American Diabetes Association

Table 4

Suggestions for replacing language with potentially negative connotations

Language with potentially negative connotations	Suggested replacement language	Rationale
Compliant/compliance, noncompliant/noncompliance, adherent/nonadherent, adherence/nonadherence	“He takes his medication about half the time.” “She takes insulin whenever she can afford it.” “He eats fruits and veggies a few times per week.” Engagement Participation Involvement Medication taking	The words listed in the first column are inappropriate and dysfunctional concepts in diabetes care and education. Compliance and adherence imply doing what someone else wants, i.e., taking orders about personal care as if a child. In diabetes care and education, people make choices and perform self-care/self-management. Focus on people’s strengths—what are they doing or doing well and how can we build on that? Focus on facts rather than judgments.
Control (as a verb or adjective)
Controlled/uncontrolled, well controlled/poorly controlled	Manage “She is checking blood glucose levels a few times per week.” “He is taking sulfonylureas, and they are not bringing his blood glucose levels down enough.”	Control is virtually impossible to achieve in a disease where the body no longer does what it is supposed to do. Use words/phrases that focus on what the person is doing or doing well. Focus on intent and good faith efforts, rather than on “passing” or “failing.” Focus on physiology/biology and use neutral words that don’t judge, shame, or blame.
Control (as a noun)
Glycemic control, glucose control, poor control, good control, bad control, tight control	A1C Blood glucose levels Blood glucose targets Glycemic target/goal Glycemic stability Glycemic variability	Focus on neutral words and physiology/biology. Define what “good control” means in factual terms and use that instead.
Diabetic (as an adjective)
Diabetic foot	Foot ulcer, infection on the foot	Focus on the physiology or pathophysiology.
Diabetic education	Diabetes education	“Diabetic education” is incorrect (education does not have diabetes).
Diabetic person	Person with diabetes	Put the person first.
“How long have you been diabetic?”	“How long have you had diabetes?”	Avoid using a disease to describe a person.
Diabetes patients	Patients with diabetes	Avoid describing people as a disease.
Diabetic (as a noun)
“Are you a diabetic?”	“Do you have diabetes?” Person living with diabetes Person with diabetes Person who has diabetes	Person-first language puts the person first. Avoid labeling someone as a disease. There is much more to a person than diabetes. When in doubt, call someone with diabetes by their name.
Nondiabetic, normal	Person who does not have diabetes Person without diabetes	See above. The opposite of “normal” is “abnormal”; people with diabetes are not abnormal.
Imperatives
Can/can’t, should/shouldn’t, do/don’t, have to, need to, must/must not	“Have you tried…” “What about…” “May I make a suggestion…” “May I tell you what has worked for other people…” “What is your plan for…” “Would you like to consider…”	Words and statements that are directives make people with diabetes feel as if they are being ordered around like children. They can inflict judgment, guilt, shame, and blame.

