dStigmatize Language Guide

Instead of:

normal person

Try:

person without diabetes

Example:

Tom has type 1 diabetes, however neither of his children have diabetes.

Rather than:

Though Tom has type 1 diabetes, his children are both normal.

Rationale:

Person-first language avoids labeling people with their disease and recognizes that there is more to a person than their diabetes – this also holds true for people without a defining characteristic or condition. Avoiding labelling people as “normal,” means we can also avoid implying that those with diabetes are “not normal.” 

Instead of:

Victim, suffer, stricken, afflicted

Try:

Lives with diabetes, has diabetes.

Example:

Linda was diagnosed with diabetes at age 16.

She lives with diabetes.

Linda has diabetes and uses insulin to manage her condition.

Rather than:

At age 16, Linda was stricken with diabetes.

Linda suffers from diabetes.

Linda is a diabetes victim who uses insulin to control her condition.

Rationale:
Person-first language avoids labeling people with their disease and recognizes that there is more to a person than their diabetes. 

Some people with diabetes (and its complications) find it challenging and distressing, yet few ‘suffer’. Using handicapping language, such as labeling people with diabetes as ‘sufferers,’ ‘afflicted’, or ‘stricken with’ disregards their individual experience and is strongly negative; a neutral description such as ‘lives with diabetes’ is an effective substitute. (Dickinson et al., 2017)

Instead of:

Patient (especially outside of a healthcare setting)

Try:

person, person with diabetes, person living with diabetes

Example:

Insulin is an important treatment for people with diabetes.

Rather than:

Insulin is an important treatment for diabetes patients.

Rationale:

Labeling people as ‘patients’ outside of a healthcare setting reduces people with diabetes to their medical condition and positions them as passive participants in their own care. The term ‘patient’ doesn’t acknowledge their humanity; this can lead to mistreatment by healthcare providers and others around them who don’t view them as their equals deserving of respect.

Discussion:

‘Patient’ has become a loaded term, with debate around whether it should be used outside of clinical settings, or used at all, to describe people with diabetes. 

Why some may choose to use ‘patient’:

The terminology used to describe people depends on the context they are put in and the people they interact with. In various settings, people take on the identities of ‘patients’, ‘clients’, or ‘consumers’, to name a few. ‘Patient’ is the default term to refer to people who are receiving care by a healthcare professional, and can be preferred by people with diabetes and healthcare professionals when receiving or administering care in a healthcare setting. 

Things to consider:

When people with diabetes are referred to as ‘patients’ in the healthcare setting, this term can endure even when they aren’t seeking care in a doctor’s office which can be dehumanizing.

The argument for always using ‘people’ stresses that in all contexts, they are people first. Referring to individuals as ‘people’, especially outside of the healthcare setting, acknowledges their personhood which can influence the way these people are viewed and treated.

Instead of:

Subject (in research)

Try:

Participant(s), people

Example:

Study participants include 80 people with diabetes and 80 people living without diabetes.

Rather than:

Our study population includes 80 diabetic patients and 80 normal subjects.

Rationale:

Researchers have traditionally labeled those who take part in studies as ‘subjects’. However, people who take part in research consent to do so and rarely sit passively and have things done to them. They are often active, undertaking a number of tasks and activities. People who take part in research deserve to be treated with respect. In addition, research participants are not always ‘patients’ and should not be referred to as such. (Speight et al., 2021)

Instead of:

In denial, unmotivated

Try:

Participant(s), people, has concerns about…, has other priorities right now

Example:

Dan understands that diabetes can harm him; he does not see diabetes as a priority with everything else that’s going on in his life right now.

Rather than:

Dan is in denial.

Dan is unwilling or unmotivated to deal with his blood glucose.

Rationale:

‘In denial’ is inaccurate. Most people described this way know they have diabetes and are not denying that they have it. This is instead a reflection that the person does not see diabetes as an important and/or immediate concern.

Few people are unmotivated to live a long and healthy life. The challenge in diabetes management is there are many perceived obstacles that can outweigh the understood benefits. As a result, many people come to the conclusion that changes are not worth the effort or are unachievable.

Instead of:

Is obese

Try:

Has excess weight, has obesity, use exact numbers.

Example:

Though Susan has obesity, she is still very active and goes to the gym several times a week.

There are many people with obesity or excess weight in the US.

Susan, your weight at this appointment is 180 lbs.

Rather than:

Susan is obese.

Susan is overweight.

Obese patients are more difficult.

There are many obese and overweight people in the US.

Rationale:

The terms ‘obese’ and ‘overweight’ are often used to describe people in a way that suggests the person’s body size is a characteristic or trait of theirs, and not a state or medical condition. It also dehumanizes people when others use condition-first language such as, “She is an obese person.” (Speight et al., 2021)

Weight bias is extremely prevalent and leads to worse health outcomes and outright discrimination for people with obesity (Puhl et al., 2009). Stigmatizing language contributes to this bias and disempowers people.

