From language matters to stigma‐free communication in diabetes: Evolution, challenges, and next steps

Abstract

Language profoundly shapes how diabetes is perceived, experienced and managed, with the potential to perpetuate stigma or promote dignity and respect. This expert review, conducted by an international, multidisciplinary team, traces the evolution of the global diabetes #LanguageMatters movement and synthesises evidence on the effects of language on diabetes management, health and wellbeing, alongside community‐preferred terminology. We identified 32 language position statements/guidance documents published in more than 19 countries. Most are applicable to all diabetes types, diverse audiences and address verbal communication; many also consider non‐verbal, paraverbal and, to a lesser extent, visual communication. Beyond recommendations of terms to use or avoid, these statements articulate overarching principles grounded in person‐centred, strengths‐based, empathic and non‐judgemental communication. Evidence of uptake is emerging, including incorporation into clinical standards and research presentation guidance, alongside gradual shifts in language use within some research and media contexts. However, implementation remains uneven, and stigmatising language persists across healthcare, research, policy and public discourse. Despite growing momentum, empirical evidence on community preferences and robust evaluation of adoption and impact remain limited. Language practices are also evolving alongside new technologies, screening approaches and therapeutics, creating additional challenges and opportunities. We identify key gaps in evidence, guidance and implementation mechanisms, and highlight persistent and emerging forms of hidden stigma within systems and structures. We propose a constructive agenda centred on community partnership and system‐level implementation. Treating language as foundational to person‐centred, equitable and compassionate diabetes care is essential to ending diabetes stigma and discrimination across all settings.

What's new?

• Language shapes diabetes experiences, influencing self‐perception, wellbeing, self‐care and healthcare engagement, quality and outcomes; assumptions and judgmental and morally charged terms perpetuate stigma, while person‐first, strengths‐focused language fosters respect, trust and agency.

• This expert review synthesises the global diabetes #LanguageMatters movement, including position statements and uptake, situating it within the broader diabetes stigma research and advocacy landscape. It examines progress, challenges and interdisciplinary perspectives on inclusive, respectful communication across clinical care, research, policy and public discourse.

• Language guidance must continue to evolve. Key gaps are highlighted, and a constructive agenda is proposed to advance context‐specific, culturally sensitive, stigma‐free communication across the diabetes ecosystem.

Our language shapes how we perceive and interact with our world. This means that the words and phrases used in clinical encounters, research, policy, media and everyday conversations are central to how we conceptualise diabetes, interact with people living with or affected by diabetes ¹ , ² , ³ and to the self‐perceptions and experiences of those living with the condition. ³ There is growing international recognition of the need to adopt person‐centred, strengths‐based and non‐stigmatising language that fosters respect for people with diabetes and of the influential role of language in the broader diabetes stigma research and advocacy landscape. ⁴ Drawing on published evidence and the collective expertise of an international, multidisciplinary authorship team (including people with lived experience of diabetes, researchers, health professionals and advocates), this review identifies progress to date, enduring and emerging challenges, and a forward‐looking agenda to achieve stigma‐free communication across diabetes care, research, policy and public discourse.

1. A BRIEF HISTORY OF THE #LANGUAGE MATTERS MOVEMENT

1.1. Language has always mattered: Early critiques of diabetes language

People with diabetes, clinicians and academics have long expressed concern about common diabetes discourse. At the launch of Diabetic Medicine in 1984, a critique and justification for the use of the term diabetic in the journal title appeared in The Times article New Words for Old, ⁵ marking the start of a discussion that continues four decades later. ⁵

Across health and medicine, a shift in terminology from compliance to adherence is presented as progress. ⁶ Yet, more than two decades ago, advocates and researchers critiqued the use of adherence as a concept because, like compliance, it perpetuates a power dynamic that centres the health professional; reinforces the person with diabetes as a passive recipient of advice and care; implicitly frames non‐adherence as personal failure or wilful defiance; and is an ineffectual construct, which does not acknowledge the expertise and role of people with diabetes in self‐managing their condition, ⁷ , ⁸ , ⁹ nor the complex reality of contextual, structural and psychosocial influences on self‐management and health outcomes. ⁸ In 2004, a qualitative investigation ¹⁰ explored how adults with type 2 diabetes (T2D) understand their condition, management, and identity through language, finding that diabetes was commonly framed within a moral discourse of control, surveillance, discipline, and responsibility. This work highlighted that the ideals of control can be stigmatising, which has since been further demonstrated. ¹¹ , ¹² Metaphors of control and compliance are entwined with judgement, blame and the erosion of personal agency, prompting calls for more supportive communication that restores autonomy without implicit or explicit judgement.

Crucially, people living with diabetes have long discussed the power of language, expressing collective frustration at judgmental, inaccurate or dehumanising language. Early advocacy and commentary emerged within peer groups and in magazines, in online communities, blogs and social media, and, most recently, ‘in person’ at diabetes conferences and meetings because #NothingAboutUsWithoutUs. As the value of meaningful community involvement has gained broader recognition across health research and practice, ¹³ these perspectives have achieved greater visibility. They have driven influential grass‐roots advocacy efforts and peer‐led communities (e.g., diabetes organisations, the diabetes online community, ¹⁴ shaping both the tone and substance of diabetes discourse) and contributed to leadership within diabetes organisations ¹⁵ and research environments. ¹⁴ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ Their sustained advocacy has ensured that the #LanguageMatters movement remains grounded in (if not led by) lived experience.

1.2. International recognition of diabetes language and stigma

In 2011, longstanding research and advocacy efforts converged in two landmark publications that formally called for action to reduce diabetes stigma and harmful language. The International Diabetes Federation (IDF) published the International Charter of Rights and Responsibilities of People with Diabetes, affirming the right to social justice, dignity, full participation in society and freedom from discrimination. ²⁰ In parallel, A New Language for Diabetes, published by Diabetes Australia, was the first position statement globally to explicitly recognise that language can either support or stigmatise people with diabetes. ³ , ²¹ It provided practical guidance for respectful communication across healthcare, media, education, policy and public discourse and catalysed the global #LanguageMatters movement (Figure 1). Since then, numerous language position and consensus statements have been issued by national diabetes organisations, professional bodies and grassroots advocacy groups worldwide. More recently, an international consensus to end diabetes stigma was accompanied by a Global Pledge committing signatories to use accurate, respectful, inclusive, non‐judgemental and strengths‐based language and to avoid fear‐based messaging and imagery. ⁴ As of 1 December 2025, the Pledge has been endorsed by more than 4000 individuals and 400 organisations across 117 countries. ²² Together, these initiatives reflect growing global recognition of the need to transform how diabetes is represented and discussed.

