Rising Above the Bias: Let’s Talk About Diabetes

Stigma is, unfortunately, not new for many people living with diabetes. In fact, more than 70% of adults and 98% of children with diabetes report experiencing stigma, which can have profound effects on both mental and physical health. 

While stigma may be all too familiar for those living with the condition, people without diabetes may not realize how damaging a joke or offhand remark can be. Well-intentioned friends, family, and even healthcare professionals may not realize that comments or suggestions they think are helpful can actually be hurtful. As Sarah Zarr wrote in her essay about navigating the food police, “You want those who love you to just…get it.”

This is exactly why Abbott launched Above the Bias, a new campaign that aims to help others see the world from the perspective of someone living with diabetes. Part of the campaign is "The Emotional Toll of Diabetes," a short film designed to show people what it’s like to live with diabetes prejudice and help dismantle harmful stereotypes.

“In my 20 years as a clinical psychologist specializing in diabetes, I’ve really seen the full spectrum of life with diabetes and heard their stories,” said Dr. Susan Guzman, director of clinical education at the Behavioral Diabetes Institute. “A common theme that comes up again and again is, ‘I feel really misunderstood as a person with diabetes and alone with the experience.’” 

“That’s the whole point of this project: to help the rest of us who don’t live with diabetes understand and have empathy for those who do.”

Also supporting the campaign is actress and dance legend Debbie Allen. Though Allen doesn’t live with diabetes, it runs in her family; her father passed away from diabetes-related complications and she received a prediabetes diagnosis in 2021.

“I remember my aunt at a party saying to another family member living with diabetes, ‘Girl, you better put down that cake, we don’t want you to end up in the hospital in a coma.’ That was laughed at, but it wasn’t funny. I could see the pain that it gave,” Allen said. “This stigma comes mostly from family and friends. That’s who we’re talking to, that’s who this is for.”

How stigma can impact diabetes care

The old “sticks and stones may break my bones but words will never hurt me” rhyme you may remember from childhood isn’t exactly true – words can hurt. Studies have shown that diabetes stigma not only affects mental health, but has also been linked to higher A1C levels and a higher frequency of diabetes-related complications in adults with diabetes.

Also involved in the Above the Bias initiative is Jane Dickinson, a registered nurse and certified diabetes care and education specialist. Dickinson has lived with type 1 diabetes for almost 50 years and has been studying the impact of language on people with diabetes for over a decade.

“The flip side is the physical impact that stigma has on people with diabetes,” Dickinson said. She referenced a survey conducted by Abbott that showed nearly 40% of respondents experienced increases in body temperature, heart rate, and sweating when exposed to stigmatizing phrases – especially those related to food.

“The statement, ‘Should you really be eating that?’ really triggered a stress response in people. It was along the lines of what someone would experience at a job interview,” she said. “And we all know that high stress isn’t great for the human body.” 

Diabetes stigma can also have an impact on getting proper care; roughly 40% of people with diabetes said they’ve skipped or missed a doctor’s appointment due to shame or stigma. Jeniese Hosey, who lives with type 2 diabetes, described how isolating it was being diagnosed at age 26, as well as a less than ideal experience with her first endocrinologist. 

“They dismissed all of my cares and concerns. It made me feel very small and insignificant. It made me feel like I was making some things up in my head,” Hosey said. “Growing up plus-size, I already had a lot of stigma that surrounded me and I felt like the diagnosis of diabetes was just adding to that.”

As both a healthcare professional and person living with diabetes, Dickinson said one way to combat stigma in healthcare settings is to focus on communicating in a person-centered way.

“Always think about the person. When we use labels like ‘diabetic,’ ‘noncompliant,’ and ‘uncontrolled,’ where’s the person? That’s why we’re trying so hard to say ‘person living with diabetes.’ It reminds us that they are indeed living with this and they’re managing it every day,” she said. 

Hosey added that while she’s come a long way and is often able to roll her eyes or brush off insensitive comments, stigmatizing comments – even ones that aren’t intended to be – still affect her. 

“The weight of other’s opinions about living with diabetes is something I’m faced with every day,” she said. “Offer people empathy and grace because you never know what someone is dealing with.”

Collectively addressing diabetes stigma

“It’s incredibly encouraging to see more and more companies and organizations call attention to this issue,” said Matthew Garza, director of diaTribe’s dStigmatize program, which is dedicated to raising awareness and addressing diabetes stigma through research, educational initiatives, and campaigns. “Abbott’s Above the Bias campaign is a great first step to raise awareness among people without diabetes about the impact of stigmatizing language.” 

“When we launched dStigmatize in 2022, we knew that eliminating diabetes stigma was going to take decades-long advocacy efforts from all different sectors,” said Garza, referencing additional efforts and campaigns from other groups including Lilly, Insulet, Diabetes Canada, and the Bermuda Diabetes Association. “This isn’t a problem that any one person or group can solve on their own.”

This idea is reinforced by the international consensus on diabetes stigma, published in 2024 by some of the world’s leading diabetes researchers, advocates, and healthcare professionals in the Lancet Diabetes & Endocrinology. That consensus effort identified gaps in the public’s understanding of diabetes and provided recommendations for interventions, research, and messaging. It also challenged everyone – from individuals to diabetes organizations to industry leaders – to prioritize ending diabetes stigma as part of their long-term goals.

“I think it’s important to continually challenge everyone in this space, ourselves included, to work collaboratively with one another and always make sure people with diabetes are in the room from the very beginning,” Garza said. “We also need to make sure we aren’t just repeating harmful stereotypes and messages about people with diabetes over and over again, but replacing these stigmatizing narratives with actionable information and more respectful and empowering language.”

There’s research to show that this strategy can really make a difference. The Abbott survey found that close to 70% of people living with diabetes said supportive comments helped motivate them to manage their condition. 

“We know that people do better when they feel loved, cared for, encouraged, and supported,” said Guzman. “We can do better.”

“The bottom line is that people with diabetes deal with barriers every single day,” Dickinson added. “Stigma and bias are just one more. If we can remove that barrier, then we can help and support people with diabetes.”

Want to learn more about how to support people with diabetes and end diabetes stigma? Here are some more helpful resources: 

• Changing the Narrative Around Diabetes
• Take the Pledge to End Diabetes Stigma and Discrimination
• How To Talk About Nutrition With People With Diabetes
• Diabetes Stigma is Everywhere, But You Can Do Something About It
• How To Talk About Diabetes-Related Complications

Photo credit: Associated Press