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Expert Perspectives: How does stigma affect people with type 2 diabetes?
February 24, 2021

Diabetes affects about 29 million people in the United States. However, people living with diabetes may sometimes experience diabetes stigma. Feelings of inadequacy or judgment linked to living with a chronic disease can harm a person’s self-image and potentially affect their self-care.

What is diabetes stigma? 

Diabetes stigma occurs when a person living with diabetes feels excluded, rejected, or blamed for living with a chronic condition, say researchers. The person may feel as though others are judging them.

Certain observable behaviors and characteristics of diabetes may lead a person to feel stigma and shame. Examples include:

  • taking insulin injections
  • having hypoglycemic episodes
  • regularly monitoring blood glucose levels
  • adhering to dietary restrictions
  • having excess body weight

“Much of the stigma about weight and being in a larger body […] becomes associated with type 2 diabetes,” explains Dr. Elizabeth Wassenaar, a regional medical director at the Eating and Recovery Center and Pathlight Mood and Anxiety Center in Denver, CO.

Diabetes stigma can affect people in unexpected ways. An article that appeared in The Lancet describes a woman who won a discrimination lawsuit against a local concert venue because a security guard refused to let her bring an energy drink into a show despite it being necessary to treat hypoglycemia.

A 2018 survey by the nonprofit organization Diabetes UK found that more than one-third of people with diabetes had not told their employers about their diagnosis. In addition, 1 in 6 people said that they felt discriminated against in the workplace due to their diabetes, and 1 in 4 wished that they had more time for breaks to monitor their blood sugar levels, take insulin, and attend doctor appointments.

Why does diabetes stigma exist?

Researchers and diabetes experts have several theories about why diabetes stigma exists.

One theory is that shame may be associated with self-criticism. A 2017 study involving 5,422 people with type 1 and type 2 diabetes concluded that stigma disproportionately affects those who struggle to manage their condition. The researchers found that people who had a high body mass index (BMI) or A1C level or reported that they were unable to control their blood glucose levels were most likely to feel stigma.

Jaclyn Morris, a registered dietitian with the DaVita Kidney Care outpatient dialysis center in Moorpark, CA, says that diabetes stigma causes many of her patients to feel guilty and responsible for their condition. “They feel they didn’t control their blood sugars enough and now are on dialysis, requiring more care, which can place more strain on their families and finances,” says Morris.

A person living with type 2 diabetes may also feel criticized by others for having excess body weight, eating the wrong foods, or not doing enough to prevent their condition.

A 2013 review article reported that people living with diabetes might feel as though people are continually judging and monitoring them. Meanwhile, people without diabetes often do not realize that diabetes stigma exists. The researchers conclude that these realities can affect the self-care, the self-esteem, and, ultimately, the clinical outcomes of people living with diabetes.

“Many people erroneously believe that if you control your diet or weight, you can completely prevent type 2 diabetes. They translate that to mean that if you have type 2 diabetes, you are ‘out of control’ and bringing this on yourself,” explains Dr. Wassenaar.

Media may also play a role in promoting stigma. According to the diaTribe Foundation, a nonprofit organization, reputable news organizations have published stories about how diabetes treatment contributes to the rising cost of healthcare. The group says that people living with diabetes feel frustrated that society seems to believe that the condition is no big deal and that fully managing it is possible with simple lifestyle changes.

How does diabetes stigma harm people with type 2 diabetes? 

Research has shown that diabetes stigma can harm 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 distress.

“I have several patients who come to treatment carrying the belief that they’ve brought [type 2 diabetes] on themselves. They have a great deal of difficulty letting these ideas go — that their own value or worth is tied to how their body responds to food,” says Dr. Wassenaar.

These beliefs can prevent people from caring for themselves and seeking the help they need. “Intrinsic bias impacts almost everything, including medical education, and can cause people who need help with mood or disordered eating to be missed by healthcare providers or given medical advice that worsens their mental health,” says Dr. Wassenaar.

An accurate mental health diagnosis and proper care can ultimately improve type 2 diabetes markers, Dr. Wassenaar explains. “Don’t assume that dieting is going to address depression, anxiety, or disordered eating,” she says.

The takeaway

Diabetes stigma is the feeling of being judged or shamed for living with this chronic condition. If it goes unrecognized, it can increase the person’s risk of anxiety and depression. Experiencing stigma can discourage people from seeking the treatment they need and engaging in self-care, which can increase the risk of diabetes complications.

People who feel stigma related to diabetes should be sure to talk to their healthcare team and consider seeing a mental health professional. Getting the proper care can help improve not only a person’s mental health but also their diabetes outcomes.

     

     

     

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