FIGURE 1.

Evolution of diabetes language position statements and guidance across the globe.

2. EVIDENCE ON POWER, PREFERENCES AND POWER DYNAMICS

Despite the broader evidence on the power of language to influence perceptions, communication and reality ²³ and long‐standing commentary on diabetes language, ¹¹ relatively little research has systematically examined preferences for, or impacts of, specific terms and phrases among people living with diabetes.

2.1. Words have power

Supportive and caring versus unsupportive and biased diabetes language influences (and is influenced by) affective, cognitive and behavioural responses, with downstream impacts on physical health, psychological wellbeing and social outcomes (Figure 2). ²⁴ These effects are not inherent to words alone but arise through communication processes embedded in context, involving a sender and receiver who encode and decode meaning through existing beliefs and challenges (Figure 3). For example, moralising language about glucose levels, complication risk, or treatment intensification can imply success or failure, increasing distress and influencing engagement with care, whereas collaborative, respectful language supports agency and care engagement. ³ , ¹² , ²⁵

FIGURE 2.

How diabetes language both influences and is influenced by affect, cognition and behaviour within broader socio‐cultural and environmental contexts, with downstream implications for physical, psychological and social health.

FIGURE 3.

Diabetes language and communication processes.

Qualitative studies on diabetes language, ¹² , ¹⁹ , ²⁶ unmet needs in diabetes healthcare ²⁶ , ²⁷ , ²⁸ and diabetes stigma ⁴ show that negative, judgemental or moralising terminology has markedly different effects compared with neutral, accurate and person‐centred language. Two cross‐sectional survey studies quantified cognitive and affective responses to commonly used diabetes language, ¹² , ²⁹ supporting qualitative evidence on feelings of blame and judgement and a lack of motivation in response to terms with moral connotations or which reduced self‐agency, such as non‐compliant, failed, good/bad control. In contrast, positive reactions, such as words feeling helpful or lead to feelings of being understood or respected, are reported for morally neutral and person‐first terms, such as managing diabetes, person with diabetes and referring to glucose levels as within/outside target range. Note that subgroup variation in emotional responses to (and preferences for) specific terms has been observed by diabetes types, ¹¹ , ¹² age, gender, ethnicity and education level. ¹¹

Quantitative evidence on the immediate or longer‐term impacts of diabetes language remains limited, ¹¹ with no experimental or longitudinal studies, to our knowledge, that directly test the causal or temporal impacts of specific diabetes terminology. A recent review reported associations between stigmatising communication and diabetes distress, HbA1c and self‐care behaviours, though evidence is limited and often indirect. ¹¹ Finnegan and colleagues ³⁰ found that recalled exposure to harmful language from family, friends, healthcare providers or media was associated with higher anxiety, depression and diabetes distress, and/or lower treatment satisfaction. Negative language can also cause indirect harm by reinforcing stigmatising social narratives about diabetes. ⁴ Stigmatising messaging is associated with reduced willingness to participate in diabetes screening among at‐risk individuals, ²⁵ , ³¹ lower interest among health professionals in pursuing specialist diabetes training or joining the diabetes workforce, ³² diminished public understanding of diabetes and support for people living with the condition, ³³ and reduced political and policy‐level support, including government investment. ³⁴

2.2. Community preferences

Qualitative studies that examine community preferences for diabetes language have been conducted in Australia, ¹² , ³⁵ , ³⁶ India, ²⁶ Ireland ³⁰ and the United States. ¹⁹ The 2011 Diabetes Australia Position Statement ³ , ²¹ was informed by focus groups (N = 32 adults with type 1 diabetes [T1D] or T2D). ³⁵ , ³⁶ Across focus groups, some labels (sufferer and victim) and words implying moral imperatives (should, must, can't) or judgement (uncooperative, bad, failure) were perceived negatively; whereas diabetic and patient were perceived as neutral: some described these labels as factual, while others preferred person‐first language to maintain an identity independent of diabetes. Words enabling autonomy (self‐management and collaborative goal setting) were viewed positively. Words describing behaviours or outcomes (good, poor, control) evoked mixed responses: some participants used these as cues for self‐assessment and improvement, whereas others experienced guilt, shame or feelings of failure. These early findings are replicated elsewhere, ¹² , ¹⁹ , ²⁶ , ³⁰ including outside diabetes. ³⁷ For example, a qualitative US‐based study (N = 68 ¹⁹ ) identified five categories of problematic language: (1) judgemental, (2) directive or prescriptive, (3) labelling, (4) perpetuating misconceptions and (5) fear‐inducing.

Only one study, to our knowledge, has quantified preferences. In a predominantly Australian online survey (N = 865 adults with T1D, T2D, other types of diabetes and parents of children with diabetes), more than 20 words/phrases were examined for their relative acceptability. ¹² Six terms were consistently endorsed as acceptable and preferable to commonly used alternatives: diabetes needs to be managed (90%, vs. controlled: 28%); diabetes‐related complications (82%, vs. diabetic complications: 32%); person with diabetes (74%, vs. diabetic: 55%); family (73%, vs. carers: 22%); within target/outside target (72%, vs. good/bad: 17%) and condition (70%, vs. disease: 44%).

