for insulin available 102 (63.4%)
Private space for injection available 18 (11.2%)
Place of Injection: Classroom 19 (11.8%)
Place of Injection: Bathroom 27 (16.8%)
Place of Injection: Home 34 (21.1%)
Place of Injection: Office 12 (7.45%)
Place of Injection: House 9 (5.59%)
Place of Injection: Sickbay 12 (7.45%)
Place of Injection: Dormitory 17 (10.6%)
Place of Injection: Teacher's House 9 (5.59%)
Place of Injection: Others 6 (3.73%)
Awareness/support for diabetes at work/school
    No 80 (51.6%)
    Partially 53 (34.2%)
    Unsure 15 (9.68%)
    Yes 7 (4.52%)
    Unknown 6
Feel DM is stigmatized in community 114 (72.2%)
    Unknown 3
Worry people will discover your DM 55 (34.4%)
    Unknown 1
Experienced discrimination because of DM 45 (28.0%)
Who informed of Diabetes
    Only close friends and immediate family members (inner circle) 99 (61.5%)
    Inner circle and school/work authorities 41 (25.5%)
    Only immediate family member(s) 17 (10.6%)
    Inner circle and acquaintances 4 (2.48%)
Avoided activities because of DM 69 (42.9%)
Experienced difficult relationship because of DM?
    CHILD IS VERY INTELLIGENT AND PLACES FIRST IN CLASS BUT IS SOCIALLY WITHDRAWN 1 (0.62%)
    DIDNOT INFORM PARTNER ABOUT HER DIABETES. HAD A CHILD WITH HIM BUT ARE NOW SEPARATED 1 (0.62%)
    I HAVE A BOYFRIEND BUT I HAVE NOT DISCLOSED MY DIABETES STATUS TO HIM 1 (0.62%)
    I HAVE A BOYFRIEND WHO KNOWS I HAVE DIABETES AND HE IS OK WITH THAT 1 (0.62%)
    No 113 (70.2%)
    Not applicable 21 (13.0%)
    Yes (specify) 23 (14.3%)
Talking to family members 63 (39.1%)
Talking to friends 34 (21.1%)
Talking to health professionals 78 (48.4%)
Joining a support group 48 (29.8%)
Avoiding stigma-prone situations 56 (34.8%)
Received formal stigma counselling 64 (40.0%)
    Unknown 1
Need for school-based diabetes education 117 (72.7%)
Need for caregiver support groups 60 (37.3%)
Need for counselling services 63 (39.1%)
Need for community awareness campaigns 123 (76.4%)
Good glycaemic control 23 (14.3%)
Age in years
    >= 18 years 76 (47.2%)
    11–17 years 67 (41.6%)
    0 to 10 years 18 (11.2%)
Educational Level
    Primary or less 72 (44.7%)
    Secondary 60 (37.3%)
    Tertiary 29 (18.0%)
Consistent access to free insulin 151 (96.8%)
    Unknown 5
Disruption of glucometer/test strips 35 (22.0%)
    Unknown 2
Difficulty obtaining regular meals 38 (23.8%)
    Unknown 1
Caregiver's Occupation
    Self-Employed 99 (61.5%)
    Others 34 (21.1%)
    Professional 28 (17.4%)
Difficulty affording transport to clinic 49 (30.4%)
Receive family support for DM management 137 (86.2%)
    Unknown 2
Awareness/support for diabetes at work/school 75 (48.4%)
    Unknown 6
Place of insulin injection
    Bath/Class/Building 45 (29.6%)
    Others 73 (48.0%)
    Home 34 (22.4%)
    Unknown 9
Informed inner circle about DM 140 (87.0%)
Strained relationships because of DM 24 (17.3%)
    Unknown 22
1 n (%)

Table 1. Socio-demographic, Clinical Characteristics, and Availability of Diabetes Supplies (N = 161)

