The Use of Person-First Language in Diabetes Care & Research. How Far Have We Come Since ADA & ADCES Recommendations?: A Systematic Review

Denise Nicole Portillo, University of Texas at El Paso


Background: Diabetes is a chronic medical condition that affects more than 34 million people across the United States (Centers for Disease Control and Prevention (CDC), 2020). Diabetes is characterized as the inability to create or regulate insulin adequately (Costabile et al., 2020). There are three main types of diabetes, type 1 diabetes mellitus (T1D), type 2 diabetes mellitus (T2D), and gestational diabetes (CDC, 2020). Of the more than 34 million people with diabetes, 5 to 10% have T1D, while the remaining 90-95% have T2D (CDC, 2020). In 2017, the Association of Diabetes Care & Education Specialists (ADCES) and the American Diabetes Association (ADA) recommended changing the language used in diabetes care and education (Dickinson et al., 2017). There is substantial support for person-centered and person-first language as a priority for improving health outcomes. Purpose: This research aims to: 1) review the literature on the use of Person-First Language (PFL); 2) identify thematic characteristics of organizations and institutions that do not use the proper PFL; and 3) determine differences in the use of PFL among ethnic/racial samples. Methods: The systematic review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). Inclusion criteria used to conduct searches focused on peer-reviewed literature regarding 1) diabetes patient care and management; 2) human subject intervention research related to behavior and treatment care; and 3) research conducted in the US. The articles included were from 2018 to 2020. Articles with at least one use of disease first language (e.g., 'diabetic,' 'compliant,' 'control,' and 'adhere') were included. Exclusion criteria consisted of all research literature focused on molecular level diabetes research and non-human research; and articles published before 2017 and after 2020. Articles that utilized 100% PFL, and international studies and journals were also excluded. Articles were searched using the online databases of PubMed, CINAHL, and PsycInfo. Results: The total number of identified articles was 3,481; after inclusion and exclusion criteria were applied and duplicates were removed, only 62 articles met the criteria to be used for analysis. Overall, of the articles assessed, 17.74% still used the term 'diabetic' within the article; 16.13% used 'compliant/compliance;' 93.55% used 'control/controlling/controlled;' and 70.97% used 'adhere/adherence/adherent.' When considering the credentials of the senior authors, 100% of Master of Arts used the terms' control' and 'adhere' within the article; 100% of Medical doctors (MD) used 'control;' 90% of MDs with additional degrees and/or certifications used 'control;' 95.45% of PhDs used 'control;' 58.33% of PhDs and additional degrees and/or certifications used 'adhere.' Among pharmacists, 100% used 'control' and among pharmacists with additional degrees and/or certifications 100% used 'control; 100% of nurse practitioners used 'diabetic' and 'control;' 80% of nurse practitioners with additional degrees and/or certifications used 'adhere;' and 100% of individuals with a Certified Diabetes Care and Education Specialist certification used the terms' control' and 'adhere.' Among senior authors from an academic setting, 94.12% used the term 'control' in the articles; 92.31% of medical schools used 'control;' 100% of nursing schools used 'control;' 100% of associations used 'control;' 88.89% of hospitals or clinics used 'control; and 100% of research based institutions used 'control.' Of the 62 articles analyzed, only 35.48% had Hispanic/Latinos in their studies. Conclusion: In literature specific to diabetes patient care and management, between 2018 through 2020, this review showed the frequency of use of PFL with the term 'people with diabetes' vs. the terms' diabetic' and 'managed' vs. the term 'compliant.' This review, however, revealed a high frequency of the non-recommended terms' control' and 'adherence.' Moreover, Hispanic/Latinos continue to be an underserved population when it comes to diabetes patient care and management.

Subject Area

Public health|Health care management

Recommended Citation

Portillo, Denise Nicole, "The Use of Person-First Language in Diabetes Care & Research. How Far Have We Come Since ADA & ADCES Recommendations?: A Systematic Review" (2022). ETD Collection for University of Texas, El Paso. AAI29211579.