Across studies, several key issues have been consistently highlighted. First, specifying diabetes type is important for accuracy and to reduce misconceptions. ¹² , ¹³ , ²⁷ , ³⁰ Second, while preferences vary somewhat by diabetes type, ¹² and some people with diabetes use the term diabetic (and this preference should be respected), neutral and person‐first language is acceptable to the majority. ³⁷ Third, echoing early critiques, people living with diabetes emphasise that meaningful change means addressing underlying assumptions, not simply replacing words. ⁹ , ¹⁹ Beyond specific words, intention and delivery matter: some people are less concerned about the specific words used than about whether communication is accurate and empathic. ¹² , ¹⁹ , ²⁶ Communication practices highlighted as demotivating, threatening and/or scary include avoiding eye contact, lack of attentiveness, judgemental facial expressions, aloof body language, unrealistic expectations, using scare tactics to motivate behaviour change, and repeating messages without listening to the person. ²⁶ Furthermore, the power of imagery has also been highlighted. ¹⁴ , ³⁸ People with lived experience perceive a hyperfocus in healthcare and the media on imagery depicting larger bodies, overeating, and diabetes‐related complications, all of which dehumanise those living with diabetes. ¹⁴ , ³⁸

2.3. Contexts and power dynamics

Experiences of stigmatising, unhelpful or unwanted language are reported across multiple contexts. In a study of 183 adults with T1D and T2D in Ireland, most reported stigmatising language use in the media; around half experienced it from family, friends and colleagues; and more than one‐third had encountered it from a health professional in the past 12 months. ³⁰ Similar experiences are reported in relation to social media, diabetes networks and health campaigns. ¹⁴ People with diabetes have emphasised that the acceptability and impact of language depend on context, that is who is speaking and where. ¹² , ¹⁹ , ²⁶ , ³⁰ As diabetes stigma occurs in the context of power imbalance, ⁴ negative diabetes language experienced in the context of healthcare, education or workplaces, for example, may be particularly harmful. ¹² Use of supportive, non‐judgemental language was a key recommendation from a co‐created quality improvement study among adults with T1D that identified medical trauma as a driver of avoidance of care. ³⁹ Across studies, people with diabetes express a desire for person‐centred and respectful interactions that do not reinforce power imbalances. ¹² , ²⁶ , ²⁷

3. REVIEW OF DIABETES LANGUAGE POSITION STATEMENTS

A non‐exhaustive document review including citation searching and listings on the Diabetes Language Matters website (www.languagemattersdiabetes.com) and dStigmatize website (www.dstigmatize.org) identified N = 32 diabetes language position statements/guidance documents, published across 19 countries, in addition to one international, and two regional (European and Latin American) statements/guidance (Table S1).

Most statements are generic (i.e. not tailored to a specific diabetes type and one dedicated to noncommunicable conditions in general, emphasising diabetes), while two focus on T1D and one each on T2D, early‐stage T1D, women and pregnancy with diabetes, and COVID‐related diabetes communication. There remains a relative lack of language recommendations for non‐stigmatising communication specifically among people with gestational diabetes (GDM) and rarer types of diabetes, children with diabetes and those at risk of diabetes. While most statements are broad‐reaching and relevant to all communications, nine are tailored specifically for healthcare professionals, two for the media (news and social), and one for parents and families. In addition to verbal communication, most discussed non‐verbal and paraverbal communication, and some made brief reference to imagery. There have been separate calls for non‐stigmatising imagery within clinical settings, media and health communications. ⁴ , ⁴⁰ , ⁴¹

Table 1 summarises the commonly suggested terms to avoid and recommended alternatives across position statements. Across the 32 guidance documents, more than 50 distinct terms (and their derivatives) were identified as problematic. Notably, over half of these did not feature in the original 2011 statement, ³ , ²¹ suggesting a differing and/or evolving understanding of the language that people with diabetes experience as negative, stigmatising or misaligned with contemporary standards of care. Translations and adaptations of existing position statements are common, while in several countries (i.e., Australia, Brazil, the United Kingdom, the United States) revised editions or new position statements have been published, informed by emerging evidence. Yet, no single statement can be considered comprehensive or universally reflecting the preferences of people with lived experience. Relatively little empirical work has examined preferences and perceptions of diabetes terminology across countries, cultures or specific identity groups, limiting the extent to which current guidance reflects global and subpopulation diversity. Though, a strategy widely used has been developing these guidance documents with or by leaders living with diabetes in the respective countries.

TABLE 1.

Problematic terms/phrases and recommended alternatives for communicating about (people living with) diabetes, identified from published language position statements. ¹⁶ , ²¹ , ⁴² , ⁴³ , ⁴⁴

Problematic terms/phrases	Recommended alternative(s)
About people living with diabetes
Diabetic, patient, consumer a (all as nouns)	Person (living) with diabetes
Sufferer, afflicted, a victim, a stricken a
Normal, healthy (person), non‐diabetic a	Person without diabetes
Burden, cases (e.g., when talking about diabetes prevalence and economic impacts) a	Have diabetes, live with diabetes
Subject(s), patients (noun; in research setting) a	People with diabetes, participant(s), respondent(s)
Cooperative, uncooperative, difficult/challenging patient a Unmotivated/unwilling a In denial a	Describe the behaviour, outcomes; recognise the person's challenges, preferences, priorities and choices, e.g., Finding it difficult…, Has concerns about…, Has other priorities right now…
About support people
Health provider(s), a Clinicians a	Health professional(s), Diabetes care team
Carers a	Family/friends/loved ones/health partners
About diabetes and complications
Disease	Condition, diabetes
Mild diabetes a	Diabetes
Mild hypoglycaemia a	Self‐treated hypoglycaemia
Lifestyle disease a	Diabetes
Obese, normal weight, overweight a	Person living with obesity, excess weight
Diabetic complications a	Diabetes complications, Diabetes‐related complications, Diabetes‐specific complications, complication related to diabetes
About managing diabetes/diabetes risk
(Non)Adherence, (non)compliance and related variations, e.g., adhere, adherent, comply, conform a	Describe specific behaviours, e.g., medication taking, glucose checking
Control: uncontrolled, poor/good control, well controlled, when referring to diabetes management efforts	Manage or influence glucose Describe the behaviour(s)
Should (not), have to, can't, must (not)	You could consider, may want to try, have options
Test(ing), e.g., glucose	Check(ing), monitor(ing), e.g., glucose
Treat(ing), e.g., diabetes	Managing diabetes
Chances e.g., of complications	Health risks, risk of complications
Refused a	Declined
Cheating, a sneaking a	Making choices/decisions
Correct(ing) glucose levels a	Adjust(ing) insulin, Optimising glucose levels
Regimen, a rules a	Plan, choices
Intensify/escalate treatment a	Tailor/personalise/change to more effective or appropriate treatment(s)
Good/bad/poor a	Choices
Lifestyle a , e.g., prescribed lifestyle; lifestyle program	Specify prescription (e.g., dietary changes, increased physical activity) or program (e.g., behaviour change; weight loss); health behaviour
Avoid(ing) a ; preventing/prevention a e.g., diabetes, complications	Reduce risk(s)/risk reduction, delay
About diabetes outcomes
Control, uncontrolled, poor/good control, well controlled. e.g., when referring to HbA1c or glucose levels	Specify level/outcome without a moralistic descriptor. e.g., Stable/optimal, within or outside (above/below) target range, high/low
Failed, failing	Specify level/outcome without a moralistic descriptor e.g., Has not, does not…. e.g., achieve target outcome
Good/bad/poor a	Specify level/outcome without a moralistic descriptor
Results a	Levels, outcomes

