Implicit Bias in Diabetes Care (and What You Can Do) - The Diabetes Link

Close your eyes.  Think about the last time you visited your diabetes clinic:  the medical assistant calls your name, accepts your patient paperwork, takes you through the maze of exam rooms and tells you to stand on the scale.  You step up and watch as the scale settles on your number.  She writes it down. You ask yourself: What is she thinking? What if I had taken off my shoes – would that make the number go down? Is she judging my number?  Is she judging me, based on my number? 

People and Their Perceptions

Unfortunately, the stigma and shame surrounding weight and diabetes is heavy (pun intended.)  When you look back in history and at people’s (including those who work in healthcare) perceptions of diabetes, weight almost always comes into play.  Especially for people with diabetes the topic is one that we have to discuss; 

• Yes, weight can affect your insulin sensitivity (how insulin works in your body).  
• Yes, weight can affect your risk for complications (like heart disease or kidney problems.)  
• And yes, weight can play a role in your mental and emotional health (which in turn, can affect blood sugars). 

But… 

• NO, your weight does NOT equal your health.
• NO, your weight does not define you. 
• And NO–your diabetes will not just go away if you lose weight. There is so much more that goes into diabetes management than your weight. 

Understanding Unconscious Bias

Adding to the emotional toll of weight in general are the biases that exist amongst racially and ethnically minoritized groups.  As a healthcare provider, we are taught about the concept of “implicit (or unconscious) bias” in our classes and through continuing education.  Through studies about implicit bias (the way you think about someone or view someone, even though you’re not aware that you’re doing it, based on the way they look or the groups they belong to), it has been shown that healthcare providers often do not provide the same empathy, treatment recommendations, and expectations for sticking with a treatment regimen to underrepresented groups.¹  

These studies show that healthcare providers make harmful assumptions that underrepresented communities are less intelligent and less interested in their health; therefore, underrepresented groups often do not receive the best quality healthcare. For context: Did you know that physicians often show preferential treatment to patients who are thin?¹ And did you know that people with public insurance (Medicare, Medicaid) are less often offered pumps or CGMs by their provider?¹

Be An Advocate for Change

Now, if you’re thinking like I am:  Weight + Diabetes + Implicit bias = Problem. The problem is a systemic one.  One that will take acknowledgement, an entire community, thought change, and time to improve.  Still, you can be your own biggest advocate:

1. Remind Yourself of Your Worth

• Reminder:  You are not defined by your weight.  
• Reminder: Your diabetes is not defined by your weight. 

 2. Don’t Be Afraid to Bring Up the Hard Stuff

• This isn’t all on you.  Recognize and acknowledge the barriers that exist to your best quality diabetes care, and discuss these with your healthcare provider.  Work as a team and ask for resources. 
  • Are you able to afford your insulin (and other supplies) each month? 
  • Do you have enough money to buy food each week?
  • Do you have a safe area to exercise?
  • Do you have children or other family members that you are caring for, who also need food each month?
  • Do you have transportation to the grocery store to purchase food?
  • Do your work hours affect the times that you’ll be able to eat?

3. Find a Provider You Align With 

• Most importantly – and something that I have told most of my patients or friends with diabetes – find a provider that you align with.  Don’t settle.  Not comfortable discussing those barriers listed above with your provider? They are probably not a good fit.  Challenge yourself and your provider–work together to figure out what is best for you. 
• If you’re looking for resources about disparities in diabetes care, or you’re looking for an inclusive care professional near you, check out Diversity in Diabetes (they’re dedicated to addressing inequity in diabetes care):  Diversity in Diabetes 

4. One size does not fit all

• One size does not fit all.  When we seek out care for a complex condition like diabetes, we need individualized care.  Your situation is not the same as the person who is sitting in the exam room next to you.  You have different needs, wants, and accessibility related to your diabetes.  Check out this graphic about equality vs. equity, which can help you visualize that one solution or recommendation won’t be equally as helpful for everyone. 

Want to dive even deeper? If you’re interested in the topic of implicit bias and diabetes care, I highly encourage reading this article:  Implicit or Unconscious Bias in Diabetes Care 

References

1.  A. Enrique Caballero, Nuha A. ElSayed, Sherita Hill Golden, Raveendhara R. Bannuru, Brigid Gregg; Implicit or Unconscious Bias in Diabetes Care. Clin Diabetes 15 April 2024; 42 (2): 308–313. https://doi.org/10.2337/cd23-0048