Discussion:

Obesity is a medical condition, but there is no universal agreement among scholars about which term is the ‘recommended’ term to use when talking about and to people with obesity or excess weight. More research is needed to understand which language is preferred by diverse populations and which language empowers people and leads to better health outcomes. Generally, person-first language is the recommended choice when talking about medical conditions.

Why some may choose to use different language:

Especially for healthcare professionals and researchers, Puhl et. al. highlighted that different populations find different terms more negative than others. So the ‘right’ term for a white woman who is trying to lower her body weight might not be the ‘right’ term for a Black man who is participating in a research study (Puhl et al., 2020).

Things to consider:

For healthcare professionals and researchers, because each person may respond differently to the language being used to discuss body weight, it is often best to begin any conversation with neutral language, such as using exact numbers to describe a person’s weight instead of a term with value judgment like obese or overweight. From there you can ask the person what language they are comfortable using when discussing their weight. This can help bring people into the conversation about their health and empower them to choose the language they want to use, without making assumptions about what language is best for them. (Puhl et al., 2020)

For communications professionals and journalists, it is usually best to use person-first or neutral, fact-based language as often as possible, unless asked to do otherwise by the individual(s) you are talking about.

Instead of:

Mild diabetes, mild hypoglycemia

Try:

Diabetes, hypoglycemia, self-treated hypoglycemia

Example:

Sean has diabetes and was able to self-treat his most recent instance of hypoglycemia.

Rather than:

Sean has a mild case of diabetes.

Sean often has mild hypoglycemia at night.

Rationale:
‘Mild diabetes’ does not exist. Diabetes is a serious issue and labeling it as such is inaccurate and inconsiderate to people with diabetes. (Speight et al., 2021)

People with diabetes can experience low glucose levels, also called hypoglycemia. Sometimes, hypoglycemia can be self-treated. However, even in these instances, the hypoglycemia is not ‘mild.” Describing it as such ignores the effects of hypoglycemia that can have a very real impact on people’s lives and it ignores the effort that people with diabetes put in to avoid severe hypoglycemia. (Speight et al., 2021)

Instead of:

Disease

Try:

Condition

However this is often context dependent: “disease” in a medical context is an accurate term; in other contexts, some people prefer “condition.”

Example:

Robyn has diabetes, but she doesn’t let her condition slow her down.

Rather than:

Robyn has diabetes, but she doesn’t let her disease slow her down.

Rationale:

The term disease has a negative connotation that often brings to mind something contagious or gross and people with diseases are often avoided by others. By describing diabetes as a condition, you are more accurately portraying the chronic nature of diabetes and the ways it must be managed.

Discussion:

While the recommended term ‘condition’ is preferred by many, there are some cases in which disease is more appropriate.

Why some may choose to use “disease:”

In medical terms, diabetes is a disease. There is a clear functional impairment in the body, which is the way the body produces or responds to the hormone insulin, and a set of symptoms that result from this. In a medical context, it may be appropriate and/or useful to use the term “disease” when talking about diabetes.

Things to consider:

The word “disease” can carry negative connotations, which can impact an individual’s self-perception and management of their diabetes. It can also impact the way other people view diabetes, which can affect the way they treat people with diabetes.

“Condition” could be a more neutral alternative that allows people with diabetes and others around them to view diabetes as manageable, non-threatening, and non-communicable.

Instead of:

Control (especially when referring to diabetes, HbA1c, or glucose levels), (e.g. poor control, good control, normal control, well controlled, poorly controlled, uncontrolled, diabetes control, metabolic control, glycemic control, glucose control)

Try:

Manage glucose levels, within/outside target range, high/low glucose levels, target glucose levels

[“ …experienced ____ and the result was ____”]

Example:

Tim manages his glucose levels with metformin and exercise.

Tim sometimes has high glucose levels outside of his target range.

Tim ate a sandwich that caused his glucose levels to rise higher than he wanted.

Rather than:

Tim controls his diabetes with diet and exercise.

Tim sometimes loses control of his glucose levels when he eats a dessert.

Tim has poorly controlled diabetes.

Rationale:

A person’s diabetes is influenced by many factors outside of their ‘control’ including socioeconomic factors, hormones, access to medications and technology, their environment, stress, etc. (Speight et al., 2021)

‘Management’ is preferred over ‘control’ because it acknowledges the effort people put in to maintain their health and it acknowledges the improvements people can make over time. The term ‘control’  can lead to feelings of guilt, shame, and frustration and implies that if people try hard enough they can ‘control their diabetes,’ which is untrue given the many external factors that affect diabetes and the landscape of medications and technology currently available to people. (Speight et al., 2021)

Instead of:

Intensify treatment, escalate treatment

Try:

Tailor treatment, personalize treatment, change to more effective or appropriate treatment(s)

Example:

Kyle, let’s try personalizing your medication regimen to see if we can get different results.

