Let’s Talk about Diabetes – UROP Symposium

Let’s Talk about Diabetes

Anderson Riley

Research Mentor(s): Kevin Joiner
Authors: Kevin Joiner, PhD, Anderson Riley, Alicia Carmichael, M.S., Natalie Leonard, M.S., Janeann Paratore, B.S.


The Centers for Disease Control and Prevention describes type 2 diabetes as when cells do not respond normally to insulin; this is called insulin resistance. Eventually, insulin resistance leads to a rise in blood sugar, and high blood sugar is damaging to the body. The uptake and sustained use of biomedically advanced treatments, new technologies among people with type 2 diabetes, and the implementation of comprehensive treatment guidelines among primary care providers (PCPs) have shown signs of success in preventing or slowing type 2 diabetes-related complications and mortality. However, the benefits to health and health care of type 2 diabetes have not reached all populations equitably.

Emerging data suggest that adults with type 2 diabetes encounter stigma and discrimination due to diabetes in social spaces, workspaces, and healthcare facilities. Sigma processes occur due to a characteristic that “marks” an individual as different from others, typically in the context of power. There are two general forms of stigma: social stigma and self-stigma. Social stigma can be experienced or perceived by an individual as blame, judgment, stereotyping, rejection, exclusion, and discrimination. Self-stigma occurs when an individual internalizes social stigma, manifested as feelings of embarrassment or shame. This is a major issue because diabetes stigma is recognized to negatively impact health-related outcomes for people with type 2 diabetes.

In the context of racial, ethnic, and socioeconomic disparities in health care of people with type 2 diabetes, effectively minimizing diabetes-stigmatizing language in patient-PCP communication is a important research element. Effective communication between the person with type 2 diabetes and the PCP is a crucial gateway to surmounting the logistical and structural impediments that might arise that can hinder appropriate self-management. Research suggests that individuals’ experiences and perceptions of stigma related to health conditions vary by race and ethnicity. PCPs may be unaware of how diabetes stigma impacts people with type 2 diabetes, and PCPs may also lack the skills to use non-stigmatizing alternative language.

Given these challenges, our solution was to design a training module for PCPs that allows for teaching and reinforcing skills to reduce type 2 diabetes-stigmatizing language in PCP-patient communication. First, the participants role-play a consultation session with a trained standardized patient, which is recorded in high-definition audio and video (AV). Next, the participants view a demonstration video in which skills in recognizing the diabetes-stigmatizing language and using non-stigmatizing alternative language are portrayed. In addition, they receive a quick guide to identifying diabetes-stigmatizing language and finding non-stigmatizing alternative language. Finally, the participants view their own recorded consultation session with the standardized patient, annotate any diabetes stigmatizing and diabetes non-stigmatizing language that they used in the consultation session, and suggest non-stigmatizing alternative language that they may have used instead. These skills have the potential to minimize diabetes-stigmatizing language inpatient-PCP communication, with the long-term goal of contributing to improving the health and healthcare of people with type 2 diabetes, accelerating health equity, and eliminating diabetes disparities. Minimizing diabetes-stigmatizing language in patient-PCP communication could lead to improved health outcomes, increased health equity, and reduced diabetes disparities.

lsa logoum logo