Picture the moment someone tells you they have diabetes.

What is the first thought that crosses your mind? Be honest, because the answer matters more than you might expect, and because most people, even well-meaning, educated, health-conscious people, have absorbed assumptions about diabetes that are neither accurate nor kind.

Do you wonder, even briefly, whether they brought it on themselves? Whether they eat too much sugar, exercise too little, or made choices they should have known better than to make? Do you feel a faint but real distinction between diabetes and, say, cancer, a sense that one is fate and the other is somehow failure?

If any part of that resonates, you are not unusual. You have simply absorbed the cultural narrative that surrounds diabetes in the UK, a narrative that is deeply embedded, widely shared, and causing measurable harm to millions of people every single day.

This Diabetes Awareness Week, Diabetes UK's campaign is called Strike Out Stigma. We want to explain exactly why that matters, and why it should change the way all of us think and speak about this condition.

What the numbers actually tell us

Almost six million people in the UK are currently living with diabetes, the highest number ever recorded. A further 13.6 million are at high risk of developing type 2 diabetes. Diabetes costs the NHS approximately £10.7 billion per year, around ten percent of the entire NHS budget, and the number of people living with the condition has more than doubled over the past twenty years.

These are not the statistics of a niche or marginal condition. Diabetes is one of the defining public health challenges of our time, and it touches the lives of an extraordinary proportion of the population, as patients, as family members, as colleagues, as friends.

Approximately ninety percent of cases are type 2 diabetes, which is strongly linked to obesity, physical inactivity, and diet. It is increasingly affecting younger age groups, with the number of people under forty diagnosed with type 2 having more than doubled in the past decade. Type 1 diabetes, which accounts for roughly ten percent of cases, is an autoimmune condition with no known prevention and no connection whatsoever to lifestyle or diet. The immune system attacks the insulin-producing cells of the pancreas, and it does so regardless of what the person eats, how much they exercise, or how carefully they live.

That distinction matters enormously, and it is one that the general public consistently fails to make.

The stigma that causes real harm

Eight out of ten people living with diabetes in the UK say they have faced negative attitudes because of their condition. People passing judgement, making sweeping statements, blaming and shaming. The impact is not abstract or merely emotional. Over half of people surveyed by Diabetes UK said that stigma, judgement, or shame means they sometimes avoid medical appointments.

Read that again. People are avoiding the healthcare they need because they feel they deserve their diagnosis. Because the shame of being seen, of having their condition witnessed and managed in a clinical setting, outweighs the physical risk of leaving it unaddressed. Diabetes stigma manifests as discrimination, social rejection, and internalised shame, adversely affecting self-care, physical health, and quality of life.

Almost six in ten people say stigma impacts their self-confidence, and over half have internalised that shame so completely that they genuinely believe they are at fault for their own condition. In the case of someone living with type 1 diabetes, a condition they were entirely powerless to prevent, that internalised shame is not just cruel. It is a fundamental injustice.

And even in the case of type 2, the picture is far more complicated than the cultural narrative suggests.

Why type 2 is not a simple story of personal failure

This is where the conversation requires the most care, because the relationship between lifestyle and type 2 diabetes is real and documented, and pretending otherwise would be dishonest. Diet, physical activity, body weight, and metabolic health are all genuinely connected to type 2 diabetes risk.

But here is what the stigma narrative consistently erases: genetics plays a profound role. People from Black African, Black Caribbean, and South Asian communities are significantly more likely to develop type 2 diabetes, at younger ages and at lower body weights than white European populations. Socioeconomic factors play a role. Access to fresh food, safe spaces for exercise, time for sleep, and freedom from chronic stress are not equally distributed across the population, and all of them influence metabolic health in ways that have nothing to do with individual willpower or personal discipline.

Type 2 diabetes is not a simple story of people who ate badly and paid the price. It is a complex, multifactorial condition shaped by genetics, environment, socioeconomic circumstance, and yes, lifestyle, in proportions that vary enormously from person to person. Reducing it to a moral failing is not only inaccurate. It is a distortion that carries a very real human cost.

This is something we understand not just intellectually, but personally. A few years ago, we lost someone we loved deeply to complications from diabetes. She struggled with her diet and rarely exercised, and yes, those things mattered. But what we remember is not a set of choices. We remember a person. A person who deserved care and compassion, not judgment, at every stage of her illness. That is what this campaign means to us, and why we are writing this today.

What we say, and what it does

Language matters in ways we underestimate. The casual comment at someone's birthday party about whether a person with diabetes should really be eating that. The colleague who raises an eyebrow when someone injects insulin at their desk. The well-meaning friend who says you just need to sort out your diet to someone whose type 1 diagnosis was entirely outside their control.

Diabetes stigma often stems from misconceptions about the condition, but nonetheless adversely affects the self-care, physical health, and quality of life of people living with it. Every time we speak about diabetes as though it is the inevitable consequence of poor choices, we add a small weight to the burden of every person living with it who hears us. And that burden accumulates into something that keeps people away from their doctors, away from their medication, away from the management of a serious condition that requires consistent, unashamed, and well-supported care.

Striking out stigma is not about pretending that lifestyle does not matter for metabolic health. It is about separating the conversation about prevention from the conversation about the people who are already living with the condition. Prevention is a public health conversation. Stigma is a human one. Conflating them causes harm.

A note on metabolic health and nutritional support