Regimen, rules	Plan Choices	Use words that empower people, rather than words that restrict or limit them.
Words/phrases that focus on the provider
“I got him/her to…”	“He started taking insulin…” “She lost 25 pounds…” “May we make a plan for…” “May I make a suggestion…” Facilitating identified goals and creating a plan with… Self-directed goals
“I want you to…”
Let people…		Give the person with diabetes credit for what they accomplished. Make it about the person with diabetes and choices, rather than making it about the provider.
Setting goals for…
Prevent, prevention	Reduce risk(s)/risk reduction Delay	There is no guarantee of prevention (disease or complications); therefore, focus on what the person can do, which is lower their risks and/or delay onset. This also limits blame if the person does develop diabetes or complications eventually, despite efforts to prevent it.
Refused	Declined	Use words that build on people’s strengths and respect the person’s right to make their own decisions.
Victim, suffer, stricken, afflicted	…lives with diabetes …has diabetes …diagnosed with diabetes	We cannot assume someone is suffering. This puts them in the victim mode, rather than empowering them. Build on people’s strengths instead.
Words or phrases that imply judgment
Lifestyle disease	Diabetes
Difficult patient	“Ms. Smith has a foot sore that is not healing and is having a difficult time with offloading.” “I’m having a difficult time with Ms. Smith.”	Describe behavior factually rather than labeling the person.
In denial	“Dan understands that diabetes can harm him; he does not see diabetes as a priority with everything else that’s going on in his life right now.”	“In denial” is inaccurate. Most people described this way know they have diabetes and are not denying that they have it. This is a reflection that the person does not see diabetes as an important and/or immediate concern.
Unmotivated, unwilling	“John has not started taking insulin because he’s concerned about weight gain. He sees insulin as a personal failure.”	Few people are unmotivated to live a long and healthy life. The challenge in diabetes management is there are many perceived obstacles that can outweigh the understood benefits. As a result, many people come to the conclusion that changes are not worth the effort or are unachievable.
“What did you do?”	“Tell me about…” “May I make a suggestion?”	The idea is to encourage the person to move away from “why?” to “what now?” Discussion of successful responses can be a more effective teaching tool than pointing out mistakes and erratic numbers.
Cheating, sneaking	Making choices/decisions	Use strengths-based language.
Good/bad/poor	Numbers Choices Food Safe/unsafe	Good and bad are value judgments. Focus on physiology/biology and tasks/actions using neutral words.
Fail, failed, failure “She failed metformin.”	“Metformin was not adequate to reach her A1C goal.”	People don’t fail medications. If something is not working, we choose a new direction.
Test Test blood glucose	Check blood glucose/blood glucose monitoring	A test implies good/bad or pass/fail. Blood glucose monitoring/checking blood glucose is a way to gather information that is used to make decisions.
Test strips	Strips, glucose strips
Words or phrases that threaten
“You are going to end up blind or on dialysis.”	“More and more people are living long and healthy lives with diabetes. Let’s work together to make a plan that you can do in your daily life.”	Many people who are not reaching metabolic goals understand they are at risk for complications. Scare tactics rarely are effective. Work together on specific, achievable, and realistic self-directed goals that can improve metabolic outcomes.

Language with potentially negative connotations	Suggested replacement language	Rationale
Compliant/compliance, noncompliant/noncompliance, adherent/nonadherent, adherence/nonadherence	“He takes his medication about half the time.” “She takes insulin whenever she can afford it.” “He eats fruits and veggies a few times per week.” Engagement Participation Involvement Medication taking	The words listed in the first column are inappropriate and dysfunctional concepts in diabetes care and education. Compliance and adherence imply doing what someone else wants, i.e., taking orders about personal care as if a child. In diabetes care and education, people make choices and perform self-care/self-management. Focus on people’s strengths—what are they doing or doing well and how can we build on that? Focus on facts rather than judgments.
Control (as a verb or adjective)
Controlled/uncontrolled, well controlled/poorly controlled	Manage “She is checking blood glucose levels a few times per week.” “He is taking sulfonylureas, and they are not bringing his blood glucose levels down enough.”	Control is virtually impossible to achieve in a disease where the body no longer does what it is supposed to do. Use words/phrases that focus on what the person is doing or doing well. Focus on intent and good faith efforts, rather than on “passing” or “failing.” Focus on physiology/biology and use neutral words that don’t judge, shame, or blame.
Control (as a noun)
Glycemic control, glucose control, poor control, good control, bad control, tight control	A1C Blood glucose levels Blood glucose targets Glycemic target/goal Glycemic stability Glycemic variability	Focus on neutral words and physiology/biology. Define what “good control” means in factual terms and use that instead.
Diabetic (as an adjective)
Diabetic foot	Foot ulcer, infection on the foot	Focus on the physiology or pathophysiology.
Diabetic education	Diabetes education	“Diabetic education” is incorrect (education does not have diabetes).
Diabetic person	Person with diabetes	Put the person first.
“How long have you been diabetic?”	“How long have you had diabetes?”	Avoid using a disease to describe a person.
Diabetes patients	Patients with diabetes	Avoid describing people as a disease.
Diabetic (as a noun)
“Are you a diabetic?”	“Do you have diabetes?” Person living with diabetes Person with diabetes Person who has diabetes	Person-first language puts the person first. Avoid labeling someone as a disease. There is much more to a person than diabetes. When in doubt, call someone with diabetes by their name.
Nondiabetic, normal	Person who does not have diabetes Person without diabetes	See above. The opposite of “normal” is “abnormal”; people with diabetes are not abnormal.
Imperatives
Can/can’t, should/shouldn’t, do/don’t, have to, need to, must/must not	“Have you tried…” “What about…” “May I make a suggestion…” “May I tell you what has worked for other people…” “What is your plan for…” “Would you like to consider…”	Words and statements that are directives make people with diabetes feel as if they are being ordered around like children. They can inflict judgment, guilt, shame, and blame.