Code
df_glycemic_clean %>% # labelled::look_for("availa")
    select(
        age_of_patient, gender, educational_level, family_income_level, 
        caregiver_educ, caregiver_occup, type_of_diabetes, dura_dm, 
        most_recent_hb_a1c, hba1c_cat, visit_freq, free_insulin, 
        disrupt_strip) %>% 
    gtsummary::tbl_summary(
        statistic = list(most_recent_hb_a1c ~ "{mean} ({sd})")
    )%>% 
    gtsummary::bold_labels()
Characteristic N = 1611
Age of Patient
    0–5 years 3 (1.86%)
    5–10 years 15 (9.32%)
    11–17 years 67 (41.6%)
    18–25 years 58 (36.0%)
    Above 25 years 18 (11.2%)
Sex
    Female 107 (66.5%)
    Male 54 (33.5%)
Educational Level
    None 2 (1.24%)
    Primary 70 (43.5%)
    Secondary 60 (37.3%)
    Tertiary 29 (18.0%)
Family Income Level
    Low 68 (42.2%)
    Medium 88 (54.7%)
    High 5 (3.11%)
Caregiver's Educational Level
    None 23 (14.4%)
    Primary 50 (31.3%)
    Secondary 48 (30.0%)
    Tertiary 39 (24.4%)
    Unknown 1
Caregiver's Occupation
    CLERICAL/SERVICE WORKERS 10 (6.21%)
    MANAGER/SENIOR OFFICIAL 3 (1.86%)
    ORPHANED 1 (0.62%)
    PROFESSIONALS/TECHNICAL WORKERS 28 (17.4%)
    SKILLED MANUAL WORKER 13 (8.07%)
    TRADER/SELF-EMPLOYED 99 (61.5%)
    UNEMPLOYED 6 (3.73%)
    UNSKILLED MANUAL WORKER 1 (0.62%)
Type of Diabetes
    Type 1 131 (81.4%)
    Type 2 30 (18.6%)
Duration of diabetes
    <1 year 31 (19.3%)
    1–3 years 31 (19.3%)
    >3 years 99 (61.5%)
Most recent HbA1c (%)
    Mean (SD) 9.97 (2.45)
hba1c_cat
    Good Control 23 (14.3%)
    Suboptimal 36 (22.4%)
    Poor control 102 (63.4%)
Clinic visit frequency
    1–3 months 127 (78.9%)
    4–6 months 23 (14.3%)
    Less frequently 11 (6.83%)
Consistent access to free insulin
    No 5 (3.21%)
    Sometimes 5 (3.21%)
    Yes 146 (93.6%)
    Unknown 5
Disruption of glucometer/test strips
    No 124 (78.0%)
    Sometimes 7 (4.40%)
    Yes 28 (17.6%)
    Unknown 2
1 n (%)

Table 2. Financial Constraints and School/Workplace Support for Diabetes Management

Code
df_glycemic_clean %>% 
    select(
        diff_transport, diff_meals, add_burden, adm_public, 
        avail_health_p, avail_health_clinic, avail_health_fridge, 
        inj_place, inj_p_private, inj_p_classroom, inj_p_bathroom, 
        inj_p_home, inj_p_office, inj_p_house, inj_p_sickbay, 
        inj_p_dorm, inj_p_teacher_house, inj_p_others, 
        awareness_work) %>%
    gtsummary::tbl_summary() %>% 
    gtsummary::bold_labels()
Characteristic N = 1611
Difficulty affording transport to clinic
    No 112 (69.6%)
    Sometimes 33 (20.5%)
    Yes 16 (9.94%)
Difficulty obtaining regular meals
    No 122 (76.3%)
    Sometimes 32 (20.0%)
    Yes 6 (3.75%)
    Unknown 1
Additional diabetes-related financial burden
    No 104 (64.6%)
    Sometimes 40 (24.8%)
    Yes 17 (10.6%)
Challenges administering insulin at school/work
    No 39 (24.2%)
    Non applicable 4 (2.48%)
    Sometimes 14 (8.70%)
    Yes 104 (64.6%)
Health professional available 24 (14.9%)
Sick bay/clinic/pharmacy available 41 (25.5%)
Refrigerator for insulin available 102 (63.4%)
Place of insulin injection
    Bath/Class/Building 45 (29.6%)
    Others 73 (48.0%)
    Home 34 (22.4%)
    Unknown 9
Private space for injection available 18 (11.2%)
Place of Injection: Classroom 19 (11.8%)
Place of Injection: Bathroom 27 (16.8%)
Place of Injection: Home 34 (21.1%)
Place of Injection: Office 12 (7.45%)
Place of Injection: House 9 (5.59%)
Place of Injection: Sickbay 12 (7.45%)
Place of Injection: Dormitory 17 (10.6%)
Place of Injection: Teacher's House 9 (5.59%)
Place of Injection: Others 6 (3.73%)
Awareness/support for diabetes at work/school
    No 80 (51.6%)
    Partially 53 (34.2%)
    Unsure 15 (9.68%)
    Yes 7 (4.52%)
    Unknown 6
1 n (%)

