Expert Opinion: Language Matters When Discussing Diabetes

Miriam E Tucker

October 26, 2017

In addressing individuals with diabetes, clinicians should be mindful of the language they use to ensure that their words empower and motivate rather than discourage and potentially undermine self-management efforts, according to a new statement from two leading professional diabetes organizations.

The evidence-informed expert opinion document, "The Use of Language in Diabetes Care and Education," was published online October 17, 2017 in both Diabetes Care and the Diabetes Educator .

The 10-member writing panel included representatives from the American Diabetes Association and the American Association of Diabetes Educators and was chaired by Jane K Dickinson, RN, PhD, CDE, of the department of health and behavior studies, Columbia University, New York.

"Words have the power to 'elevate or destroy.' This is also true of language referring to persons with diabetes, which can express negative and disparaging attitudes and thereby contribute to an already-stressful experience of living with this disease. On the other hand, encouraging and collaborative messages can enhance health outcomes," Dr Dickinson and colleagues write.

The focus on language dovetails with the diabetes care and education paradigm shift in recent years away from the traditional view of the healthcare provider as the expert who tells people what to do and toward a more collaborative approach in which people with diabetes are viewed as the center of their own care teams.

"Healthcare professionals have an opportunity to reflect on the language used in diabetes and adapt strengths-based, collaborative, and person-centered messages that encourage people to learn about and take action to manage this complex disease," the authors say.

Five Broad Recommendations

Based on a review of the literature and clinical experience, they make five broad recommendations: 

  1. Use language that is neutral, nonjudgmental, and based on facts, actions, or physiology/biology. Avoid "control" as a verb, adjective, or noun, including "controlled," "poorly controlled," "good control," or "bad control," A better word might be "manage." And, rather than indicate that the person "failed" on a medication, a neutral, judgment-free replacement would be, "He is taking sulfonylureas and they're not bringing his glucose levels down enough," for example.

  2. Use language that is free from stigma. Terms such as "compliant," "noncompliant," "adherent," or "nonadherent" should be avoided. Replacements might include "engagement" or "involvement" and using sentences such as "he takes his medication about half the time," or "she takes her insulin when she can afford it."

  3. Use language that is strengths-based, respectful, inclusive, and imparts hope. Instead of "you are going to end up blind or on dialysis," say, "More and more people are living long and healthy lives with diabetes. Let's work together to make a plan that you can do in your daily life."

  4. Use language that fosters collaboration between patients and providers. Avoid imperatives that imply a power differential, such as "can"/"can't," "should"/"shouldn't," or "must"/"must not." Better words are "plan" and "choices" and phrases such as "have you tried…," "May I make a suggestion…," "What is your plan for…," or "May I tell you what has worked for other people…"

  5. Use language that is person-centered. "Diabetic" should not be used as a noun or adjective to describe people. They are "people" first, who happen to be living with diabetes.

Dr Dickinson has no relevant financial relationships. Disclosures for the coauthors are listed in the paper.

Diabetes Care. Published online October 17, 2017.  Article

Diabetes Educator. Published online October 17, 2017.  Article

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