After Kyle ended up in the ER, he increased his dosage of metformin by 100mg.

Rather than:

Kyle, we are going to have to intensify your insulin treatment.

We will need to escalate your treatment to get better results.

After Kyle ended up in the ER, his treatment was intensified.

Rationale:

When people with diabetes need to change their treatment, it is crucial to discuss this change in a way that feels approachable and achievable. Using words like ‘intensify’ and ‘escalate’ can incite fear or make the adjustment seem burdensome. This can lead to people with diabetes delaying the necessary changes to avoid feeling scared or dealing with a difficult change, which can have a negative impact on their health. (Speight et al., 2021)

Instead of:

Correct(ing) glucose levels

Try:

Adjust(ing) insulin, optimizing glucose levels

Example:

Sara adjusts her insulin dose when she is exercising to keep her glucose levels in range.

Rather than:

Sara had to correct her glucose levels during a run.

Rationale:

Words like ‘correcting a glucose level’ implies the need to fix something that is wrong or incorrect. These terms can lead to people with diabetes feeling guilty, blamed, or ashamed, of the choices they make. (Speight et al., 2021)

Instead of:

Fail, failing to, failed, failure

Try:

Did not, has not, does not…

Example:

Monique ate ice cream and now her glucose level is 185 mg/dL.

Metformin has not lowered her HbA1C as much as we hoped, we should consider a GLP-1.

Rather than:

Monique is failing to control her diabetes and has really bad glucose levels because she ate ice

cream.

She failed on metformin and must not intensify treatment.

Rationale:

When discussing the choices people make and the health outcomes that result, it is more accurate and considerate to be descriptive and neutral without assigning a value judgement to the choice or result, such as ‘failed,’ ‘good,’ ‘bad,’ or ‘poor.’ All of these terms can lead to people with diabetes feeling guilty, blamed, or ashamed, of the choices they make. (Speight et al., 2021) Diabetes is a serious and complex condition that is difficult to manage – no one should feel like a failure for not being perfect.

Instead of:

Good, bad, or poor glucose levels

Try:

Using exact numbers, referring to choices or decisions

Example:

Luis’s glucose levels fluctuate often.

He struggles to maintain a good HbA1c.

Rather than:

Luis’s glucose levels have always been poor.

His HbA1c is not always at goal.

Rationale:

When discussing the choices people make and the health outcomes that result, it is more accurate and considerate to be descriptive and neutral without assigning a value judgement to the choice or result, such as ‘failed,’ ‘good,’ ‘bad,’ or ‘poor.’ All of these terms can lead to people with diabetes feeling guilty, blamed, or ashamed, of the choices they make. (Speight et al., 2021)

Instead of:

Cheating, ‘being a bad diabetic’

Try:

Referring to choices or decisions

Example:

Sam is not as active as he could be.

Rather than:

Sam is a bad diabetic and refuses to exercise. He even cheats on his diet.

Rationale:

Diabetes is a serious and complex condition that is difficult to manage. People make choices every day that may not be in the interest of their best health – whether they have diabetes or not – and this does not mean they “cheated” or that they are a “bad diabetic.” Diabetes management is not a test of morality, responsibility, or motivation, it is simply something that must be done in order to live with a chronic condition.

Instead of:

Test, testing (especially when referring to blood glucose monitoring or finger sticks)

[explicit: this does not refer to talking about lab tests]

Try:

Check, checking; monitor, monitoring (e.g. glucose); read, reading (e.g., on a CGM)

Example:

Evita checks her glucose levels with her continuous glucose monitor.

Rather than:

Evita tested her blood sugars.

Rationale:

‘Tests’ are associated with results, scores, or grades. You can ‘pass’ a test, or ‘fail’. ‘Testing’ your blood glucose can imply that blood glucose level is a score, which can feel like a ‘failure’ if people see a value that is higher or lower than target. Using words like ‘check’ or ‘monitor’ are more enabling words, which provide people with diabetes with information they can act on without the negative association. (Speight et al., 2021)

Instead of:

Treating diabetes

Try:

Helping people manage diabetes, managing diabetes

Example:

We are helping about 50 people manage their diabetes in our office.

Rather than:

We are treating about 50 people for diabetes in our office.

Rationale:

‘Treating diabetes’ or ‘treating patients’  implies that providers are doing something to the person with diabetes, who is passively accepting treatment rather than being an active participant in their care. Providers are giving people with diabetes the tools to effectively manage their condition, empowering them to make their own informed decisions about their health. (Speight et al., 2021)