title: Type 1 diabetes stigma in China: a call to end the devaluation of individuals living with a manageable chronic disease.
abstract: Stigma is a significant barrier to improving care for individuals with type 1 diabetes mellitus (T1DM). This commentary describes this phenomenon in China, where stigma has led to labeling and devaluing of individuals with T1DM. Difficulties finding a spouse and regulations restricting admission to universities and government employment have forced many individuals to hide their diabetes. The shame, fear, and guilt stemming from stigma may preclude the use of insulin pumps; multiple daily injections, which require pre-meal insulin dosing at school or the workplace; participation in research studies; and general health-seeking behaviors. A multifaceted, multilevel approach is urgently needed and should involve improving public awareness and understanding of T1DM; adoption by health care providers of holistic rather than biomedical approaches to disease management; patient counseling on positive coping skills; and expansion of the scope of research to consider the psychosocial realities of diabetes care in China. Recent media attention in the form of a nationally broadcasted documentary on T1DM is an important step in the right direction. We believe that coordinated action by multiple stakeholders can lead to meaningful improvements in treatment, ultimately leading to better physical and emotional health outcomes for individuals living with this manageable chronic disease.
authors.affiliation: Department of Nutrition, The University of North Carolina, Chapel Hill, NC, USA. Electronic address: jaacks@email.unc.edu.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Jaacks
authors.affiliation: Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
authors.forename: Linong
authors.initials: L
authors.lastname: Ji
authors.affiliation: Department of Nutrition, The University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Mayer-Davis
mesh_terms: D001294:Attitude to Health / Q000208:ethnology*; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D019468:Disease Management; D004651:Employment / Q000523:psychology; D006801:Humans; D007267:Injections / Q000523:psychology; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000523:psychology; D008393:Marriage / Q000523:psychology; D057545:Social Stigma
chemical_list: D007328:Insulin
keywords: China; Discrimination; Stigma; Type 1 diabetes mellitus