Healing words

By Katharine Russo, PharmD, Johns Hopkins Medicine 

Stigma surrounding type 2 diabetes is a silent barrier to care, one that dismantles trust in the healthcare system, discourages engagement, and weakens outcomes. As healthcare professionals, we have the power and responsibility to eliminate stigma in our practices. 

Type 2 diabetes is often falsely characterized as a condition solely caused by poor lifestyle choices, ignoring the complex interplay of genetics, environment, socioeconomic factors, and comorbidities. This oversimplification fuels blame and shame, leaving patients feeling judged rather than supported. 

We have a duty to shift the narrative. A duty to create a safe environment where patients feel comfortable sharing their achievements and challenges. That begins with language and how we communicate with patients. Avoid terms like “non-compliant” or “failed therapy,” and instead use empowering, person-first language such as “working toward goals” or “experiencing challenges.” Every interaction is an opportunity to affirm dignity and reinforce that diabetes management is a journey, not a moral failing. 

Language shapes perception, and even well-intentioned words can unintentionally reinforce stigma. Here’s a breakdown of common stigmatizing terms and their preferred alternatives, based on guidance from the American Diabetes Association: 

Stigmatizing term: “Diabetic” (as a noun)
Preferred language: “Person with diabetes”
Why it matters: Labels someone by their condition; person-first language affirms identity.

Stigmatizing term: “Diabetic” (as an adjective), e.g. “Diabetic foot,” “Diabetic education”
Preferred language: “Foot ulcer related to diabetes,” “Diabetes education”
Why it matters: Conditions don’t own people; use descriptive, instead of possessive, words. Focus on the physiology or pathophysiology.

Stigmatizing term: “Non-compliant”
Preferred language: “Experiencing barriers,” “struggling with adherence,” or “decreased engagement”
Why it matters: Shifts from blame to understanding; recognizes systemic and personal challenges. For example: “She takes her medication when she can afford it.”

Stigmatizing term: “Normal” (blood sugar, weight)
Preferred language: “In target range,” “healthy weight”
Why it matters: “Normal” implies others are abnormal and can be alienating.

Stigmatizing term: “Failed treatment”
Preferred language: “Treatment didn’t achieve desired outcome”
Why it matters: Avoids framing the patient or therapy as a failure.

Stigmatizing term: “Obese”
Preferred language: “Person with obesity”
Why it matters: Person-first language reduces labeling and judgment.

Stigmatizing term: “Should” (e.g., “You should exercise more”)
Preferred language: “Let’s explore ways to increase activity”
Why it matters: Encourages collaboration rather than giving a directive or using guilt-inducing tone. Focus on what patients are doing well and how to build upon it.

Ending stigma is part of delivering high-quality care. We can commit today to person‑first, strengths‑based language, curiosity about barriers, and shared decision‑making. Two ways to do this include auditing your notes and educating your team. When we change how we speak, we rebuild trust, strengthen engagement, and support better outcomes—affirming that people are more than their A1C. Small shifts in language, repeated consistently, become the culture of care. 

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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.