Editorial

Diabetes stigma and discrimination: finding the right words

Jesper Klausen/SPL
awarded £2000 in damages after a judge ruled that her diseases as a matter of personal responsibility rather
treatment at a Red Hot Chili Peppers concert in Belfast, than the result of complex biological and environmental
UK, in 2016, amounted to discrimination. The security determinants. Such associations can also affect the
guards at the event refused to let her take a bottle of stigma experienced by people with type 1 diabetes, due to For more on the discrimination
case in Belfast see https://www.
Lucozade energy drink—used by many people with public misunderstanding of the different conditions, and bbc.co.uk/news/uk-northern-
type 1 diabetes to treat hypoglycaemia—into the venue, the tendency of many media outlets not to differentiate ireland-44730450

despite showing them her insulin pack and glucose between diabetes types. For more on the Diabetes UK
workplace discrimination
monitor, and her diabetes tattoo. The case was brought Health professionals have a crucial role, as the way in survey see https://www.
under the Disability Discrimination Act 1995 and had which doctors and other health workers communicate diabetes.org.uk/about_us/news/
discrimination-workplace
the support of the Equality Commission for Northern with and about patients can reinforce or minimise the For more on diabetes and social
Ireland—its successful outcome highlights the need to stigma experienced by people with diabetes. In this stigma see Patient 2013; 6: 1–10
ensure that the needs of people with diabetes are better context, the increasing recognition of the importance For the new NHS England
Language Matters guidance see
recognised and accommodated. of language used in interactions with and about people https://www.england.nhs.uk/
Unfortunately, such incidents reflect a more widespread with diabetes is a welcome development. In June, 2018, wp-content/uploads/2018/06/
language-matters.pdf
problem—discrimination is a common challenge facing the National Health Service in England published a guide,
For the Diabetes Australia
people with diabetes. Earlier this year, the charity Diabetes Language Matters, setting out how health professionals language position statement
see https://static.
UK reported survey findings showing that one in can avoid stigmatising language and encourage more
diabetesaustralia.com.au/s/
six working adults with diabetes felt that they were positive interactions with people with diabetes. The work fileassets/diabetes-australia/
f4346fcb-511d-4500-9cd1-
discriminated against by their employer because of their follows in the pioneering footsteps of Diabetes Australia,
8a13068d5260.pdf
condition, while more than a third said that living with which published a position statement on language use For the US consensus report on
diabetes had caused them difficulty at work. A quarter in 2011, and the American Diabetes Association and language in diabetes care and
education see Diabetes Care 2017;
of those surveyed said that they would like to have time American Association of Diabetes Educators, which 40: 1790–99
off work for appointments and greater flexibility with published a US consensus report in 2017. The use of
respect to breaks for measuring blood glucose and taking person-first language is recommended, to avoid labelling
medication; some respondents reported that they had people as their condition (eg, “a diabetic”). Terminology
not told their employer that they had diabetes. that seems judgmental or reinforcing of negative
Active discrimination at work or in social life is the stereotypes, such as “failing”, “control”, and “compliance”
tip of the iceberg of the stigma experienced by people should be avoided. Such terms are highlighted as
with diabetes. According to findings from research into potentially problematic because they can be perceived
diabetes-related stigma, people without diabetes do as judgemental and do not take into account the various
not generally view it as a stigmatised condition, but the factors in people’s lives that can impact their diabetes
experience of those with diabetes suggests that stigma management, nor the realities of living with such a
is widespread. demanding, unpredictable, and relentless condition.
Even though the fact that someone has diabetes might Stigmatisation of diabetes can lead to negative
not be immediately apparent, physical and behavioural psychological outcomes, as well as poorer clinical
features can be conspicuous and result in social stigma. outcomes. It is therefore imperative that those involved
For example, people who take insulin can feel stigmatised in diabetes care take a leading role in ensuring that
due to the association of injections with illicit drug people with diabetes are treated as people first, and use
use. The effects of hypoglycaemia can be mistaken for language carefully to engender positive relationships,
drunkenness, or for mental illness or epilepsy, which reduce the stigma experienced, and improve confidence
are also subject to social stigma. The association of type and self-care. The right words can go a long way.
2 diabetes with obesity—and of both with unhealthy ■ The Lancet Diabetes & Endocrinology

www.thelancet.com/diabetes-endocrinology Vol 6 September 2018 673