Language Matters in Diabetes and in Diabetes Science and Research

The language that healthcare providers use regarding diabetes can have a profound impact on people living with diabetes. This also extends to diabetes researchers. Language matters in diabetes, not only because problematic language can reinforce or introduce negative messaging and judgments about people living with diabetes, but because more specific and accurate language also improves the understanding of science, medicine, and research.

In the last few years, there has been significant effort ¹ to document the impact of language on people living with diabetes and how language might be received when spoken by healthcare providers. Diabetes researchers who are not also clinicians, however, may not have been exposed to the many position statements ² encouraging the shift in language use related to diabetes. But they, too, would benefit from adapting commonly used language regarding diabetes, if only for one other reason: vague and imprecise language often obfuscates the meaning that the author is intending to convey.

I have seen this firsthand as a patient, researcher, peer reviewer, and as a grant reviewer for diabetes-related research. Simply put, much scientific writing, regardless of the audience, includes vague, unspecific terms related to control, mechanisms of diabetes, or medication effects.

For example, it is common to read about an “anti-diabetic effect,” without any detail on whether that means addressing the source of one or more types of diabetes or whether it is intended to simply refer to a glucose-lowering effect. It would be more effective to describe the glucose-lowering effect of a drug if that is indeed what is being referred to. Otherwise, readers are left guessing, and it dilutes the potential impact and understanding of the work.

Similarly, “control” is often used in vague ways, either as a noun or as a verb. Both are often used ineffectively. “Control” as a verb is often used to refer to an aggregate of multiple human behaviors (e.g. checking blood glucose, carbohydrate counting, and injecting insulin). “Poor control” is also used as a derogatory and stigmatizing noun regarding outcomes, without regard to whether those outcomes are impacted by human behaviors and/or things a person cannot, in fact, control (such as metabolism). In either case, researchers should instead use words that focus on describing actions or behaviors or glycemic results.

There is a growing body of evidence in diabetes showing the effect of different behaviors on the clinical outcomes ³ achieved. With increasing access to diabetes technology, we will increasingly move from guessing to choosing what manual behaviors a person with diabetes wants to do to achieve their goal outcomes, whether those be clinical outcomes, reducing effort, improving quality of life, or all three. ⁴ It is especially important to acknowledge the disparities, too, in who has access to tools that enable them to achieve their desired diabetes outcomes ⁵ and ensure that any individuals who do not have access to diabetes technology are not also stigmatized for that.

It is no longer necessary in research or in clinical practice to use vague, unspecific terms regarding people with diabetes, their chosen behaviors, and clinical outcomes. Language matters, and it is time to effect these changes in all aspects of diabetes care, ⁶ including research.