Kyoto, Japan -- For people with medical conditions, stigma is a real problem they must worry about on top of their health. Stereotypes about health conditions often cause discrimination even by healthcare providers, as many may assume those affected don't take care of their health, when in reality they likely have no control over their condition.
Diabetes affects nearly ten percent of the global adult population and causes almost two million deaths per year, yet the persistent stigma surrounding people with the disease is a global concern. Physicians may act as inadvertent perpetrators, but their level of awareness is still poorly understood.
To address this, it is essential to gauge the level of awareness of a diabetes stigma among future physicians and identify the need for strategic interventions in medical education. This approach motivated a team of researchers at Kyoto University to first assess awareness of stigma and advocacy among medical students in Japan.
"Until now, no studies have investigated the awareness of diabetes stigma and advocacy activities among medical students and residents," says corresponding author Takaaki Murakami.
Takaaki and the research team conducted a questionnaire-based survey between July 2024 and March 2025 at Kyoto University and St Marianna University School of Medicine, including both university hospitals. Their study was aimed at residents and medical students, the latter including students at all three training stages of preclinical, clinical lectures, and clinical training. The researchers then analyzed the 921 responses.
The findings revealed some awareness of diabetes stigma and advocacy, but with much room for improvement. Among those surveyed, 57.0% and 25.9% reported awareness of diabetes stigma and advocacy, respectively. Awareness significantly increased with training stage, but nearly half across all stages held misconceptions and limited knowledge.
Although clinical lectures on diabetes stigma are effective in increasing awareness, this study shows that subsequent training and medical education may have limited impact. Even after attending clinical lectures, about half of the medical students and residents still held misconceptions such as "diabetes is always a genetic disease" and "people with diabetes always have a shorter life expectancy." Surprisingly, a higher proportion of residents, compared to medical students, held these stigma-related beliefs.
Unsurprisingly, the findings also showed that entering clinical practice without acquiring accurate knowledge can lead to the reinforcement and persistence of a diabetes stigma.
The research team aims to continue assessing awareness, and plans to conduct a three-year follow-up survey among third- and fourth-year medical students after they have completed their clinical medicine lectures. The researchers also expect to see similar studies conducted not only in Japan but across the Western Pacific region to understand the effectiveness and challenges of current medical education.
"Based on our findings, we expect that medical education curricula in Japan will be reviewed to help realize a world free from diabetes stigma," says first author Mari Matsushiro.
