Dismantling Diabetes Stigma

An Introduction and Exercise on Shifting Narratives

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At the d20 Executive Innovation Lab, we took on the ambitious goal of dismantling diabetes stigma.

If you want to get involved in disrupting diabetes stigma, please see the three-step primer below for videos to watch and exercises to complete. We have adapted and consolidated the learnings from d20’s pilot program to provide this foundational knowledge and actionable information for anyone to begin this work with us. For more information, please refer to the d20 Executive Summary.


Diabetes stigma and discrimination work to prevent people with and at risk for diabetes from seeking and receiving necessary treatment. Stigma also contributes to a lack of openness about having diabetes, which impacts public perception of the severity of the problem and our ability to mobilize for collective action and policy solutions.

Therefore, working together to address diabetes stigma is crucial to catalyzing the changes needed across all parts of the diabetes ecosystem — from food and healthcare policy to treatments and behavior change interventions among patients, those at risk, and healthcare providers.

One important step is to create a shared narrative — a cross-sector understanding — of how to think and talk about diabetes in order to reduce stigma and promote better health. However, to truly change the narrative around diabetes in the US, it will require the power and commitment of us all.

Getting Started

1. LEARN about the science of stigma and of changing norms through changing the stories we tell. 

Watch the three Lightning Talks below to learn about the impact of stigma on people with diabetes and their health outcomes, and how narrative changes can transform public perception and treatment of people with diabetes.

Rebecca Puhl: Research shows that diabetes stigma exists and worsens health outcomes.

Nat Kendall-Taylor: How to use strategic framing and language to influence behavior, medicine, and policy.

Joan Garry: Case study – How the LGBTQ+ community successfully reduced stigma through media advocacy.

2. SHAPE shared language – a new narrative – to shift how Americans think, talk, and act about diabetes that will help reduce stigma, increase health, and amplify impact.

Watch the Framing Workshop with Marisa Gerstein Pineau from The FrameWorks Institute to learn about common communications traps and five major frames to reduce diabetes stigma.

After watching the workshop, answer the discussion questions below.

What excites you? 

  • Which frame or frames had the biggest impact on your thinking about combating stigma in your communications?
  • What do you find useful or compelling about this frame or part of the framing strategy?
  • For each of these, how or with which audience do you see using it?

What are you questioning?

  • Which frame or frames do you have questions about or find challenging when you think about your communications? 
  • [For each frame]: What do you find challenging about this?
  • What would be helpful when it comes to using this part of the strategy? (Adjustments, customizations, supplemental resources, etc).

3. Test and implement the frames in your personal and professional life.

Thinking about the frame(s) you found most compelling, work on customizing 1-2 talking points that you want to use or test. Then, go out and test these customizable frames and talking points in your life – starting with the dinner table and taking it into your professional spheres of influence.

You will likely run into challenges and push backs in your conversations. We identified five major challenges that d20 participants ran in to while testing these frames:

  1. Keeping the conversation focused on diabetes, not obesity. Participants found that once diabetes was brought up in conversations, people often shifted the conversation to obesity and weight stigma. How might we refocus conversations on diabetes, specifically?
  2. Combatting the blame and shame ‘individual responsibility’ frame. In America, individualism is a core value, and many people believe that personal choice and lack of willpower are the sole causes of diabetes. How might we pivot/reframe when people come back to blaming ‘bad behavior’?
  3. Introducing the health equity frame where it’s not already understood/believed among the audience. The health equity frame presented two challenges for frame-testers: (i) the difficulties around explaining health equity to audiences who don’t resonate with that concept, and (ii) the phenomenon where the concept of health equity often triggered thoughts around race and gender, but not diabetes. How might we bridge the gap in people’s understanding of the link between equity and health?
  4. Inspiring healthy habits without shaming. People are often told to ‘make healthy choices,’ but the dichotomy of ‘unhealthy’ versus ‘healthy’ is often oversimplified and even stigmatizing. How might we inspire behavior change without being stigmatizing n the process?
  5. Getting attention for diabetes without crisis messaging. Frame-testers found difficulty in communicating urgency around diabetes without sparking fatalism. How might we get attention to this issue without adding to our society’s crisis-driven media?

The important piece is to keep revising and testing out new frames. Our collective action to shift the narrative around diabetes can start to dismantle the misconceptions and stereotypes than fuel diabetes stigma. To learn more, explore our dStigmatize Resource Library.