Just Read: The use of language in diabetes care and education

“Slaying it with KETO🥩🥓🍳🍗🍖 from 249 in January 2019 to 211 December 2019”

This image was sent to me today. It’s from someone in my life who was diagnosed with prediabetes and has now lost forty pounds through diet alone.

When I see physicians or other health care providers using words that destroy (see below), I smile. One day, someone close to them will reverse their diabetes/prediabetes and they won’t be able to unsee it.

Then, their language will change.

Language that shames and judges may (contribute) to diabetes distress, and ultimately slow progress in diabetes outcomes

I was prompted to read these two pieces while reviewing the Standards of Medical Care in Diabetes—2020 of the American Diabetes Association. There’s a revolution underway in our understanding of diabetes management. Language is due for the same change.

I see fellow physicians use language related to diabetes that seems at cross-purposes to the needs of the people they are here to serve.

Specifically, the use of terms like “fad” as well as other terms of judgement. Terms cited in one of the papers:

“noncompliant/compliant,” “uncontrolled/control,” “good/bad,” “test,” “morbidly obese,” “can/can’t,” “should/shouldn’t,” “are you supposed to?”

Dickinson JK. The experience of diabetes-related language in diabetes care. Diabetes Spectr. 2018 Feb 1;31(1):58–64. 

Directive terms were also cited, including:

“you’ll get used to it,” “just,” “should,” “lose weight,” and “at least it’s not . . .” “lose weight,” “exercise more,” “should/ shouldn’t,” “can’t,” “no,” “stop,” “not allowed to,” and “don’t.”

Dickinson JK. The experience of diabetes-related language in diabetes care. Diabetes Spectr. 2018 Feb 1;31(1):58–64.

Even when these words are not used in an explicitly directive way, I see the meaning as directive, as in “the answer is for you to….”

Words have the power to “elevate or destroy”

Dickinson JK, Guzman SJ, Maryniuk MD, O’Brian CA, Kadohiro JK, Jackson RA, et al. The Use of Language in Diabetes Care and Education. Diabetes Care [Internet]. 2017 Dec 1;40(12):1790–9.

In the era of diabetes reversal….

Curiously, these papers were written without an awareness of the potential of diabetes reversal:

Control is virtually impossible to achieve in a disease where the body no longer does what it is supposed to do.

Dickinson JK, Guzman SJ, Maryniuk MD, O’Brian CA, Kadohiro JK, Jackson RA, et al. The Use of Language in Diabetes Care and Education. Diabetes Care [Internet]. 2017 Dec 1;40(12):1790–9.

At the same time, I respect the difficulty of the term “control” and appreciate the sensitivity presented here. Still, I wonder what a style guide written with the new ADA guidelines in mind would say.

There’s also a discussion about the negative impact of stigma. Again, some of the language I see physicians using in regard to patients who are reversing their diabetes seems to only foment stigma rather than remove it. Why do they use this language?

Forty pounds – some things you can’t unsee

Forty pounds.

I wish this experience on every nurse and doctor in their lifetimes.

Once you see the benefits of LCHF you can never unsee them.

Belinda Fettke

References

1. Dickinson JK. The Experience of Diabetes-Related Language in Diabetes Care. Diabetes Spectr [Internet]. 2018 Feb 1;31(1):58–64.

2. Dickinson JK, Guzman SJ, Maryniuk MD, O’Brian CA, Kadohiro JK, Jackson RA, et al. The Use of Language in Diabetes Care and Education. Diabetes Care [Internet]. 2017 Dec 1;40(12):1790–9.

Conflicts of interest noted

B.M. is employed by AstraZeneca Pharmaceuticals. K.L.C.: Close Concerns reports that several academic institu- tions, government bodies, and pharmaceutical and device companies in the diabetes field subscribe to the company’s fee-based newslet- ter, Closer Look, and The diaTribe Foundation re- ports that it receives donations from a number of pharmaceutical and device companies in the di- abetes field. M.M.F. served as an advisory panel member for Eli Lilly and Sanofi.

Dickinson JK, Guzman SJ, Maryniuk MD, O’Brian CA, Kadohiro JK, Jackson RA, et al. The Use of Language in Diabetes Care and Education. Diabetes Care [Internet]. 2017 Dec 1;40(12):1790–9.

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