Note: This list is not universally endorsed and identifies problematic and alternative words and phrases different between position statements.

^a Indicates terms/phrases identified in position statement published subsequent to the first 2011 guidance.

Beyond lists of specific words and phrases to use or avoid, most position statements outline core principles for improved communication (Table 2). Largely, these principles pertain to the adoption of person‐centred, strengths‐based, non‐judgemental language and empathic communication. ¹⁶ , ²¹ , ⁴² , ⁴³ , ⁴⁴ Such principles are aligned with the recommendations of people with lived experience of diabetes for addressing not only the words but also the underlying attitudes and assumptions. ¹² , ¹⁹ , ²⁶ , ³⁰

TABLE 2.

A summary of core principles for communicating about (people living with) diabetes, identified from published diabetes language position statements, and proposed mechanisms for their support of stigma‐free communication and healthcare.

Principle	Description	Towards stigma‐free care
Respectful 16 , 21 , 42 , 43 , 44	Treating the person with dignity, acknowledging autonomy, preferences, and cultural values	Validates personhood; reduces perceived inferiority
Empathic/compassionate 21 , 42 , 43 , 44	Demonstrating ability to understand the person's emotional and lived experience	Builds emotional safety; reduces shame and isolation
Collaborative 16 , 21 , 42 , 43 , 44	Engaging the person as equal partner in decision‐making and care	Shifts power balance; promotes shared responsibility
Person‐centred/individualised 16 , 21 , 42 , 43 , 44	Tailored to the individual's needs, experiences, and type of diabetes	Counters generalisations; affirms individuality
Strengths‐based/empowering 16 , 21 , 42 , 43 , 44	Highlighting the person's abilities, achievements, and self‐care efforts	Reinforces self‐efficacy; reduces internalised stigma
Neutral and nonjudgmental 16 , 21 , 42 , 43 , 44	Using objective, factual language without moral or emotional bias	Prevents negative labelling and moralising
Accurate and clear 16 , 21 , 42 , 43 , 44	Using plain language that avoids judgment, ambiguity or exaggeration	Reduces confusion and misinformation‐driven stigma
Curious and open 16 , 42 , 43 , 44	Asking questions and seeking understanding rather than making assumptions	Encourages dialogue; disrupts bias and stereotyping
Culturally competent 42 , 43	Recognising and respecting diverse cultural perspectives and communication	Reduces cultural alienation; promotes inclusion
Encouraging/hopeful 16 , 21 , 42 , 43 , 44	Fostering optimism and motivation through supportive tone	Enhances psychological resilience; mitigates despair
Accessible and understandable 44	Ensuring language is clear, simple, and inclusive of literacy needs	Promotes equity and active participation; minimizes exclusion based on literacy and technical terms
Congruent: words and behaviour align 21 , 43	Aligning verbal messages with actions and attitudes to build trust	Builds authenticity; prevents perceived hypocrisy
Blame‐free/non‐authoritarian 16 , 21 , 42 , 43 , 44	Avoiding language that imposes control or moralises behaviour	Shifts power from control to support; reduces guilt and defensiveness

4. REAL‐WORLD IMPLEMENTATION: PROGRESS, CHALLENGES AND OPPORTUNITIES

The #LanguageMatters movement is gaining traction in health promotion, healthcare, research, and the media. Yet, adoption is uneven, and evidence of impact remains limited due to few rigorous evaluations. Further research is needed to examine the adoption of preferred language and communication principles and effective implementation strategies to overcome barriers to adoption.

4.1. Health and diabetes organisations

Most published position statements have been led (or endorsed) by diabetes organisations and/or professional associations. ¹⁶ , ²¹ , ⁴² , ⁴³ , ⁴⁴ Increasingly, such diabetes organisations are making public commitments to bring an end to diabetes stigma and discrimination. ⁴ , ⁴⁵ , ⁴⁶ However, as organisational outputs do not immediately and consistently reflect language standards, it is clear that change of this magnitude takes time, and that health and diabetes organisations may not yet have the knowledge, skills or resources to implement recommended approaches. Some public health and diabetes campaigns are known to be damaging ⁴⁰ and continue to be publicly challenged by the diabetes online community when stigmatising language and imagery are evident. ⁴⁰ For example, in March 2025, the inaugural ‘World Adherence Day’ was launched by the World Heart Foundation and supported by the International Diabetes Federation, ⁴⁷ despite extensive evidence that many people with diabetes perceive the term adherence as stigmatising, ⁶ , ⁷ , ⁸ , ⁹ communication guidelines advising against its use, ³ , ¹⁹ , ⁴³ , ⁴⁴ and longstanding calls to move toward more person‐centred language that respects systemic barriers, priorities and choices experienced by people with diabetes. ¹³ This is not an isolated case. ¹⁴ One study found that eight Australian diabetes awareness campaign videos were experienced as stigmatising by 15% of adults with and without diabetes. ⁴⁸ A review of complications‐focused messaging in Australasian and North American diabetes organisation publications similarly identified issues in language, content and framing that may distort perceptions of complication risk, heighten diabetes‐related distress and undermine engagement in self‐management. ⁴⁹ Another evaluation of 29 online T1D education resources found that all contained problematic language, most commonly using imperative‐based language, such as must/must not. Encouragingly, materials produced after 2018, and those developed by diabetes organisations rather than government bodies, demonstrated fewer disempowering terms. ⁵⁰

