The BMJ Opinion piece, Diabetes advocacy campaigns should focus on living a life, not fighting a battle (opens in a new tab) (7 August 2026), raises important points regarding the psychological burden of disease framing. However, while there is much the broader diabetes community can get behind, perspectives from patients in low-income countries (LICs) and less-resourced settings remain largely sidelined.
In over a decade of work with people living with diabetes globally, there has been a consistent frustration that the wider community is often preoccupied with the specifics of language rather than the emergency of access. As the authors acknowledge, managing diabetes is not a “fair fight” due to socioeconomic inequities. Yet, by focusing on the language of the “battle” metaphor as the problem, there is a risk of sanitizing a reality that remains, for millions, a literal struggle for life.
While the piece nods to the stark differences in care, it primarily reflects a population with access to the latest tools and technology. Much of this discourse is led by advocates who have the breathing room and privilege to debate terminology. Those in positions of influence must use their platforms and networks to build genuine relationships with those less connected to the Diabetes Online Community — those for whom “fighting” is not a metaphor, but a daily requirement for survival. It is not for those of us in comfortable settings to tell someone in a resource-desert or crisis situation how to frame their life-and-death struggle.
Frankly, when the diabetes community gives only token acknowledgement to the massive inequalities faced by those in LICs, it is insulting to those who are genuinely struggling to get through each day. For example, while roughly 64% of people with Type 1 diabetes in Europe utilize continuous or flash monitoring systems and 40–62% of adults with Type 1 diabetes in the USA use insulin pumps [1,2,3], many African nations lack even basic regional data on technology access due to its near-total absence in the public sector [4].
For these populations, the “battle” is not against the body, but against a system that has often failed to provide the bare minimum. This is an important distinction the authors overlook. “Fighting diabetes” can frame the condition as a personal war to be “won” or “lost” through individual effort, placing health outcomes squarely on the individual and increasing stigma and self-blame. However, combatting injustice and broken systems collectively is a very different, and necessary, fight. Cooperative advocacy led by people with diabetes can create connections, build confidence, and — when done the right way — give people true agency over their own narrative. Rather than be passive recipients of a narrative written by industry-funded organizations, individuals can choose to join efforts where they co-create campaigns that address the root causes of injustice for people with diabetes.
Those with a genuine interest in the well-being of everyone with diabetes should spend their social capital holding power to account. Discussions about language hold some value, but they can also serve as a distraction from structural failures. Efforts should be redirected toward demanding accountability from pharmaceutical and device manufacturers who maintain high costs, governments who fail to prioritize insulin security, and structural failures that directly lead to the dangerous rationing of life-saving supplies [5].
The diabetes community must re-evaluate its priorities. Not a single campaign should exist that does not center the voices and experiences of those in the most precarious positions. Ultimately, language matters, but for the person without insulin or test strips, actions speak much louder than words.
References:
- Miller, R. et al. (2026). Global Trends in Diabetes Technology: The Digital Divide. Frontiers in Digital Health
- Conway RB, et al.Disparities in Diabetes Technology Uptake in Youth and Young Adults With Type 1 Diabetes: A Global Perspective. J Endocr Soc. 2024;9(1):bvae210. PMC11655873.
- Choudhary P, Thabit H.Diabetes Technological Revolution: Winners and Losers?J Diabetes Sci Technol. 2019;13(4):619-621. doi:10.1177/1932296819853556
- Gregory, G.A., et al. (2022). The Type 1 Diabetes Index: predicting the prevalence, and costs of Type 1 diabetes in 201 countries. The Lancet Diabetes & Endocrinology.
- Souris, K. J., et al. (2024). Out-of-pocket expenses and rationing of insulin and diabetes supplies: findings from the 2022 T1International cross-sectional web-based survey. Frontiers in Clinical Diabetes and Healthcare.
Competing Interests:
Elizabeth Pfiester is the Founder of T1International. She receives no financial compensation for her role with the organization.
While the authors of “Diabetes advocacy campaigns should focus on living a life, not fighting a battle” offer an important perspective on the language of advocacy, the institutional context of these viewpoints should be considered. Several authors represent organizations that receive funding from the pharmaceutical industry, yet those connections were not declared as competing interests.