Language Guide

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 refer to themselves as diabetic; this is their choice and that choice does not affect the recommended practice.

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)

Discussion:

While the recommended term ‘person with diabetes’ has been increasingly adopted in recent years, ‘diabetic’ is still widely used within the diabetes community. 

Why some may choose to use “diabetic”:

Identity-based language is sometimes intentionally used to create a sense of pride among members of a marginalized group. Using an identifier like ‘diabetic’ can be a way to build solidarity among other people with diabetes, and demonstrate diabetes pride. 

Things to consider: 

Research has shown that when identity-first language (‘diabetic’) is used over person-first language (‘person with diabetes’), it can lead to feelings of low self-esteem and isolation which contribute to worse diabetes outcomes. 

The way people talk about, and directly to, people with diabetes, especially in healthcare and media settings, influences the language people in the diabetes community use to refer to themselves. Choosing to use person-first language when talking about people with diabetes can create a large-scale shift, pushing us towards communication that always puts emphasis on the individual.

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.

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)

‘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.

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. 

Using the terms, ‘diabetic,’ or, ‘diabetes complications,’ can have unintended consequences. It incorrectly ties a complication to all people with diabetes. Saying, ‘diabetic heart disease,’ can make it seem like all people with diabetes will experience this complication, which is untrue. In addition, it dehumanizes the issue by focusing on treating just the problem or specific body part, and not the whole person. In addition, describing the complication as being ‘diabetes-related’ is more scientifically accurate. (Speight et al., 2021)

‘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)

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. 

Using terms that imply collaboration between the person with diabetes and their healthcare professional is empowering and highlights that people with diabetes are not passive in the management of their condition. Words like ‘adherence’ and ‘compliance’ suggest that healthcare professionals are always correct and that people with diabetes are disobeying them if they are not able to follow orders exactly. In reality, diabetes management is more complicated than simply ‘following orders’ and terms like ‘adherent’ and ‘compliant’ ignore the many challenges people with diabetes face every day.

It is accurate, descriptive, and neutral to describe the actual choices or behaviors of a person with diabetes and the effects it has on health outcomes.

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)

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)   

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

‘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)

‘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)