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Does the Term “Borderline” Cause Harm?

Nov 25, 2017
By: Courtney Fagan, BSN, RN

Is it true that how healthcare professionals talk about diabetes really matters? Research articles and organizations such as AADE and the ADA have found that the language we use when educating patients about diabetes has a monumental impact on their ability to manage the condition. It is the consensus that our language should be patient-centered, empowering and free of judgement or criticism to promote positive outcomes.

We now understand that the way we speak to our patients during education is crucial for their success, including when we teach them how to control their blood glucose, manage a healthy weight, and how to properly take their diabetes medications. As diabetes educators, we are also aware our choice of words is extremely critical, especially in the beginning stages of their diagnosis. Since the physician is often the first person to speak to the person about diabetes, wouldn’t it make sense to start thinking about the language used with people at the first point of contact?


This question leads me to my main point—it is important for the physician to carefully speak to the person at the time of diagnosis.


This question leads me to my main point—it is important for the physician to carefully speak to the person at the time of diagnosis. When we talk about using appropriate language with our patients with diabetes, we often focus on choosing the correct words that will encourage, motivate, and improve their psychosocial well-being.

However, during my first few months as a diabetes educator, I quickly realized how many patients I saw who had no clue that their prediabetes was a precursor for diabetes mellitus type 2, or who even understood that once they received a type 2 diabetes diagnosis, it was permanent. I immediately had a theory— was it possible that some of the language used was inaccurate and maybe even harmful for the person’s health at some point?

Not only did the patients not understand their diagnosis, but I began to see a trend during my initial consultations. Many of my type 2 diabetes patients remembered being called the term “borderline” by their physicians at one point in time. During my training as a diabetes educator, I was instructed to never use the description “borderline” because it does not carry the same weight as the term, prediabetes. After weeks of hearing various patients who came in upset and frightened, state that if they had known that they had prediabetes, they would have taken the diagnosis more seriously and made more of an effort to make healthy lifestyle changes, I decided it was time to test my theory.

Does the term “borderline” cause harm? I began asking my patients with prediabetes what their physicians discussed with them at the first evaluation after receiving an A1C over 5.6%. Surprisingly, close to 60-70% of the patients reported being told they were “borderline” or “just slightly over the normal blood sugar value.” I now understand why these patients continued to struggle with impaired glucose tolerance or eventually developed type 2 diabetes. Because they did not fully understand what “borderline” meant until our first education session, they never made changes to their diet or activity level. The question now is, will the removal of the term “borderline” during diagnosis improve patient outcomes in regards to diabetes management?


COurtney-Fagan-headshotGreetings! I am Courtney Fagan, I am a registered nurse in the state of Wisconsin and Illinois. I have been a nurse for 12 years and have a nursing background in the ICU, critical care, and skilled rehabilitation departments. I am also an approved Certified Nursing Assistant Instructor for Wisconsin, as well as a technical college adjunct instructor teaching CPR and First Aid. In my current role as a Diabetes Educator, I work for the Clinical Nutrition and Diabetes Management Program, seeing people with prediabetes, DM type 1 and 2, and gestational diabetes on an outpatient basis.

I hold a Bachelor’s of Science in Nursing from Concordia University-Wisconsin and I am currently pursuing a Master’s of Science in Nursing Education. I am an active member of AADE, a member of the American Heart Association’s Instructor Network, and affiliated with the American Heart Association’s Stroke Council. I am extremely passionate about Diabetes education and I am currently studying for my CDE.

In my personal life, I have been blessed with a wonderful, active, and playful son. We enjoy outdoor activities, travel, and trying new and healthy foods from various places around the country. During the holidays we volunteer our time to deliver hot meals to people in need during Thanksgiving and Christmas. We enjoy giving back to our community and are always looking for ways to offer support for those less fortunate.

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