By Dr Patrick Ngassa Piotie, Chairperson of the Diabetes Alliance
A child quietly skips an insulin dose at school, not because they forgot, but because they don’t want to be seen. A mine worker hides his condition, fearing he will be declared unfit for the shaft. Even at home, a family gathering becomes a moment of anxiety where every food choice is watched, judged, and whispered about.
This is the face of diabetes stigma.
A pervasive global challenge
A landmark international consensus published in The Lancet Diabetes & Endocrinology defines diabetes stigma as the negative social judgments, stereotypes, and prejudice directed at people simply because they live with the condition.
As highlighted during the first-ever Global Summit to End Diabetes Stigma last month, diabetes stigma is a global issue. It affects millions regardless of their geographic locations or socio-economic backgrounds.
It is widespread.
Research estimates that up to four in five adults with diabetes experience stigma, and one in five face outright discrimination in healthcare, schools, and workplaces. South Africa is no exception; we are part of a global reality where “blame” is often the first response to a diagnosis. Until we confront this prejudice, South Africa will continue to struggle to address a condition described by the Lancet as the “defining disease of the 21st century”.
Stigma in everyday life
Policy discussions often focus on medicine and logistics. But the reality of diabetes stigma is felt most sharply in the quiet, everyday moments of a person’s life.
In our schools, this manifests as children skipping life-saving insulin just to “fit in” or being sidelined from sports because teachers mistakenly view them as too “sick” to participate. This bias follows them into adulthood, where employees are frequently passed over for promotions or forced out of their roles based on nothing more than a manager’s assumptions about their productivity.
Perhaps most pervasive is the way we speak about the condition; when the media and clinicians use “othering” labels like “diabetics,” “non-compliant,” or “lifestyle disease”, they effectively strip away a person’s humanity and reduce them to a series of perceived failures.
Impact on national targets
Stigma dictates behaviour in many ways. When people anticipate judgment, they hide. They ignore symptoms, they avoid screening, and they stay away from clinics to escape the “lecture” often expected from healthcare professionals. Stigma, therefore, becomes a direct roadblock to South Africa’s ambitious 90-60-50 targets.
The goal of diagnosing 90% of people living with diabetes cannot be reached if people are too afraid of the social label to come forward. Stigma also erodes the quality of care. The evidence is clear: people who experience diabetes stigma are more likely to skip medication, reduce self-care, and disengage from services.
Whether it is skipping medication at work to avoid questions or avoiding glucose monitoring in public, these actions are not “difficult” behaviour; they are survival strategies in a culture of judgment. It is dangerous to characterise “non-adherence” as a mere medical failure when it is, in fact, multifactorial. Clinical control (the final 50% target) cannot be achieved if people are not treated with empathy but instead are repeatedly stigmatised and do not feel safe managing their condition in public.
Systemic problems, not individual failures
The most damaging narrative is the idea that diabetes is a simple “choice”. This blame-heavy perspective ignores the complex interplay of genetics, social and commercial determinants of health, and the environments in which we live. When stigma shapes our thinking, it poisons everything from how policies are designed to how resources are allocated.
Addressing stigma is not a “soft” issue; it must be treated as a core health systems priority. We can build the clinics and procure the insulin, but if the patient feels judged the moment they walk through the door, the medicine will stay in the box and our investments will be in vain.
A necessary shift: From blame to empathy
If we are serious about improving outcomes and achieving the diabetes targets, we must change our approach completely. This means transforming healthcare interactions into person-centred care, reforming discriminatory workplace policies, and holding the media and healthcare professionals accountable for the language they use.
The path forward has already been charted through the Johannesburg Declaration for Accelerated Action on Diabetes in South Africa.
Diabetes stigma is a barrier to diagnosis, treatment, and a healthy life.
If South Africa is serious about reaching the 90-60-50 targets, we must confront not only the physiology of the disease but also the social realities that shape how people live with it. Behind every statistic is a human being navigating a chronic condition while carrying the unnecessary weight of judgment. It is time we took that weight off their shoulders.
