Diabetes stigma is a significant global issue. The statistics tell a compelling story, with roughly four in five adults with diabetes experiencing some form of diabetes stigma. Additionally, up to one in three people with diabetes have been discriminated against – meaning they have been treated differently (by an individual or an organisation) due to their diabetes.
Diabetes stigma often stems from misunderstandings, misconceptions, or ignorance about what diabetes is, how it is managed, and the complications that may be associated with it. A crucial contributor to diabetes stigma is the myth that diabetes is caused solely by unhealthy behaviours and a lack of personal responsibility. This oversimplifies the risk factors, which include genetics, biology, ethnicity, family history, aging, a person’s environment, and behaviour. No matter what the type of diabetes, no one chooses to have this condition; and no one deserves to be judged for having it or for how they manage it.
The impacts of diabetes stigma are significant, taking a damaging toll on a person’s mental and physical health, self-care and self-esteem, as well as their social and professional lives. For example, diabetes stigma can be associated with increased depressive and anxiety symptoms, diabetes distress, and lower self-esteem. It can also be associated with increased concealment of diabetes and its management (e.g. not checking glucose levels in public), higher HbA1c (average blood glucose), and disengagement from the healthcare system.
It manifests in the looks, stares, judgemental comments, jokes and other ways in which people with diabetes can be treated differently than those without diabetes. And it can lead to rejection, exclusion, or outright discrimination (e.g. in workplaces, schools, and other settings).
The Pledge to reduce diabetes stigma
In 2010, the International Diabetes Federation initiated a call to action to stop discrimination against people with diabetes. Since then, greater research and advocacy has led to an increased understanding of diabetes stigma, and its occurrence. Still, the problem of diabetes stigma and discrimination and its harmful impacts persist.
In a major step forward, two leading organisations in the international diabetes community – the Institute’s Australian Centre for Behavioural Research in Diabetes (ACBRD) and the diaTribe Foundation – have come together with a shared commitment to improving the lives of people with diabetes.
Central to the partnership between ACBRD and diaTribe is collaboration and collective leadership on a series of research projects and initiatives aimed at understanding and reducing diabetes stigma. This will include conducting and publishing further research, developing resources for people with diabetes, healthcare professionals, and the broader diabetes community, as well as global advocacy efforts to raise awareness about, and to bring an end to, diabetes stigma.
One of the first key outcomes emanating from this movement to reduce diabetes stigma is the End Diabetes Stigma and Discrimination Pledge.
The Pledge was formed by an expert panel of 51 people from 18 countries, who united to identify what it would take to bring an end to diabetes stigma. The panel included people living with diabetes who have experience of diabetes stigma, as well as professionals with research and/or clinical experience.
The culmination of the panel was arriving at an International Consensus, which centred not only on the evidence that diabetes stigma and discrimination exist and have harmful impacts, but also on recommendations and the Pledge to bring an end to diabetes stigma and discrimination. These findings were then highlighted in an International Consensus, published in The Lancet Diabetes & Endocrinology.
IHT’s Professor Jane Speight, founding Director of the ACBRD, was the co-lead of the International Consensus and one of the driving forces behind the Pledge.
“Diabetes stigma can have a negative impact on a person’s health and wellbeing,” Professor Speight says.
“It can lead to depression, anxiety, and emotional distress. It can lead them to conceal their condition in public, which can affect how well they manage it. It can also have impacts on their personal, family, social and professional lives.
“Stigma can also have a negative impact on public and government support and funding for diabetes research, prevention, care, and treatments.”
The aim of the International Consensus and Pledge is to galvanise global leadership, commitment, and actions to end the negative stereotypes and prejudice that exist in discourse and decision making about diabetes.
The panel identified the need for people throughout the world to come together to commit to these actions. In uniting as a global community, we can hold a mirror up to reflect how we may have been contributing to diabetes stigma in the past. It’s not about blaming and shaming. It’s about realising where we need to make improvements for the future. Only then will we be able to bring an end to diabetes stigma and the harm it inflicts.
Taking up the Pledge
In August 2023 a website was launched to enable people and organisations across the world to take the Pledge.
The Pledge contains seven key actions.
To contribute pro-actively to bring an end to diabetes stigma and discrimination by:
- respecting people with all types of diabetes.
- recognising diabetes stigma exists and has harmful impacts.
- acknowledging and challenging my/our own prejudices about (people with) diabetes.
- using accurate, respectful, inclusive, non-judgmental, and strengths-based language, messaging, and imagery when communicating with or about people with diabetes.
- avoiding and challenging fear-based messaging and imagery.
- condemning discrimination due to diabetes and advocating for equal treatment and support for people with diabetes.
- encouraging initiatives, policies, and laws that promote equity for all people with diabetes.
Since launching the Pledge, this Australian-led effort has received global support, with the Pledge now being taken up by over 2750 people from 300+ organisations in 100+ countries.