Regimen, rules	Plan Choices	Use words that empower people, rather than words that restrict or limit them.
Words/phrases that focus on the provider
“I got him/her to…”	“He started taking insulin…” “She lost 25 pounds…” “May we make a plan for…” “May I make a suggestion…” Facilitating identified goals and creating a plan with… Self-directed goals
“I want you to…”
Let people…		Give the person with diabetes credit for what they accomplished. Make it about the person with diabetes and choices, rather than making it about the provider.
Setting goals for…
Prevent, prevention	Reduce risk(s)/risk reduction Delay	There is no guarantee of prevention (disease or complications); therefore, focus on what the person can do, which is lower their risks and/or delay onset. This also limits blame if the person does develop diabetes or complications eventually, despite efforts to prevent it.
Refused	Declined	Use words that build on people’s strengths and respect the person’s right to make their own decisions.
Victim, suffer, stricken, afflicted	…lives with diabetes …has diabetes …diagnosed with diabetes	We cannot assume someone is suffering. This puts them in the victim mode, rather than empowering them. Build on people’s strengths instead.
Words or phrases that imply judgment
Lifestyle disease	Diabetes
Difficult patient	“Ms. Smith has a foot sore that is not healing and is having a difficult time with offloading.” “I’m having a difficult time with Ms. Smith.”	Describe behavior factually rather than labeling the person.
In denial	“Dan understands that diabetes can harm him; he does not see diabetes as a priority with everything else that’s going on in his life right now.”	“In denial” is inaccurate. Most people described this way know they have diabetes and are not denying that they have it. This is a reflection that the person does not see diabetes as an important and/or immediate concern.
Unmotivated, unwilling	“John has not started taking insulin because he’s concerned about weight gain. He sees insulin as a personal failure.”	Few people are unmotivated to live a long and healthy life. The challenge in diabetes management is there are many perceived obstacles that can outweigh the understood benefits. As a result, many people come to the conclusion that changes are not worth the effort or are unachievable.
“What did you do?”	“Tell me about…” “May I make a suggestion?”	The idea is to encourage the person to move away from “why?” to “what now?” Discussion of successful responses can be a more effective teaching tool than pointing out mistakes and erratic numbers.
Cheating, sneaking	Making choices/decisions	Use strengths-based language.
Good/bad/poor	Numbers Choices Food Safe/unsafe	Good and bad are value judgments. Focus on physiology/biology and tasks/actions using neutral words.
Fail, failed, failure “She failed metformin.”	“Metformin was not adequate to reach her A1C goal.”	People don’t fail medications. If something is not working, we choose a new direction.
Test Test blood glucose	Check blood glucose/blood glucose monitoring	A test implies good/bad or pass/fail. Blood glucose monitoring/checking blood glucose is a way to gather information that is used to make decisions.
Test strips	Strips, glucose strips
Words or phrases that threaten
“You are going to end up blind or on dialysis.”	“More and more people are living long and healthy lives with diabetes. Let’s work together to make a plan that you can do in your daily life.”	Many people who are not reaching metabolic goals understand they are at risk for complications. Scare tactics rarely are effective. Work together on specific, achievable, and realistic self-directed goals that can improve metabolic outcomes.

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