Opinion-based consensus guidelines promote the use of certain diabetes-related words and avoidance of others, based on the assumption they cause distress. Our study tested this hypothesis using a validated tool to systematically assess the emotional responses of people with type 1 and type 2 diabetes to diabetes-specific language.
Methods: The Diabetes Language Task (DLT), a tablet-based Application, includes words and phrases derived from consensus guidelines and other published research. Each word/phrase is rated on 2 scales assessing levels of Anxiety and Distress. T-tests were used to determine differences between the recommended Avoid and Use Language and among sub-groups, applying the Bonferroni correction for multiple comparisons.
Results: The DLT was completed by 90 study participants (Median age= 50 years (range 19-75 years); 66% female; 59% with type 1 diabetes; median A1c=8% (range 6-13%); median diabetes duration=15 years (range 3 months-45 years)) attending public and private diabetes services. Hypotheses were confirmed in 8/14 (57%) comparisons of Avoid vs. Use words, e.g., ‘suffering from diabetes’ was rated more distressing than ‘person living with diabetes’ (p<0.00001) and ‘non-compliant’ rated more distressing than ‘making choices’ (p<0.00001). Other terms assumed to be negative were rated as positive by study participants including ‘nondiabetic’, ‘normal’, ‘in control' and ‘adherent.’ Complications-related terminology including ‘Amputations’, ‘Blindness’, 'Kidney damage’ and ‘Disease progression’ generated the highest levels of distress and anxiety within the DLT. Few differences in emotional reactions were found according to type of diabetes, complications status or A1c.
Conclusions: Study findings provide support for some published diabetes language recommendations but also highlight discrepancies and identify the need to address the use of Complications Language.
L.J. Beeney: None. R. Hinton: Other Relationship; Self; Medtronic, Novo Nordisk Inc., Roche Diabetes Care. J. Overland: None.
Australian Diabetes Educators Association; Australian Diabetes Research Foundation