To date, no systematic or comprehensive analysis has assessed diabetes communication materials, education programs, organisational policies or campaign outputs at scale. Furthermore, there is limited published evidence on the development of campaigns and messaging, that is community‐involved and evidence‐based. ⁴⁸ A recent community‐led survey identified the acceptability of diabetes‐specific public messaging statements that might be incorporated by diabetes organisations, but the effectiveness or potential unintended consequences are not evidenced. ¹⁴ Given the substantial evidence on health communications broadly, ⁵¹ there is a critical need to bridge this knowledge‐translation gap by supporting diabetes organisations to implement language recommendations into routine communications, thereby delivering more effective, person‐centred campaigns and, simultaneously, modelling non‐stigmatising communications for the wider community, both serving to reduce diabetes stigma. ⁴⁸

4.2. Healthcare: Hidden linguistic environments

Diabetes language guidance has been incorporated into some clinical guidelines, ⁵² , ⁵³ , ⁵⁴ , ⁵⁵ , ⁵⁶ professional resources ⁵⁷ , ⁵⁸ , ⁵⁹ , ⁶⁰ and training ⁶¹ , ⁶² , ⁶³ ; however, stigmatising language remains pervasive in healthcare and public health practice. ¹² , ¹⁶ , ⁴⁹ People with diabetes report stigmatising communication in clinical settings, ¹² , ²⁷ , ³⁰ , ⁶⁴ and problematic language (e.g., noncompliant, uncontrolled, refuses, denies) persists in professional dialogue, ⁶⁵ clinical records, ⁶⁶ , ⁶⁷ textbooks ⁶⁸ and diagnostic classifications and coding systems. ⁶⁹ Other examples of deep language issues, such as insurance coding, remain underexamined in diabetes.

Barriers to clinical implementation identified in the literature include (a) low awareness among non‐specialists of diabetes stigma and language recommendations ⁷⁰ and training options to support implementation ⁴ ; (b) perceptions that careful language is time‐consuming or merely ‘politically correct’, and unspecific or less technical ⁷¹ , ⁷² ; and (c) perceptions that fear‐based communication increases perceived seriousness and motivates behavioural change. ²⁶ These findings highlight the need to enhance and increase accessibility to training and professional development to build skills in empathic, non‐stigmatising communication, encourage the adoption of community‐preferred terminology and address the practical and attitudinal barriers currently limiting implementation. Current recommendations emphasise reflexivity and active listening, ¹ , ⁷³ deeper stigmatising attitudes may require more substantial interventions. While empathic, non‐stigmatising communication can be strengthened through training, ⁷⁴ few diabetes‐specific programmes have been developed or evaluated, and entrenched attitudes may require more intensive intervention. Emerging practices, including AI‐enabled decision support, may support stigma‐free care ⁷⁵ but also risk undermining person‐centred communication if they reduce meaningful clinical interactions. ⁷⁶ , ⁷⁷ , ⁷⁸ Importantly, the ongoing use of stigmatising language in curricula, textbooks and diagnostic classifications represents a significant infrastructural challenge to the adoption of stigma‐free communication.

Biased language is more common in the clinical records of people with higher HbA1c, complications, women and people of colour, pointing to intersectional stigma. ⁶⁶ , ⁷⁹ This underscores the need for targeted anti‐discrimination training and systematic review of medical curricula, resources, clinical documentation and coding systems to prevent the perpetuation of harmful language.

4.3. Research

Diabetes researchers have a responsibility to communicate accurately, with minimal bias or harm. ² Use of preferred diabetes language in journal articles has increased over time but remains incomplete. ⁸⁰ A 2014 database search found that terms such as compliance and control were prevalent. ⁷² A 10‐year review from 2011 to 2020 ⁸⁰ showed that 43% of diabetes articles used person‐first language, with the rate of adoption increasing by 3% per year before plateauing in 2018–2020. Only 28% of journals had formal person‐first language policies, and articles published in those journals were nearly three times more likely to meet recommended standards. ⁸⁰ Evidence remains limited on how well language recommendations are implemented in funding calls, grant applications, research protocols, materials (e.g., plain language statements, clinical outcome assessments, questionnaires), interventions and outputs (e.g., presentations, media releases). Some recent interventions have adopted preferred language. ⁸¹ , ⁸² A qualitive study exploring lived experience perceptions of five commonly used diabetes‐specific quality of life questionnaires respondents reflected on some words and phrases that they perceived as victimising (e.g., normal, control, burden). ⁸³ Indeed, outdated language in person‐reported outcome measures remains a key challenge, given that researchers must balance the need to use instruments with proven psychometric properties against the importance of adopting stigma‐free, person‐centred terminology. Thus, although there is progress in research settings, adoption remains incomplete, highlighting the need for ongoing awareness‐raising, training, policy implementation and editorial oversight to improve diabetes research materials, practice and dissemination.

4.4. Media

The media is a key facilitator of stigma, often using inappropriate language in diabetes coverage. ¹⁴ , ³⁰ Investigations of media coverage across various time periods and countries consistently highlight a focus on individual responsibility and behaviour attribution, alongside growing attention on economic and societal burden, while paying minimal attention to structural determinants of health and either omitting distinctions between diabetes types or reinforcing stereotypes when they do differentiate. ³³ , ⁸⁴ , ⁸⁵ , ⁸⁶ , ⁸⁷ , ⁸⁸ Two reviews of Australian newspaper coverage have examined the use of diabetes‐related language. One observed a statistically significant reduction in problematic language (from 70% of articles in 2010 to 46% in 2014) and a concurrent increase in preferred language, although most articles used a mix of both. ⁸⁹ Another analysis of 2013–2017 media found that approximately one‐quarter of articles still used the term diabetic. ⁹⁰ There is a relative lack of implementation strategies and media‐specific language guidance, suggesting an area for further work. Similar implementation and evaluation are needed in film, television and social media to benchmark diabetes‐related discourse and guide further intervention.

