Addressing the Cultural Stigma of Type 2 Diabetes in India and Beyond
- t2diabetesnetwork
- Jul 28
- 6 min read
Key Highlights
✅ 80% of adults with diabetes report stigma; 20% report discrimination.
✅ India could see 134.3 million people living with diabetes by 2045, the highest globally.
✅ An India-based study found mild but socially significant stigma around diabetes.
✅ Cultural beliefs reinforce fatalism and shame, undermining self-care and mental health
✅ Global studies show stigma raises HbA1c, worsens complications, and reduces healthcare engagement.
Type 2 diabetes (T2D) is a growing global health crisis, affecting over 422 million people worldwide. India stands at the forefront of this epidemic, with projections estimating that 134.3 million people could be living with diabetes by 2045.
While much attention has been paid to the clinical and lifestyle aspects of the disease, less is understood about its social and cultural dimensions, especially the stigma that shadows many living with this chronic condition.
A recent study published in the Indian Journal of Community Medicine sheds light on this very issue. Conducted in the urban slums of Pune, India's 7th most populous city, the study explores how stigma related to T2D manifests in everyday life, with far-reaching consequences for mental health, social mobility, and healthcare access.
Understanding the Cultural Stigma in Urban India
The Pune study used a cross-sectional, community-based survey of 100 non-diabetic residents to investigate public perceptions of diabetes. Using a locally adapted Explanatory Model Interview Catalog (EMIC), researchers uncovered significant insights: while diabetes awareness was high, so was a pervasive fatalism. More than half of the participants believed untreated diabetes to be fatal, which reinforced negative perceptions of the disease.
The stigma index derived from survey responses was 7.22 out of 36, a score reflecting a mild but socially meaningful level of stigma.
Despite being “mild,” this stigma was expressed through:
Concealment of diagnosis, especially among married individuals, due to fear of social judgment.
Difficulties in arranging marriages, particularly for unmarried individuals and those from non-Hindu or marginalized communities.
Workplace discrimination, where diabetes was seen as a liability.
WHO Stigma Campaign
These findings highlight the intersection of health and culture, particularly how caste, religion, and marital status amplify the social challenges faced by those with diabetes. As the researchers noted, stigma was not only a product of misinformation but was deeply embedded in cultural norms around marriage, productivity, and self-reliance.
The Emotional and Psychological Impact
The social stigma of diabetes is more than an abstract cultural issue, it carries real emotional weight. The Centers for Disease Control and Prevention (CDC) states that stigma can cause feelings of guilt and shame that undermine diabetes management.
Individuals living with diabetes often internalize societal judgments, leading to:
Low self-esteem
Depression and psychological distress
Avoidance of medical care and reduced self-care behaviors
In India, the stigma surrounding diabetes, especially for young women, is deeply connected to the issue of marriage. Many families are reluctant to accept a diabetic individual as a potential spouse, fearing the everyday management needs, risk of complications, and misconceptions about fertility or health, which leads to discrimination and social exclusion in the matrimonial context. This stigma often forces diabetics and their families to lower expectations, make compromises on caste or socioeconomic status, and sometimes conceal the condition entirely, contributing to feelings of depression, anger, and frustration for those affected.
Despite these challenges, dedicated diabetic marriage bureaus and advocates are working to shift mindsets, provide emotional support, and demonstrate that diabetes can be effectively managed with the right care, offering hope for social change and more inclusive attitudes in the future
Even with legal protections in place, such as the Madras High Court ruling affirming that diabetes should not disqualify someone from employment, stigma continues to manifest subtly, particularly in professional settings.
A Global Perspective: Parallels in the Evidence
The cultural stigma of diabetes isn't unique to India. A review of studies focusing on immigrants with diabetes, the majority of which were to the U.S. (71.9%), found that social exclusion stemming from diabetes diagnosis heightened diabetes distress, a condition that disrupts emotional well-being and leads to poorer self-care. Cultural beliefs around shame and personal failure were shown to directly impact glucose management, physical activity, and dietary adherence, ultimately raising HbA1c levels and complication risk.
This research used an integrative model that links cultural, psychological, behavioral, and biological factors, offering a more complete understanding of how stigma affects health. Similar themes have been observed among other immigrant communities, where language barriers, lack of social support, and limited health literacy amplify the burden of managing diabetes.