Table 3. Stigma, Disclosure, and Social Impact of Diabetes

Code
df_glycemic_clean %>% 
    select(
        feel_stigma, worries_dm, exp_discrimination, 
        inform_dm, avoid_activities, diff_relationship, 
        exp_diff_rela) %>% 
    gtsummary::tbl_summary() %>% 
    gtsummary::bold_labels()
Characteristic N = 1611
Feel DM is stigmatized in community 114 (72.2%)
    Unknown 3
Worry people will discover your DM 55 (34.4%)
    Unknown 1
Experienced discrimination because of DM 45 (28.0%)
Who informed of Diabetes
    Only close friends and immediate family members (inner circle) 99 (61.5%)
    Inner circle and school/work authorities 41 (25.5%)
    Only immediate family member(s) 17 (10.6%)
    Inner circle and acquaintances 4 (2.48%)
Avoided activities because of DM 69 (42.9%)
Experienced difficult relationship because of DM?
    CHILD IS VERY INTELLIGENT AND PLACES FIRST IN CLASS BUT IS SOCIALLY WITHDRAWN 1 (0.62%)
    DIDNOT INFORM PARTNER ABOUT HER DIABETES. HAD A CHILD WITH HIM BUT ARE NOW SEPARATED 1 (0.62%)
    I HAVE A BOYFRIEND BUT I HAVE NOT DISCLOSED MY DIABETES STATUS TO HIM 1 (0.62%)
    I HAVE A BOYFRIEND WHO KNOWS I HAVE DIABETES AND HE IS OK WITH THAT 1 (0.62%)
    No 113 (70.2%)
    Not applicable 21 (13.0%)
    Yes (specify) 23 (14.3%)
Strained relationships because of DM 24 (17.3%)
    Unknown 22
1 n (%)

Table 5. Regression tables predicting glycemic control

Table 5A: Tabulation

Code
df_for_reg <- 
df_glycemic_clean %>%
    select(
        glycemic_control, age_grp, gender, educational_level_2, 
        family_income_level, free_insulin_2, caregiver_educ, 
        disrupt_strip_2, diff_meals_2, caregiver_occup2, diff_transport_2,
        type_of_diabetes, dura_dm, rec_fam_supp, feel_stigma,
        awareness_work_2, inj_place, worries_dm, exp_discrimination,
        inner_circle, avoid_activities, avoid_activities, exp_diff_rela) 

df_for_ordreg <- 
df_glycemic_clean %>%
    select(
        hba1c_cat, age_grp, gender, educational_level_2, 
        family_income_level, free_insulin_2, disrupt_strip_2, 
        caregiver_educ, diff_meals_2, caregiver_occup2, 
        diff_transport_2, type_of_diabetes, dura_dm, rec_fam_supp,
        feel_stigma, awareness_work_2, inj_place, worries_dm, 
        exp_discrimination, inner_circle, avoid_activities, 
        avoid_activities, exp_diff_rela)
    
df_for_reg %>% 
    gtsummary::tbl_summary(
        by = glycemic_control
    ) %>% 
    gtsummary::modify_spanning_header(
        gtsummary::all_stat_cols() ~ "**Good Glycemic Control**")%>%
    gtsummary::add_overall(last=T) %>% 
    gtsummary::bold_labels() %>% 
    gtsummary::add_p() %>% 
    gtsummary::bold_p() %>% 
    gtsummary::modify_caption(
        caption = "**Table 5**: Tabulation of regression variables")
Table 5: Tabulation of regression variables
Characteristic
Good Glycemic Control
Overall
N = 1611
p-value2
No
N = 1381
Yes
N = 231
Age in years