5. CONTINUING AND EMERGING CHALLENGES IN LANGUAGE GUIDANCE

Like the diabetes research and care landscape, diabetes language is continually evolving, guided by new evidence, insights from related fields and, importantly, lived experience perspectives. Several continuing and emerging issues underscore the need for ongoing reflection on, and adaptation of, language guidance to support stigma‐free communication. Additionally, reducing stigma requires attention to language associated with conditions closely linked to diabetes. ⁹¹ , ⁹² , ⁹³

5.1. Early detection classifications

Rapid advances in early T1D detection have prompted new guidance to support accurate, non‐stigmatising communication around screening, staging, and progression, including an emphasise that T1D be presented as a disease across all stages of clinical progression. ⁹⁴ This may reflect concerns that early‐stage T1D be taken seriously, with appropriate clinical support and prioritisation for research and health system resources. However, community preferences in at least one study, and reflected in several guidance documents, favour the term condition. ¹² Framing insulitis (the autoimmune attack on beta cells) as the disease and the resulting insulin deficiency as the condition we know as T1D might mitigate this tension. This area will likely continue to evolve and require evidence‐based and community‐informed communication strategies that minimise stigma, misinterpretation and psychological burden while supporting informed decision‐making for those with access to monitoring.

It is notable that such community‐led advancements in communication are not currently mirrored in T2D. Several subclassification frameworks have been suggested for T2D, supporting opportunities for precision‐based medicine approaches, ⁹⁵ , ⁹⁶ , ⁹⁷ yet the degree to which these systems – and their language – align with community preferences or lived experience values is unclear. Terms such as severe, mild, insulin‐deficient, insulin‐resistant, obesity‐related and age‐related have been proposed in combination to describe the classifications, ⁹⁵ which risk reinforcing T2D stigma for some. ⁴

5.2. New acronyms, old challenges: The discourse of control

The proliferation of new terms and acronyms may serve evolving science and clinical purposes, but it can also generate confusion or discomfort among people living with diabetes. Recent examples include the aforementioned stages of T1D, remission of T2D, MASLD/MASH ⁹³ and GMI (an estimated HbA1c derived from continuous glucose monitoring). ⁹⁸ The extent to which new terms are acceptable to the community is unclear. The potential evolution of glucose metrics from Time In Range to Time in Tight Range (TITR) or Time In NormoGlycaemia (TING) is controversial. ⁹⁸ The evidence on the harms of the control and normality discourse in diabetes, including lived experience accounts, highlights the importance of holistic care beyond glucose management, ¹⁰ , ¹¹ , ¹² suggesting that such terminology may overlook what matters to people with diabetes and exacerbate inequities by privileging near‐perfect glucose profiles over meaningful reductions in burden and distress. Relatedly, recognising that communication transcends words, advocates have called for the use of colour‐neutral representations of glucose metrics, rather than the commonly used traffic‐light approach in which red signals ‘failure’ or a problem. ⁴¹

5.3. Lifestyle

Despite discouragement in several position statements, the term lifestyle remains common in public health and media discourse, often used to label some or all types of diabetes as a lifestyle disease caused by lifestyle factors or choices. This language is vague, conflates complex determinants of health (i.e. biological, social, commercial), and frames diabetes risk as a matter of personal choice and individual responsibility. ⁹⁹ A significant proportion of people with T2D experience stigma due to lifestyle framing, ¹⁰⁰ and individuals with T1D or GDM similarly report blame and misattribution of responsibility, sometimes prompting calls to adopt alternative terminology. ⁴ Moreover, framing T2D as a personal failure affects public attitudes and reduces support for systemic or policy‐level interventions. ³⁴ Thus, the term lifestyle perpetuates stigma, obscures structural drivers of diabetes and undermines calls for investment in research, care, technologies and policy.

5.4. Prevention, risk reduction and health promotion

Relatedly, as highlighted in language position statements, caution is needed in public health and media messaging, which often implies that diabetes and its complications are preventable or avoidable, ¹⁰¹ typically without distinguishing diabetes types. Such messaging is informed by landmark randomised controlled trials, where adults at risk of T2D received intensive support, coaching, and/or medications and were able to achieve and sustain weight loss to reduce risk. ¹⁰² However, in real‐world settings, evidence of sustained weight loss and T2D prevention has been far more modest. ¹⁰³ Similarly, while effective metabolic management may reduce the risk of complications among people with any type of diabetes, complications can still occur despite excellent self‐management. Framing diabetes or its complications as ‘preventable’ can therefore create false reassurance and contribute to blame, self‐blame, fear, and isolation. Indeed, people with diabetes report that complication messaging is fear‐inducing, ¹⁹ overestimate their actual risk of complications ¹⁰⁴ ; and worries about future complications are a leading driver of diabetes distress. ¹⁰⁵ Calls have been made to address language specific to diabetes complications. ¹⁰⁶ The term risk reduction is increasingly recognised as preferable to prevention because it accurately reflects the evidence that some risks can be reduced but not fully prevented, ¹⁰⁷ acknowledges non‐modifiable factors, social determinants and health inequities, and supports realistic agency rather than unattainable goals. While behaviour change programs can support self‐management and reduce risk, health professionals and organisations also have a responsibility to avoid simplistic or stigmatising framing and to promote equitable outcomes.

5.5. Chasing the cure

There is ongoing critique regarding the language of T2D remission. ¹⁰⁸ Remission of T2D is possible for some people with T2D. ¹⁰⁹ However, it represents a metabolic state that must be actively maintained, commonly requiring substantial long‐term behaviour change, ongoing weight management and, for some, continued pharmacotherapy. ¹⁰⁸ Unlike cancer, where remission is clearly understood as tentative, T2D remission is frequently conflated with ‘reversal’ or ‘cure’, obscuring effort, feasibility and recurrence risk. ¹¹⁰ Such language may reinforce blame if remission is not attempted, achieved or maintained. Indeed, people with T2D report differing perspectives on what a cure would look like. ¹¹¹ Similarly, despite rapid advancements in medical science, the term cure is inappropriate in the context of currently emerging treatments for T1D. ¹¹² This is particularly relevant in public communications (including media and fundraising), where the language of curing diabetes may generate unrealistic expectations, anxiety or disappointment. Guidance should emphasise accurate, factual and evidence‐based language, including clear definitions of concepts such as cure or remission where relevant.

