Diabetes is a very common chronic disease. Stigma persists and can negatively affect a person’s self-sufficient behavior. This can make them less likely to get the help they need to treat the condition.
Diabetes affects approximately 29 million people in the United States. However, people with diabetes can sometimes suffer from diabetes stigma. Feelings of inadequacy or judgment related to living with a chronic illness can damage a person’s self-image and potentially affect their self-sufficiency.
Diabetes stigma occurs when a person living with diabetes is excluded, rejected, or accused of living with a chronic condition, researchers say. The person may feel like others are judging them.
Certain observable behaviors and characteristics of diabetes can cause a person to experience stigma and shame. Examples include:
- Take insulin injections
- with hypoglycemic episodes
- regular monitoring of blood sugar levels
- Compliance with dietary restrictions
- to be overweight
“Much of the stigma about weight and body in a larger body […] is associated with type 2 diabetes, ”explains Dr. Elizabeth Wassenaar, a regional medical director at the Eating and Recreation Center and the Pathlight Mood and Anxiety Center in Denver, CO.
Diabetes stigma can affect people in unexpected ways. An article in The Lancet describes a woman who won a discrimination lawsuit against a local concert venue because a security officer refused to let her put an energy drink on a show despite the need to treat hypoglycemia.
A 2018 survey by the nonprofit Diabetes UK found that more than a third of people with diabetes hadn’t told their employers about their diagnosis. In addition, 1 in 6 people said they felt discriminated against in the workplace because of their diabetes, and 1 in 4 wanted more time to take breaks to monitor their blood sugar levels, take insulin, and visit doctor’s appointments.
Researchers and diabetes experts have different theories about why diabetes stigma exists.
One theory is that shame can be linked to self-criticism. A 2017 study of 5,422 people with type 1 and type 2 diabetes concluded that stigma disproportionately affects those who have difficulty coping with their condition. The researchers found that people who had a high body mass index (BMI) or A1C, or reported that they couldn’t control their blood sugar levels, were most likely to experience a stigma.
Jaclyn Morris, a registered nutritionist at the DaVita Kidney Care outpatient dialysis center in Moorpark, CA, says diabetes stigma makes many of her patients feel guilty and responsible for their condition. “They feel like they haven’t had enough blood sugar control and are now on dialysis and need more care, which can put a greater strain on their families and finances,” says Morris.
A person living with type 2 diabetes may also feel criticized by others for being excessively weight, eating the wrong foods, or not doing enough to prevent their condition.
A 2013 review article reported that people with diabetes may feel like they are being constantly assessed and monitored. In the meantime, people without diabetes often fail to realize that there is a diabetes stigma. The researchers conclude that these realities can affect self-sufficiency, self-esteem, and ultimately the clinical outcomes of people with diabetes.
“Many people mistakenly believe that if you control your diet or weight, you can prevent type 2 diabetes completely. You translate this to mean that with type 2 diabetes you are “out of control” and take this into your own hands, ”explains Dr. Wassenaar.
Media can also play a role in promoting stigma. Reputable news organizations have published reports on how treating diabetes is contributing to rising health care costs, according to the diaTribe Foundation, a nonprofit organization. The group says that people with diabetes are frustrated, that society seems to believe that the disease is not a big deal, and that complete treatment is possible with simple lifestyle changes.
Research has shown that diabetes stigma can damage a person’s self-image and lead to mental health problems. A 2020 study of more than 2,000 people with type 1 and type 2 diabetes linked this stigma to symptoms of depression, anxiety, and suffering.
“I have several patients who come for treatment wearing the faith they brought with them [type 2 diabetes] on yourself. You have great difficulty letting go of these ideas – that your own worth, or worth, depends on how your body reacts to food, ”says Dr. Wassenaar.
These beliefs can prevent people from looking after themselves and from looking for the help they need. “Intrinsic bias affects almost everything, including medical education, and can result in people who need help with mood swings or eating disorders being overlooked by healthcare providers or receiving medical advice that worsens their mental health,” says Dr. Wassenaar.
Accurate mental health diagnosis and proper care can ultimately improve markers of type 2 diabetes, explains Dr. Wassenaar. “Don’t assume that dieting will work against depression, anxiety, or eating disorders,” she says.
Diabetes stigma is the feeling of being judged or ashamed of living with this chronic illness. If not recognized, it can increase your risk of anxiety and depression. Experiencing stigma can deter people from getting the treatment they need and from self-care, which can increase the risk of diabetes complications.
People who feel a stigma related to diabetes should definitely speak to their health team and consider seeing a psychologist. Proper care can not only help improve a person’s mental health, but also their diabetes results.