0.7
    >= 18 years 67 (48.6%) 9 (39.1%) 76 (47.2%)
    11–17 years 56 (40.6%) 11 (47.8%) 67 (41.6%)
    0 to 10 years 15 (10.9%) 3 (13.0%) 18 (11.2%)
Sex


0.7
    Female 91 (65.9%) 16 (69.6%) 107 (66.5%)
    Male 47 (34.1%) 7 (30.4%) 54 (33.5%)
Educational Level


>0.9
    Primary or less 62 (44.9%) 10 (43.5%) 72 (44.7%)
    Secondary 51 (37.0%) 9 (39.1%) 60 (37.3%)
    Tertiary 25 (18.1%) 4 (17.4%) 29 (18.0%)
Family Income Level


0.010
    Low 64 (46.4%) 4 (17.4%) 68 (42.2%)
    Medium 71 (51.4%) 17 (73.9%) 88 (54.7%)
    High 3 (2.17%) 2 (8.70%) 5 (3.11%)
Consistent access to free insulin 132 (97.1%) 19 (95.0%) 151 (96.8%) 0.5
    Unknown 2 3 5
Caregiver's Educational Level


0.8
    None 21 (15.3%) 2 (8.70%) 23 (14.4%)
    Primary 42 (30.7%) 8 (34.8%) 50 (31.3%)
    Secondary 42 (30.7%) 6 (26.1%) 48 (30.0%)
    Tertiary 32 (23.4%) 7 (30.4%) 39 (24.4%)
    Unknown 1 0 1
Disruption of glucometer/test strips 32 (23.5%) 3 (13.0%) 35 (22.0%) 0.3
    Unknown 2 0 2
Difficulty obtaining regular meals 35 (25.5%) 3 (13.0%) 38 (23.8%) 0.2
    Unknown 1 0 1
Caregiver's Occupation


0.086
    Self-Employed 82 (59.4%) 17 (73.9%) 99 (61.5%)
    Others 33 (23.9%) 1 (4.35%) 34 (21.1%)
    Professional 23 (16.7%) 5 (21.7%) 28 (17.4%)
Difficulty affording transport to clinic 44 (31.9%) 5 (21.7%) 49 (30.4%) 0.3
Type of Diabetes


0.15
    Type 1 115 (83.3%) 16 (69.6%) 131 (81.4%)
    Type 2 23 (16.7%) 7 (30.4%) 30 (18.6%)
Duration of diabetes


0.7
    <1 year 27 (19.6%) 4 (17.4%) 31 (19.3%)
    1–3 years 25 (18.1%) 6 (26.1%) 31 (19.3%)
    >3 years 86 (62.3%) 13 (56.5%) 99 (61.5%)
Receive family support for DM management 115 (84.6%) 22 (95.7%) 137 (86.2%) 0.2
    Unknown 2 0 2
Feel DM is stigmatized in community 102 (74.5%) 12 (57.1%) 114 (72.2%) 0.10
    Unknown 1 2 3
Awareness/support for diabetes at work/school 64 (47.8%) 11 (52.4%) 75 (48.4%) 0.7
    Unknown 4 2 6
Place of insulin injection


>0.9
    Bath/Class/Building 40 (29.6%) 5 (29.4%) 45 (29.6%)
    Others 64 (47.4%) 9 (52.9%) 73 (48.0%)
    Home 31 (23.0%) 3 (17.6%) 34 (22.4%)
    Unknown 3 6 9
Worry people will discover your DM 49 (35.8%) 6 (26.1%) 55 (34.4%) 0.4
    Unknown 1 0 1
Experienced discrimination because of DM 40 (29.0%) 5 (21.7%) 45 (28.0%) 0.5
Informed inner circle about DM 122 (88.4%) 18 (78.3%) 140 (87.0%) 0.2
Avoided activities because of DM 61 (44.2%) 8 (34.8%) 69 (42.9%) 0.4
Strained relationships because of DM 21 (17.5%) 3 (15.8%) 24 (17.3%) >0.9
    Unknown 18 4 22
1 n (%)
2 Fisher’s exact test; Pearson’s Chi-squared test

