Diabetes stigma and discrimination represent a pervasive global challenge that adversely affects the emotional, mental, and physical health of millions of people living with the condition. To address this urgent issue, an international multidisciplinary expert panel of 51 members from 18 countries collaborated to establish a unified consensus on the evidence and recommendations necessary to eliminate these harmful social judgments. The authors highlight that while research into the stigma associated with other health conditions like HIV or obesity began decades ago, diabetes-related stigma has only recently received substantial academic attention. This landmark consensus statement aims to galvanize collective leadership across all sectors of society, including healthcare, policy, and media, to state unequivocally that stigma is not only unethical but also counterproductive to achieving positive health outcomes.
The foundation of this study involved a rigorous methodology consisting of 12 topic-focused rapid reviews and a three-round Delphi survey process to reach an international agreement. The expert panel, which included individuals with both lived and professional experience of diabetes, achieved unanimous consensus on a global pledge to end diabetes stigma and discrimination. Through the Delphi method, the panel reached high levels of agreement on 25 statements of evidence and 24 specific recommendations for change. This systematic approach allowed for the consolidation of over 116 relevant research papers published since 2013, representing a six-fold increase in literature on the topic over the last decade. By centering the voices of those affected, the consensus ensures that the resulting strategies are grounded in real-world experiences and scientific rigor.
Diabetes stigma is defined as negative social judgments, stereotypes, and prejudices, whereas discrimination refers to the unfair or prejudicial treatment that often serves as the endpoint of the stigmatization process. The sources describe various forms of this phenomenon, including experienced stigma (tangible examples), perceived stigma (awareness of its existence), and internalized stigma, where individuals absorb these negative views, leading to self-blame and shame. Furthermore, structural discrimination manifests in societal norms and institutional practices that constrain a person’s rights, such as unfair treatment in employment, education, or insurance. The consensus emphasizes that stigma typically occurs in the context of a power imbalance and is driven primarily by blame, perceptions of burden, and fear.
The prevalence of these experiences is staggering, with research indicating that four in five adults with diabetes experience stigma, and one in five experience direct discrimination. These negative experiences are found in every country where they have been investigated, though the specific stereotypes may vary by culture. For instance, in some societies, diabetes is inaccurately linked to contagiousness or spiritual curses, while in others, it is framed as a “lifestyle disease” caused by laziness or gluttony. Such misconceptions are often fueled by sensationalist media messaging and public health campaigns that use fear-based imagery to shock the public. These narratives perpetuate the false idea that individuals are solely to blame for their condition and its complications, ignoring complex genetic, environmental, and socioeconomic factors.
The consequences of diabetes stigma are multidimensional, affecting nearly every aspect of a person’s life. From a psychological perspective, those who experience or internalize stigma are significantly more likely to report depressive symptoms, anxiety, and lower self-esteem. Socially, stigma can lead to withdrawal, isolation, and the concealment of the condition from family, friends, and colleagues. In healthcare settings, individuals who feel judged by professionals may disengage from care, delay seeking treatment, or experience lower-quality consultations. Critically, stigma has a measurable impact on physical health, as it is associated with higher HbA1c levels, more frequent severe hypoglycemia, and an increased risk of complications.
To combat these harms, the consensus offers a comprehensive suite of 24 recommendations focused on research, communication, and policy. A central recommendation is to change the social narrative from one of blame to a balanced focus on the biological and social determinants of health. This includes the “Language Matters” movement, which advocates for clear, respectful, and non-judgmental communication in all settings. Healthcare professionals are urged to undergo training in stigma-free consultation skills, and professional bodies are called upon to include these practices in their standards of care. Additionally, the panel recommends that news and print media commit to fair and accurate reporting that avoids sensationalism and fear-based tactics.
At the structural level, the consensus demands that discrimination due to diabetes be clearly defined and prohibited by law in all countries. Many existing legal protections, such as disability acts, are often ambiguous or inaccessible to those who do not identify with the term “disabled,” creating barriers to social justice. The statement also highlights the need for equitable funding for diabetes research, noting that current allocations are often disproportionately low compared to other conditions and are sometimes influenced by stigmatizing views among policymakers. Organizations are encouraged to integrate stigma reduction into their strategic plans and to support initiatives that promote equity for all types of diabetes. Meaningful engagement with people living with diabetes is essential to the design and implementation of these policies.
Ultimately, the consensus culminates in a unanimous pledge to end diabetes stigma and discrimination, which has already been endorsed by thousands of individuals and hundreds of organizations worldwide. By taking this pledge, participants commit to respecting people with all types of diabetes, using inclusive language, and challenging their own prejudices. The authors conclude that bringing an end to this “insidious and pervasive” problem is both an urgent necessity and a collective responsibility. As we move forward, the goal is to shift the social norm from one of judgment to one of compassion and support. Diabetes stigma acts like a persistent, invisible headwind; even when an individual works hard to move forward, the social environment continuously pushes back, making every step toward health significantly more difficult than it needs to be.
Reference: Speight, J., Holmes-Truscott, E., Garza, M., Scibilia, R., Wagner, S., Kato, A., Pedrero, V., Deschênes, S., Guzman, S. J., Joiner, K. L., Liu, S., Willaing, I., Babbott, K. M., Cleal, B., Dickinson, J. K., Halliday, J. A., Morrissey, E. C., Nefs, G., O’Donnell, S., … Skinner, T. C. (2024). Bringing an end to diabetes stigma and discrimination: An international consensus statement on evidence and recommendations. The Lancet Diabetes & Endocrinology, 12(1), 61–82.