Diabetes has a special way of establishing roots where words and tone can trigger sensitive emotions. As clinicians, our words can be a source of hope or despair from the perspective of the patient living with a chronic diagnosis. Co-author Lauren, is a person living with type 1 diabetes and working closely with a diverse patient population. She can attest to the power of words in the context of disease management. 

Health care is moving in the direction of person-centered care where treatment decisions are made collaboratively — a vital approach to the success of the person with diabetes. This method allows patients to find their voices within the metrics of care management and feel personally involved. To support patient advocacy and maintain the integrity of individuals who live in partnership with disease, an American Diabetes Association (ADA) taskforce recommends that we lean in with our language.

Language has an impact on motivation and outcomes for people assuming an active role in self-care. Our choice of words must avoid placing disease as a negative presentation with respect to the individual's learning and communication preferences. 

Language lies at the core of attitude change, social perception, personal identity and stereotyping. Psychosocial well-being of the individual hinges on non-judgmental language from the moment of diagnosis. Connecting to patients on a personal level while guiding them through the challenges of chronic disease is key to acceptance and progress. When presenting a complex diagnosis like diabetes or an intensive prevention program to reverse prediabetes, empathy encourages continuity of care. If diabetes is perceived as sad, difficult to manage, hopeless, or a Sisyphean burden, patients will not feel supported or set up for success. 

The personal responsibilities of self-management in diabetes challenge the boundaries of physical and mental health. Even with continuous support, missing therapeutic goals can appear to be caused by a poor attitude or unwillingness to learn, while at the core of the problem is a frustrated person who needs to be heard and understood. 

The way health care professionals speak to people living with diabetes can encourage or discourage engagement and collaboration. Blame, fear, and denial of disease are characteristics of diabetes distress that can be linked to the tone and manner of how we speak when care is provided. Focusing on what is wrong instead of what is working leads to isolation, underreporting, and distrust of health advisors. Using deprecating labels like noncompliant, poorly controlled, and suffering, while being addressed as “a diabetic” pushes stigma to a personal level. Words that indicate failure can provoke feelings of embarrassment, stress, and shame, leading to decreased motivation and lower engagement. 

A patient’s experience with their clinical team relates to quality of life. Care and compassion is required for people living with diabetes in both verbal and non-verbal communication. A hurried approach and beginning conversations with biomarkers instead of personal conversation has the potential to degrade a person down to a numerical value. Self-worth is often tied to a moving target of sensitive measurements and data, while the threat of complications, restrictive food rules, and lack of individualization discourages personal responsibility. Listening for opportunities to identify toxic thoughts and reframe self-blame builds a bridge between patient and provider. Allowing space for patients to discuss challenges without judgement opens up the potential for collaborative solutions in the patient's best interests. 

Strengths-based language encourages self-sufficiency. How we talk to people with diabetes plays an important role in accepting responsibility. Person-first language conveys respect and focuses on what the person “has” rather than what a person “is.” Addressing a person by name as “having diabetes” directs perspective away from that of a victim and towards a position of command. A strong sense of self demonstrates potential for growth and sparks desire from within to make changes. Inversely, labeling a person as “diabetic” encourages them to adopt the same language when speaking about themselves as secondary to a diagnosis. The person-first method encourages patients to embrace diabetes as character-building, versus giving the impression that self-management is a relentless uphill battle. 

Language that elevates can change lives. Meeting patients with positivity and a gentle hand-off to trusted resources establishes a collaborative relationship based on education and continuous support. The exchange of authority for knowledge in an encouraging environment inspires patients to embrace challenges and take initiative to reduce risk at their own pace. Goals identified by patients will prioritize values as they become directors of their own care; a key step in demonstrating the will to self-advocate and take initiative with skills that can lead to a healthier and happier future. 

Three take-home summary points from recent relevant literature:

• Language lies at the core of attitude change, social perception, personal identity and stereotyping; words have the power to inspire hope. 
• The way health care professionals speak with people living with diabetes can encourage or discourage engagement; reframing self-blame builds a bridge between patient and provider that supports a collaborative relationship built on trust and empathy. The ADA strongly recommends that we avoid using the term “diabetic” and instead speak to your patient as a “person with diabetes.” 
• Strengths-based language encourages self-sufficiency; a knowledge-based approach while using language that elevates supports personal development and ability to advocate for themselves. 

To learn more, check out the following sources:

1. Language Use in Diabetes Care
2. Patient and Clinician Perceptions of Prediabetes: A Mixed-Methods Primary Care Study
3. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers

Lauren Plunkett RDN, CDCES, is a Registered Dietitian and Certified Diabetes Care and Education Specialist in St. Paul, Minnesota. She specializes in nutrition and exercise education for patients with diabetes and also works with chronic care patients on the primary care team at Doctor On Demand Telemedicine.

Prentiss Taylor MD, FACP, is an Attending Physician In Internal Medicine at Advocate Christ Hospital in Metro Chicago and also serves as V.P. for Medical Affairs for Doctor On Demand. Prentiss is a small shareholder in Doctor On Demand.

Illustration by Jennifer Bogartz