Table 5B: Tabulation three level glycemic control categories

Code
df_for_ordreg %>% 
    gtsummary::tbl_summary(
        by = hba1c_cat
    ) %>% 
    gtsummary::modify_spanning_header(
        gtsummary::all_stat_cols() ~ "**HbA1c Category**")%>%
    gtsummary::add_overall(last=T) %>% 
    gtsummary::bold_labels() %>% 
    gtsummary::add_p() %>% 
    gtsummary::bold_p() %>% 
    gtsummary::modify_caption(
        caption = "**Table 5**: Tabulation of ordinal regression variables")
Table 5: Tabulation of ordinal regression variables
Characteristic
HbA1c Category
Overall
N = 1611
p-value2
Good Control
N = 231
Suboptimal
N = 361
Poor control
N = 1021
Age in years



0.6
    >= 18 years 9 (39.1%) 17 (47.2%) 50 (49.0%) 76 (47.2%)
    11–17 years 11 (47.8%) 13 (36.1%) 43 (42.2%) 67 (41.6%)
    0 to 10 years 3 (13.0%) 6 (16.7%) 9 (8.82%) 18 (11.2%)
Sex



0.7
    Female 16 (69.6%) 22 (61.1%) 69 (67.6%) 107 (66.5%)
    Male 7 (30.4%) 14 (38.9%) 33 (32.4%) 54 (33.5%)
Educational Level



0.9
    Primary or less 10 (43.5%) 17 (47.2%) 45 (44.1%) 72 (44.7%)
    Secondary 9 (39.1%) 11 (30.6%) 40 (39.2%) 60 (37.3%)
    Tertiary 4 (17.4%) 8 (22.2%) 17 (16.7%) 29 (18.0%)
Family Income Level



<0.001
    Low 4 (17.4%) 10 (27.8%) 54 (52.9%) 68 (42.2%)
    Medium 17 (73.9%) 24 (66.7%) 47 (46.1%) 88 (54.7%)
    High 2 (8.70%) 2 (5.56%) 1 (0.98%) 5 (3.11%)
Consistent access to free insulin 19 (95.0%) 33 (97.1%) 99 (97.1%) 151 (96.8%) 0.8
    Unknown 3 2 0 5
Disruption of glucometer/test strips 3 (13.0%) 8 (22.2%) 24 (24.0%) 35 (22.0%) 0.5
    Unknown 0 0 2 2
Caregiver's Educational Level



0.8
    None 2 (8.70%) 3 (8.33%) 18 (17.8%) 23 (14.4%)
    Primary 8 (34.8%) 12 (33.3%) 30 (29.7%) 50 (31.3%)
    Secondary 6 (26.1%) 11 (30.6%) 31 (30.7%) 48 (30.0%)
    Tertiary 7 (30.4%) 10 (27.8%) 22 (21.8%) 39 (24.4%)
    Unknown 0 0 1 1
Difficulty obtaining regular meals 3 (13.0%) 7 (19.4%) 28 (27.7%) 38 (23.8%) 0.3
    Unknown 0 0 1 1
Caregiver's Occupation



0.10
    Self-Employed 17 (73.9%) 18 (50.0%) 64 (62.7%) 99 (61.5%)
    Others 1 (4.35%) 12 (33.3%) 21 (20.6%) 34 (21.1%)
    Professional 5 (21.7%) 6 (16.7%) 17 (16.7%) 28 (17.4%)
Difficulty affording transport to clinic 5 (21.7%) 8 (22.2%) 36 (35.3%) 49 (30.4%) 0.2
Type of Diabetes



0.036
    Type 1 16 (69.6%) 26 (72.2%) 89 (87.3%) 131 (81.4%)
    Type 2 7 (30.4%) 10 (27.8%) 13 (12.7%) 30 (18.6%)
Duration of diabetes