This is echoed by global research. An international panel of 51 experts from 18 countries conducted rapid reviews and a Delphi survey to build consensus on how to address this issue. They agreed on 25 evidence statements and 24 recommendations, highlighting that diabetes stigma is largely driven by blame, perceptions of burden, invisibility, and fear. Alarmingly, 80% of adults with diabetes report experiencing stigma, and 20% report discrimination in areas like healthcare, education, and employment. The panel unanimously declared that stigma is harmful, unethical, and must be actively challenged through collective leadership, culminating in a global pledge to end diabetes stigma and discrimination.
Similarly, in a recent international review, diabetes stigma was noted as a significant social burden affecting people with both type 1 and type 2 diabetes. Stigma, experienced through negative judgments, stereotypes, or prejudice, can occur in healthcare, workplaces, schools, relationships, and media. The review outlines methods for measuring stigma and examines how it varies by age, diabetes type, and social factors. Reported prevalence is alarmingly high: up to 78% in adults with type 1 diabetes (T1D), 70% in adults with T2D, and 98% in youth with T1D.
While data on youth with T2D is limited, one study found links between stigma and poorer psychosocial functioning, elevated HbA1c, and diabetic complications like retinopathy. Across populations, diabetes stigma is consistently associated with worse self-care, higher HbA1c levels, and increased rates of serious complications such as diabetic ketoacidosis and severe hypoglycemia. The review also underscores the need for further research, particularly among youth with T2D, to better understand how stigma drives these adverse outcomes.
Diabetes stigma is a widespread and harmful issue that affects the majority of people with diabetes globally, contributing to poor psychosocial well-being, reduced self-care, higher HbA1c levels, and increased risk of complications, underscoring the urgent need for collective action and further research, especially among youth with T2D.
Toward a Solution: Combating Diabetes Stigma
Whether in Pune or Los Angeles, the impact of diabetes stigma is clear. Effective leadership from all sectors is required to actively confront and eliminate the stigma and discrimination associated with diabetes.
To reduce its reach, multi-layered strategies must be adopted:
1. Educate the Public
Let’s start by busting the myths. Diabetes is manageable. With early diagnosis, healthy lifestyle changes, and consistent care, people with diabetes can live full, healthy lives. Spreading this message is key.
2. Create Culturally Relevant Awareness Campaigns
Messages that truly resonate come from within the community. Using familiar language, traditions, and trusted voices like local leaders can help challenge stigma and make conversations about diabetes more open and supportive.
3. Rethink How Healthcare Works
Diabetes care should go beyond prescriptions. That means including mental health support and training healthcare professionals in cultural competence. When care is personalized and respectful of a patient’s background, it builds trust and leads to better outcomes.
4. Push for Policy and Advocacy
Laws matter. Enforcing anti-discrimination policies and funding programs that support the emotional and social sides of diabetes can help protect patients at work, in schools, and in healthcare settings.
5. Strengthen Community and Family Support
No one should feel alone in managing diabetes. Support from family, friends, and community groups makes a huge difference. When people feel understood and backed by others, they are more likely to take care of their health.
Public campaigns like "Above the Bias" and many others calls for collective leadership across all sectors to tackle and eliminate the stigma and discrimination faced by those with diabetes. By challenging harmful stereotypes and promoting inclusivity, the campaign aims to foster a more supportive environment for people with diabetes, improving their access to care, mental well-being, and overall quality of life. With a focus on education, policy reform, and community engagement, this initiative seeks to create lasting change and ensure people with diabetes are treated with respect and empathy.
The Pune study and other global findings make one thing clear: addressing the stigma surrounding T2D is not a secondary concern, it’s central to improving outcomes. Cultural stigma erodes the foundation of self-management, damages mental health, and widens healthcare disparities.
Cultural values, beliefs, traditions, and family dynamics can serve as important guides when designing diabetes care strategies. Tailoring interventions around these cultural factors is likely to greatly enhance the effectiveness of diabetes management in the future. By acknowledging the socio-cultural dimensions of chronic disease, we take a critical step toward inclusive, patient-centered care. This means looking beyond blood glucose and HbA1c to see the human being behind the diagnosis, someone who deserves dignity, support, and freedom from judgment.
T2D is not just a health condition. It’s a social experience, one that must be understood in its full cultural, psychological, and systemic complexity. By breaking the silence and addressing stigma head-on, we can empower millions to manage their diabetes with confidence, care, and community.
Read more in our peer review publication focused on the importance of South Asian tailored interventions in diabetes management.
Watch our vodcasts with on tackling diabetes stigma on our T2DNetwork YouTube channel
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