Doctors urged to adapt language towards people with diabetes

The type of language used by diabetes healthcare teams towards the people they treat can have a significant impact on their health, according to a specialist committee board.

A report entitled Joint Consensus Statement on the Use of Language and presented at the American Diabetes Association (ADA) 77th Scientific Sessions, suggests words such as “uncontrolled” and “non-adherent” should be avoided.

The article also states many people do not like to be described as “diabetic” as it makes them feel disrespected, hopeless, and dismissed.

When referring to the person’s blood sugar levels it has been recommended healthcare professionals should avoid the use of “good,” “bad,” or “poor”.  It is suggested that explaining what safe and unsafe levels, or what a target level is would be a better way of achieving better results.

Dr Susan Guzman, who is a clinical and research psychologist at the Behavioral Diabetes Institute in San Diego and wrote the report, said: “Language conveys meaning and can reflect bias that will affect outcomes, even when you’re not aware of it.

“If you’re talking about a patient as ‘non-compliant,’ even before you go into the room, I guarantee you that they feel that from you, even if you’re not calling them that to their face.”

Any subtle tone of voice or inflection that conveys a sense that diabetes is the result of a character flaw or a failure of personal responsibility, or that they are a burden on the healthcare system is counterproductive, experts said. Patients will not do as well at getting control of their diabetes.

Guzman, along with Jane Dickinson, a certified diabetes educator and nurse at Teachers College Columbia University in New York and committee chair, and Melinda Maryniuk, director of clinical education for the Joslin Diabetes Center in Boston, presented  “Why Language Matters” at the American Diabetes Association on Sunday.

Ms Maryniuk said: “It’s not about being the word police. Think about the meaning, and the whole patient, and the conversation you’re having with them.”

She said she is optimistic the consensus statement they have written will be accepted and published, in part because the ADA last year officially banned use of the word “diabetic” from publications when referring to individuals with diabetes. In its Standards of Medical Care in Diabetes, the organization said it will continue to use “diabetic” when referring to complications, like diabetic retinopathy.

Five Recommendations

The 10-person committee presented five recommendations:

1. Use language that is neutral and non-judgmental, based on facts, action or physiology/biology.

Don’t say, “Your diabetes is not in good control. It seems your efforts with meal planning, exercise, and metformin have failed, so it’s time to add another medication.”

Instead say, “Your recent A1C level is 8.5. That is above the target goal of 7.0 we discussed. I’m thinking that adding another medicine that works in a different way could help. How does that sound?”

2. Use language free of stigma in referrals.

Don’t say, “While I’m willing to refer this patient to you (an RDN), I doubt it will do any good as she has been obese for a long time, and is unmotivated and in denial. She has not done anything I’ve suggested.”

Instead say, “I’m referring a new patient to you. She has a BMI of 35 and while I’ve suggested she cut back on high calorie foods, it has not resulted in weight loss. Let me know what you learn and what you’d recommend.”

3. Use language that is respectful, inclusive and imparts hope.

Don’t say, “Mrs. Lee, I see that you’ve been non-compliant with blood glucose testing as you’re not doing it after meals as we discussed. You really should be doing this.”

Instead say, “Mrs. Lee, I see you’ve been successfully checking fasting blood glucose two to three times this past week. Great work. What might make it easier for you to also check after meals a few times?”

4. Use language that fosters collaboration.

Don’t say, “Mr. Smith, I see that you didn’t fill your prescriptions. Let me see your blood glucose log, please.”

Instead say, “Mr. Smith, I see that your last A1C result is 9.2%. Do you have concerns you’d like to discuss … perhaps about many challenges you face taking medicines?”

5. Use person-centered language.

Don’t say, “Diabetics who suffer from hypertension should follow a DASH (Dietary Approaches to Stop Hypertension) diet.”

Instead say, “People with diabetes who also have hypertension may benefit from learning about the DASH approach to meal planning.”