0.3
    <1 year 4 (17.4%) 11 (30.6%) 16 (15.7%) 31 (19.3%)
    1–3 years 6 (26.1%) 6 (16.7%) 19 (18.6%) 31 (19.3%)
    >3 years 13 (56.5%) 19 (52.8%) 67 (65.7%) 99 (61.5%)
Receive family support for DM management 22 (95.7%) 31 (88.6%) 84 (83.2%) 137 (86.2%) 0.3
    Unknown 0 1 1 2
Feel DM is stigmatized in community 12 (57.1%) 21 (58.3%) 81 (80.2%) 114 (72.2%) 0.011
    Unknown 2 0 1 3
Awareness/support for diabetes at work/school 11 (52.4%) 19 (55.9%) 45 (45.0%) 75 (48.4%) 0.5
    Unknown 2 2 2 6
Place of insulin injection



0.3
    Bath/Class/Building 5 (29.4%) 5 (15.2%) 35 (34.3%) 45 (29.6%)
    Others 9 (52.9%) 20 (60.6%) 44 (43.1%) 73 (48.0%)
    Home 3 (17.6%) 8 (24.2%) 23 (22.5%) 34 (22.4%)
    Unknown 6 3 0 9
Worry people will discover your DM 6 (26.1%) 10 (27.8%) 39 (38.6%) 55 (34.4%) 0.3
    Unknown 0 0 1 1
Experienced discrimination because of DM 5 (21.7%) 7 (19.4%) 33 (32.4%) 45 (28.0%) 0.3
Informed inner circle about DM 18 (78.3%) 32 (88.9%) 90 (88.2%) 140 (87.0%) 0.4
Avoided activities because of DM 8 (34.8%) 15 (41.7%) 46 (45.1%) 69 (42.9%) 0.7
Strained relationships because of DM 3 (15.8%) 3 (10.3%) 18 (19.8%) 24 (17.3%) 0.6
    Unknown 4 7 11 22
1 n (%)
2 Fisher’s exact test; Pearson’s Chi-squared test

Table 5B: Univariate logistic regression

Code
df_for_reg %>% 
    gtsummary::tbl_uvregression(
        method = glm,
        y = glycemic_control,
        method.args = family(binomial),
        exponentiate = TRUE,
        pvalue_fun = function(x) gtsummary::style_pvalue(x, digits = 3)) %>% 
    gtsummary::bold_labels() %>% 
    gtsummary::bold_p() 
Characteristic N OR 95% CI p-value
Age in years 161


    >= 18 years
— —
    11–17 years
1.46 0.57, 3.87 0.433
    0 to 10 years
1.49 0.30, 5.71 0.583
Sex 161


    Female
— —
    Male
0.85 0.31, 2.13 0.734
Educational Level 161


    Primary or less
— —
    Secondary
1.09 0.41, 2.92 0.856
    Tertiary
0.99 0.25, 3.28 0.990
Family Income Level 161


    Low
— —
    Medium
3.83 1.34, 13.8 0.021
    High
10.7 1.17, 86.5 0.024
Consistent access to free insulin 156


    No
— —
    Yes
0.58 0.08, 11.6 0.630
Caregiver's Educational Level 160


    None
— —
    Primary
2.00 0.45, 14.0 0.406
    Secondary
1.50 0.31, 10.8 0.637
    Tertiary
2.30 0.50, 16.4 0.328
Disruption of glucometer/test strips 159


    No
— —
    Yes
0.49 0.11, 1.54 0.270
Difficulty obtaining regular meals 160


    No
— —
    Yes
0.44 0.10, 1.37 0.203
Caregiver's Occupation 161


    Self-Employed
— —
    Others
0.15 0.01, 0.76 0.067
    Professional
1.05 0.32, 2.99 0.933
Difficulty affording transport to clinic 161


    No
— —
    Yes
0.59 0.19, 1.60 0.332
Type of Diabetes 161


    Type 1
— —
    Type 2
2.19 0.77, 5.77 0.123
Duration of diabetes 161


    <1 year
— —
    1–3 years
1.62 0.41, 6.97 0.492
    >3 years
1.02 0.33, 3.86 0.974
Receive family support for DM management 159


