Many people with diabetes experience diabetes stigma every day through comments that judge, blame and shame them for having diabetes, for how they manage it and for developing complications. Research conducted by the Australian Centre for Behavioural Research in Diabetes (ACBRD), found that four out of five people living with diabetes had experienced stigma at some point.

Stigma is real (not imagined) and complex, and can be either externally and or internally driven. External stigma may come from ‘well meaning’ family, friends and or health workers/ professionals, or the society and culture at large. Whereas internal stigmas, are the beliefs people hold about themselves through sociocultural and familial factors. Much uninvited opinion and comment people living with diabetes receive on their food choices, eating and activity habits, and body shape is driven by stigma.

Experts warn widespread community misunderstanding and stigma about diabetes are driving high rates of mental health problems for people living with diabetes. Almost 50% of people with diabetes have experienced a mental health issue relating to diabetes in the past 12 months.

New research led by the University of Connecticut explores the potential impact of diabetes stigma among adults living with type 2 diabetes. Overall the results show that stigma is associated with a person’s behaviour, beliefs, emotions, and support. Specifically:

• People regularly blame themselves for their diabetes diagnosis and also report greater distress about living with diabetes
• This can lead to lower quality interactions with healthcare professionals and lower levels of diabetes self-care.

These physical and emotional setbacks can affect how someone manages their diabetes.

There are many reasons someone might experience stigma. It can be because they feel misunderstood, judged, blamed or even made to feel guilty about their diabetes. Mentally this can be a lot for people to deal with.

How can we help to reduce diabetes stigma in our community?

Reducing the community misunderstandings that are driving the misconception that diabetes is simply a lifestyle condition is important.

Reinforce the following with people living with diabetes, their families and the public:

• Many risk factors including genetics, family history and age influence a person’s risk of developing diabetes.
• There are many types of diabetes and it is not purely a lifestyle condition.
• Some medications and surgeries such as pancreatic resection can cause diabetes.
• Encourage the use of evidence-based information for education purposes such as via the National Diabetes Services Scheme.

Language matters

The way we communicate with people living with diabetes and others is important because it affects the physical and emotional health of that person. The words used in conversation about diabetes also influences how people in society view people living with diabetes. Communication should be clear, accurate, inclusive and free from bias. Evidence shows that 50% of people living with diabetes find the label ‘diabetic’ unacceptable and harmful, although the person with diabetes is free to use whatever words they wish.  Language, including words, tone and body language, are all important and should show we care about how they feeling, recognising their values and empathising that you understand their circumstances.

Examples of language to reduce the stigma around diabetes

Instead of……	Try………..
Diabetic	Person, person living with diabetes
Disease	Condition
Normal, Healthy (person)	Person without diabetes
Non-compliant	Collaborative words e.g. taking medication
Bad, poor glucose levels	Use the numbers
Testing glucose	Monitoring glucose

Tips for reducing diabetes stigma in the community

Be aware – language is a powerful communication tool, think carefully about how your words may be heard and understood by people.

Habits – create new, inclusive ones and let go of the old stigmatising and exclusive words and behaviours. This will require a conscious effort on your part. The language statement is helpful as a guide.

Courage – to call out stigmatising words or phrases, often people lack the awareness that their words are inappropriate. Remember to assume the person meant no harm.

Diabetes stigma, which is people’s attitudes and stereotypes about diabetes, can negatively impact a person’s mental health and lead to complications to their overall health. Having some self-awareness of the language and attitudes that may exacerbate diabetes stigma can assist in reducing its prevalence in the community.