Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations.

People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.

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Déclaration de conflit d'intérêts

Declaration of interests In the past 3 years, JSp and EH-T have received competitive research grants from the Diabetes Australia Research Program, the Medical Research Future Fund Targeted Translational Research Accelerator, and the National Health and Medical Research Council of Australia. JSp and EH-T have received an investigator-initiated research grant from Sanofi Diabetes and an unrestricted educational grant from Diabetes Australia and are supported by core funding to the Australian Centre for Behavioural Research in Diabetes derived from the collaboration between Diabetes Victoria and Deakin University. JSp has also received a competitive research grant from the Ian Potter Foundation; a research contract from the Australian Government Department of Health; a consulting fee from Diabetes Canada; honoraria to present at educational meetings from Novo Nordisk and Sanofi Diabetes; honoraria for participating in advisory boards from Insulet and Sanofi Diabetes; and support for attending meetings (including travel) from the Novo Nordisk Foundation. EH-T received honoraria for presentation at educational meetings from Roche Diabetes Care. All these payments have been made directly to the Australian Centre for Behavioural Research in Diabetes; this research centre owns the copyright of the type 1 and type 2 Diabetes Stigma Assessment Scales. JSp is the Chair, JSt the Vice-chair, and EH-T website redevelopment lead of the international PsychoSocial Aspects of Diabetes Study Group (unpaid roles). MG has received project funding from One Drop, Eli Lilly, Boehringer Ingelheim and Eli Lilly Alliance, Abbott, and Genentech and honorarium from Sanofi and Diabetes Sisters (all paid to the diaTribe Foundation). IW has shares in Novo Nordisk. ASe has received competitive research grants from the Juvenile Diabetes Research Foundation and Auckland Medical Research Foundation (all paid to the University of Auckland) and conference attendance support (as an invited speaker) from the International Society for Pediatric and Adolescent Diabetes. BA received conference funding support to present at a RAPID conference hosted by PsychoSocial Aspects of Diabetes and Steno. MdG has received competitive research grants from the American Diabetes Association and National Institute on Aging and received consulting fees from Mediflix and Kenner Family Foundation. SH has received consulting fees from Novo Nordisk, Lilly Diabetes Care, Medtronic Diabetes Care, and Dexcom Germany; received payments of honoraria from Novo Nordisk and Ascensia Diabetes Care; payment for expert testimony from VitalAire; received support for attending meetings from Ascensia, Diabetes Center Berne, Diabeloop, Dexcom, Lilly, Medtronic, Novo Nordisk, Sanofi, Tandem, embecta, and dotcool; received medical equipment from Abbott Diabetes Care, Dexcom, and Ypsomed; and is Head of Communications for #dedoc°, Dedoc Labs. RIGH has received research support from Novo Nordisk; speaker honoraria from EASD, Eli Lilly, Encore, Liberum, Novo Nordisk, and ROVI; and conference attendance funding from Novo Nordisk and Eli Lilly. KK is supported by the UK National Institute for Health Research's Applied Research Collaboration East Midlands and Leicester Biomedical Research Centre; has received research funding from AstraZeneca, Boehringer Ingelheim, Eli Lilly, MSD, Novartis, Novo Nordisk, Roche, Oramed Pharmaceuticals, and Sanofi; received consultancy fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, MSD, Novo Nordisk, Roche, Sanofi, and Servier; and received payments of honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk, Roche, and Sanofi. RLP has received research funding from the US National Institutes of Health (paid to institution); receieved presentation honorarium from the Diabetes Leadership Council; and is Chair of Policy Track for The Obesity Society Annual Meeting Program Committee (unpaid role). RMP has received research funding and consultancy fees from Eli Lilly. MSe has received conference funding support from the International Diabetes Federation and the International Society for Pediatric and Adolescent Diabetes. MV has received investigator-initiated research funding from Abbott, Bausch, and Novo Nordisk; received consulting feeds from Abbott, Abbvie, Boehringer Ingelheim, and Novo Nordisk; received payments and travel support from Abbott, Abbvie, Boehringer Ingelheim, Novo Nordisk, Eli Lilly, Merck, and Pfizer; has a pending patent with AmpHealth for a digital health intervention; and is a Diabetes Canada Mission Committee member (unpaid role). All other authors report no competing interests.