    No
— —
    Yes
4.02 0.77, 73.9 0.185
Feel DM is stigmatized in community 158


    No
— —
    Yes
0.46 0.18, 1.21 0.105
Awareness/support for diabetes at work/school 155


    No
— —
    Yes
1.20 0.48, 3.07 0.694
Place of insulin injection 152


    Bath/Class/Building
— —
    Others
1.13 0.36, 3.88 0.843
    Home
0.77 0.15, 3.40 0.739
Worry people will discover your DM 160


    No
— —
    Yes
0.63 0.22, 1.64 0.369
Experienced discrimination because of DM 161


    No
— —
    Yes
0.68 0.21, 1.84 0.475
Informed inner circle about DM 161


    No
— —
    Yes
0.47 0.16, 1.58 0.189
Avoided activities because of DM 161


    No
— —
    Yes
0.67 0.26, 1.66 0.400
Strained relationships because of DM 139


    No
— —
    Yes
0.88 0.19, 2.96 0.855
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Table 5C: Ordinal regression

Code
df_for_ordreg %>% 
    gtsummary::tbl_uvregression(
        method = ordinal::clm,
        y = hba1c_cat,
        exponentiate = TRUE,
        pvalue_fun = function(x) gtsummary::style_pvalue(x, digits = 3)) %>% 
    gtsummary::bold_labels() %>% 
    gtsummary::bold_p() 
Characteristic N OR 95% CI p-value
Age in years 161


    >= 18 years
— —
    11–17 years
0.88 0.45, 1.73 0.712
    0 to 10 years
0.56 0.21, 1.53 0.249
Sex 161


    Female
— —
    Male
0.92 0.48, 1.78 0.794
Educational Level 161


    Primary or less
— —
    Secondary
1.14 0.57, 2.33 0.709
    Tertiary
0.88 0.38, 2.10 0.769
Family Income Level 161


    Low
— —
    Medium
0.29 0.14, 0.58 <0.001
    High
0.09 0.01, 0.47 0.005
Consistent access to free insulin 156


    No
— —
    Yes
1.37 0.18, 7.72 0.732
Disruption of glucometer/test strips 159


    No
— —
    Yes
1.46 0.68, 3.29 0.347
Caregiver's Educational Level 160


    None
— —
    Primary
0.42 0.12, 1.24 0.136
    Secondary
0.52 0.15, 1.56 0.266
    Tertiary
0.37 0.11, 1.11 0.089
Difficulty obtaining regular meals 160


    No
— —
    Yes
1.92 0.89, 4.45 0.107
Caregiver's Occupation 161


    Self-Employed
— —
    Others
1.11 0.52, 2.45 0.795
    Professional
0.86 0.38, 2.06 0.731
Difficulty affording transport to clinic 161


    No
— —
    Yes
1.89 0.93, 4.03 0.085
Type of Diabetes 161


    Type 1
— —
    Type 2
0.39 0.18, 0.83 0.014
Duration of diabetes 161


    <1 year
— —
    1–3 years
1.22 0.46, 3.23 0.692
    >3 years
1.69 0.77, 3.65 0.186
Receive family support for DM management 159


    No
— —
    Yes
0.44 0.14, 1.18 0.126
Feel DM is stigmatized in community 158


    No
— —
    Yes
2.74 1.39, 5.44 0.004
Awareness/support for diabetes at work/school 155


    No
— —
    Yes
0.71 0.37, 1.34 0.290
Place of insulin injection 152


    Bath/Class/Building
— —
    Others
0.47 0.20, 1.07 0.079
    Home
0.65 0.24, 1.76 0.396
Worry people will discover your DM 160


    No
— —
    Yes
1.67 0.85, 3.39 0.143
Experienced discrimination because of DM 161


    No
— —
    Yes
1.81 0.88, 3.95 0.120
Informed inner circle about DM 161


    No
— —
    Yes
1.52 0.59, 3.73 0.370
Avoided activities because of DM 161


    No
— —
    Yes
1.32 0.70, 2.51 0.396
Strained relationships because of DM 139


    No
— —
    Yes
1.63 0.63, 4.76 0.334
Abbreviations: CI = Confidence Interval, OR = Odds Ratio