5.6. The war on diabetes

War metaphors have been used in healthcare for decades and are increasingly common in diabetes, with calls to combat, fight, beat and defeat the diabetes explosion. However, this well‐intentioned messaging has unintended consequences. The continuous battle feels insurmountable and exhausting, amplifying the negative impacts of diabetes on physical and mental well‐being. While military metaphors may seem intuitive for countering the diabetes epidemic messaging and raising awareness, they position the diabetes community to fight for limited resources rather than building sustainable partnerships. There is a compelling case for reframing messaging to position people with diabetes as experts deserving support, not soldiers in an endless battle.

6. TOWARDS STIGMA‐FREE COMMUNICATION IN DIABETES

Word swaps provide a practical foundation for supporting and evaluating stigma‐free communication. Achieving stigma‐free communication also requires attention to non‐verbal elements – including tone, body language, imagery, and colour – as well as message framing and factual accuracy. Table 2 summarises the core communication principles promoted across position statements, which may reduce diabetes stigma. Beyond the continuing and emerging issues discussed above, several key factors are essential for advancing the #LanguageMatters movement and enacting the Pledge to End Diabetes Stigma.

6.1. Respect diversity and context

There are no one‐size‐fits‐all solutions, whether in word choice or implementation strategies: individual and subgroup differences are observed in word preferences and impacts. ¹² A universal approach is unlikely to be effective, and stigma‐free communication must reflect personal, cultural and contextual nuances. A persistent limitation in research is the diversity of study populations and insufficient attention to cultural differences. Although position statements exist in multiple countries and languages, guidance still needs translation, adaptation and tailoring to local preferences and experiences, particularly for underserved or minority populations. Early engagement with people from diverse cultural, religious, and community backgrounds can support adaptable, context‐sensitive guidance. Publishing such engagement can further enhance global understanding of community preferences.

6.2. Involving and respecting lived experience expertise

Community perspectives are critical for shaping language and message interpretation. Ongoing community leadership and meaningful involvement of people with diabetes are essential for developing safe, acceptable and effective communication standards and implementation strategies. However, participatory approaches must actively address diabetes stigma ¹³ and language matters. Problematic terms are often kept in place to preserve hierarchy. ¹¹³ Terms such as patient partners, public or patient involvement, or patient authors may centre institutional authority, whereas lived experience experts foreground the person's expertise, equity and shared power.

Evidence from other health fields demonstrates that lived‐experience storytelling is an effective tool for reducing health stigma. ¹¹⁴ , ¹¹⁵ In diabetes, Knapp drew on her lived experience of T1D to illustrate the impact of language on self‐management, sharing her story with health professionals and providing recommendations for others to develop and share their own experiences. ¹¹⁶ When communication guidelines are co‐developed with those directly affected, language is more likely to reflect inclusion and respect. In this way, #LanguageMatters is inseparable from #NothingAboutUsWithoutUs.

6.3. A universal approach to stigma‐free health communication

Language Matters guidance has also been published for several other long‐term conditions, for example, obesity, ¹¹⁷ mental health and addiction, ⁹¹ , ¹¹⁸ with similarly slow uptake across sectors. ⁸⁰ , ⁹² , ¹¹⁹ , ¹²⁰ , ¹²¹ , ¹²² Some advocates have called for a universal approach to addressing health stigma, ¹²³ , ¹²⁴ recognising the multiple and intersecting forms of stigma experienced by individuals and within societies. Such an approach could help extend the reach of #LanguageMatters principles, support implementation of stigma‐reduction interventions, and enable more consistent measurement and evaluation. However, this should be balanced with attention to condition‐specific nuances. While a universal approach may promote respectful, non‐judgemental communication for all, different populations have unique needs and preferences, ¹²⁵ and the body of lived experience, advocacy and research that has informed diabetes‐specific guidance should not be disregarded.

6.4. Future research and implementation

Table 3 summarises key gaps in evidence, evaluation and implementation for stigma‐free communication in diabetes. Future research priorities include understanding population‐ and context‐specific language preferences; measuring the impacts of language on wellbeing, self‐care and health outcomes; developing standardised tools to quantify stigmatising language across clinical, educational and media contexts; balancing communication of risk without inducing self‐blame; adapting guidance for evolving terminology and community contexts; training healthcare professionals to shift both spoken and hidden language; updating research instruments for stigma‐free language without compromising validity; and identifying strategies to embed position statements, pledges and advocacy initiatives sustainably and at scale.

TABLE 3.

Key unanswered research and implementation questions and future directions in diabetes language and stigma.

Population, context and individual differences	How do language preferences and effects differ, e.g., by diabetes type, age, gender, culture, ethnicity, or care setting? How should guidance be adapted for diverse populations and contexts? How do we effectively navigate individual preferences and disciplinary differences in terminology?
Impact of language on people with diabetes and society	How does exposure to stigmatising versus person‐centred language affect wellbeing, self‐care, engagement with healthcare, and metabolic outcomes over time? What mechanisms explain these effects? How does the diabetes language used in policy, research, media, campaigns, and social media influence stigma at a population level?
Measurement of stigmatising language	How can we operationalise and develop standardised measures to quantify the prevalence of stigmatising language, e.g., in conversation, media, health promotion messaging, electronic clinical records, referral letters, healthcare education curricula, and other embedded contexts?
Balancing ethics, risk and impact	How can risk and severity be communicated effectively without inducing self‐blame at individual and population levels, including in clinical consults, health promotion messaging and funding calls?
Emerging terminology	How can language and stigma‐free guidance stay nimble to diabetes advancements and evolving communities and contexts?
Healthcare professional training and hidden language	Which educational approaches are effective in improving health professionals’ use of language and their behaviours in diabetes care? How does hidden stigmatising language in diagnostic classifications, clinical records, referrals and curricula influence diabetes clinical care and healthcare culture? What are health professionals’ views on the adoption of stigma‐free language, and what are the associated barriers and enablers?
Research, measurement and tools	How can language be modified to reduce stigma and power imbalance in research practice and dissemination? How can research instruments be updated for stigma‐free language without compromising validity and reliability? How does wording of research materials affect participants’ engagement, responses and outcome measurement?
Implementation strategies	How can position statements, pledges and advocacy initiatives achieve measurable real‐world impact, and be embedded sustainably in systems? What population‐level of context‐specific implementation strategies are effective for improving the adoption of stigma‐free communication recommendations? What role could a universal stigma‐free healthcare and communication framework play in increasing uptake of #LanguageMatters principles in diabetes care?

7. CONCLUSION

Language shapes our lives. It influences how diabetes is understood, how care is delivered and how people with diabetes experience themselves and others. Respectful, stigma‐free communication is a moral, evidential and practical imperative. While the #LanguageMatters movement has transformed awareness and practice globally, continued commitment and evolution remain essential. To end diabetes stigma and discrimination, language must not be treated as a finishing touch but as foundational to person‐centred, equitable and compassionate diabetes care. Moreover, the adoption of stigma‐free approaches must extend beyond healthcare settings, with site‐specific guidance and implementation strategies developed across all sectors. Crucially, people with diabetes must continue to lead and be meaningfully involved throughout the ongoing shape, adoption, implementation and evolution of stigma‐free communication.

AUTHOR CONTRIBUTIONS

EH‐T and JS conceived the article scope and developed the initial outline, which all authors reviewed and contributed. The full draft was prepared by EH‐T in collaboration with EE, EL, PK and JS. All authors reviewed, contributed to, and approved the final version. ChatGPT was consulted for editorial support only, to refine clarity, flow and grammar and reduce word count.

FUNDING INFORMATION

EH‐T and JS were awarded funding from Deakin University's Institute for Health Transformation to support this expert review. EH‐T, JS, TS, EL and EE are, or have been, supported by the core funding to the Australian Centre for Behavioural Research in Diabetes (ACBRD) provided by the collaboration between Diabetes Victoria and Deakin University. EE is also supported by a Deakin University Industry PhD Scholarship, in collaboration with The diaTribe Foundation. PS is supported by the Charles A Allard Chair in Diabetes Research and the Academic Medicine and Health Services Program.

CONFLICT OF INTEREST STATEMENT

Several of the authors were involved in the development of the cited diabetes language and stigma position statements, guidelines and initiatives reviewed in this article. In addition, several authors have received unrestricted educational grants, competitive funding and/or have been employed by the diabetes organisations/associations that published these guides or initiatives. However, this article was prepared independently with no formal review or input provided by/on behalf of organisational representatives. EH‐T has undertaken research funded by unrestricted educational, investigator‐initiated, and/or competitive grants from Abbott Diabetes Care, AstraZeneca, Breakthrough T1D, Diabetes Australia, Diabetes Canada, Diabetes Victoria, and Sanofi, Australia. RS has received consulting fees from Sanofi, Roche, Novo Nordisk and Eli Lilly. She has an advisory role with #dedoc°. PAS has received personal fees for consulting, or speaker fees, from Abbott, Anaptys Bio, Bayer, Dexcom, DiogenX, Eli Lilly, GSK, Insulet, Medscape, Novo Nordisk, Sana, Sanofi, Vertex and Ypsomed. He has received grant support for his institution from Bayer, Eli Lilly, Immunovant, Novo Nordisk, Sanofi, Brain Canada and CIHR, Breakthrough T1D. He is past Board Chair of Diabetes Canada, a co‐investigator with Diabetes Action Canada and Can‐ScreenT1D. MTUB is an advisory committee member of Life for a Child International; a lived experience advisory group member of FIND; scientific advisory board member of International Alliance of Patients' Organizations; commissioner for the Lancet Global Health Commission on People‐Centered Care for Universal Health Coverage; steering committee member of NCD Laboratory and Meaningful Engagement (GCM‐WHO); former vice president and honorary member of Brazilian Juvenile Diabetes Association and former vice president of the International Diabetes Federation. TCS has served on Advisory Boards for Novo Nordisk (last in 2020), AstraZeneca, Eli Lilly and Sanofi (all pre‐2007). JS has served on advisory boards for Diabetes Australia, Diabetes Canada, Janssen, Medtronic, Omnipod, Roche Diabetes Care and Sanofi Diabetes; received unrestricted educational, investigator‐initiated and/or competitive grants, or in‐kind support from Abbott Diabetes Care, AstraZeneca, Breakthrough T1D, Diabetes Australia, Diabetes Canada, Diabetes Victoria, Medtronic, Roche Diabetes Care and Sanofi Diabetes; received sponsorship to attend educational meetings from Medtronic, Roche Diabetes Care, and Sanofi Diabetes; and consultancy income or speaker fees from Abbott Diabetes Care, AstraZeneca, Insulet, Medtronic, Novo Nordisk, Roche Diabetes Care and Sanofi Diabetes, with all honoraria paid to her institution. JS is chair of the international Psychosocial Aspects in Diabetes Study group, and several authors are members of this same group. TCS reports that he has received funding from Roche Diagnostics for research projects and been CI on grants with Roche as a co‐funder. All other authors declare that they have no relevant competing interests.

POSITIONALITY STATEMENT

We acknowledge that this expert review is shaped by our identities. Our multidisciplinary authorship team brings expertise across research, healthcare, advocacy and/or lived experience of diabetes. Among us, three authors disclose lived experience of type 1 diabetes and one has experience of gestational diabetes; one author is a parent of a child with type 1 diabetes, and several have close family members with lived experience of diabetes. Our team comprises men and women across diverse ages and career stages, residing across seven countries, including Australia (EH‐T, EE, EL, RS, TS, JS), Brazil (MTUB), Canada (PS), Germany (AM), India (CS, TL), the United Kingdom (PK) and the United States (MG, SG, JKD). We recognise that our identities, demography, expertise and privilege influence our understanding and interpretation of diabetes language and stigma, and that what we perceive as cultural or social ‘norms’ may differ from the experiences and perspectives of people from other backgrounds and communities.

Supporting information

Table S1. Summary of diabetes language position statements/guidance.