Beyond identity: Practical tips for supporting LGBTIQA+ people in diabetes care

By Carolien Koreneff, Credentialled diabetes educator and registered nurse

People living with diabetes come from all communities, including people who are lesbian, gay, bisexual, transgender, intersex, queer, asexual, and other sexually or gender diverse identities (LGBTIQA+). Evidence shows that some LGBTIQA+ people experience greater challenges with diabetes risk, access to care, and diabetes‑related outcomes.

These differences are not caused by who someone is. Experiences and evidence differ across lesbian, gay, bisexual, transgender, intersex, and queer communities. These differences are closely linked to factors that health professionals see regularly in practice, such as stress, mental health concerns, delayed access to care, and past experiences of healthcare that did not feel safe or respectful.

Improving LGBTIQA+ people’s access and engagement to appropriate services is important because they commonly experience poorer mental health and substantially higher rates of depression, anxiety, and suicide than the general population due to societal marginalisation. LGBTIQA+ people also continue to face significant stigma and discrimination by individuals, organisations, and institutions.

By using supportive language and flexible care approaches, you can improve engagement and support people to manage their diabetes in ways that work for them.

What the evidence tells us (in brief)

Research from large population studies and diabetes services shows that:

• Some gender‑diverse people are diagnosed with type 2 diabetes later, often with higher HbA1c levels at diagnosis
• Ongoing stress and mental health challenges are associated with greater difficulty managing blood glucose levels
• People who have delayed or avoided healthcare due to past experiences may present with more complex care needs
• Gender‑affirming hormone therapy, as may be used in transgender and gender-diverse people, may influence insulin sensitivity, but does not appear to significantly increase the overall likelihood of developing type 2 diabetes when appropriately monitored
• Inclusive care should be culturally safe and intersectional, as stigma and access barriers often overlap with other forms of disadvantage.

The practical message for health professionals is clear: supportive relationships and consistent care play a key role in diabetes outcomes.

However, it is important to recognise that there is diversity within and across LGBTIQA+ communities; LGBTIQA+ people are not a homogenous group. When working with clients, it is important to acknowledge the complexity of people’s lived experiences (Carman et al., 2020).

Practical, person‑centred tips for diabetes care

1. Create a respectful, low‑stress care environment

Small changes in how care is delivered can make a meaningful difference.

Helpful approaches include:

• Using the name and pronouns the person shares with you
• Using inclusive language (e.g. “partner” rather than assuming relationship roles)
• Avoiding assumptions about bodies, gender, or experiences
• Acknowledging and correcting mistakes calmly if they occur

These steps support psychological safety, which can make diabetes conversations easier and more productive.

2. Ask about stress as part of diabetes care

Stress affects blood glucose levels for many people. For some LGBTIQA++ people, stress can be ongoing.

Supportive ways to ask include:

• “Many people notice stress affects their glucose levels. How have things been feeling for you lately?”
• Exploring how stress, sleep, or mental health may interact with medication, eating, or activity
• Offering support options rather than focusing only on glucose numbers

Addressing stress can support wellbeing and may assist with glucose management over time.

3. Support timely screening and follow‑up

Some people have fewer opportunities for early screening due to reduced contact with healthcare services.

In practice:

• Offer cardiometabolic screening in the context of each person’s wider life circumstances
• Avoid relying on appearance or assumptions when considering diabetes risk
• Frame missed or delayed care as an access issue, not a personal shortcoming

Early support can reduce the likelihood of future complications.

4. Gender‑affirming hormone therapy and diabetes care

For people using gender‑affirming hormones:

• Follow standard diabetes screening recommendations
• Monitor HbA1c, lipids, blood pressure, and weight when hormone therapy is started or adjusted
• Avoid framing hormone therapy as a problem if glucose levels change

Supporting affirming care can positively influence wellbeing, engagement, and confidence with self‑care.

5. Support continuity and shared decision‑making

Ongoing relationships matter in diabetes care.

Helpful strategies include:

• Offering continuity with the same clinician where possible
• Clearly explaining care options and inviting questions
• Checking whether referrals feel appropriate and accessible for the person

Collaborative care planning supports confidence and long‑term engagement.

6. Use data respectfully, when relevant

If your service collects information about sexual orientation or gender identity:

• Explain why the question is asked
  “We ask this to help provide respectful care and improve services.”
• Make sharing optional
• Use the information only to guide supportive care

Respectful data collection can improve services without affecting individual care choices.

What to avoid

To support respectful diabetes care:

• Avoid language that implies blame or failure (e.g. “non‑compliant”, “poor control”)
• Avoid linking identity with responsibility for health outcomes
• Avoid delaying care until glucose levels meet arbitrary targets
• Avoid silence when clarification would help—most people value respectful conversation

Strengths‑based language supports confidence and trust.

National Action Plan for the Health and Wellbeing of LGBTIQA+ People 2025–2035

The Australian Government has recognised the health and wellbeing challenges experienced by some LGBTIQA+ people and their difficulties in accessing support services through the release of the National Action Plan for the Health and Wellbeing of LGBTIQA+ People 2025–2035 (Department of Health and Aged Care, 2024).

The aim of this national plan is to ensure LGBTIQA+ people achieve equitable health and wellbeing outcomes with access to safe, respectful, high-quality and inclusive health and wellbeing services.

Key takeaway for health professionals

Diabetes care is most effective when people feel:

• Respected and listened to
• Supported in the context of their whole life
• Encouraged rather than judged
• Involved in decisions about their care

Understanding LGBTIQA+ terminology and using language that is inclusive demonstrates respect and recognition for how people describe their own gender, bodies, and relationships.

Using positive, person‑centred language and flexible care approaches helps ensure LGBTIQA+ people receive the same high‑quality diabetes support as anyone else.

It is worth noting that while the preferred language of LGBTIQA+ people can change over time, and can be used differently by different age groups, knowledge of LGBTIQA+ language and terminology will increase service users’ comfort and the chances of successful engagement (Ayhan et al., 2019).

This is not about labels or politics—it is about good diabetes care, delivered with care and respect.

Endnotes

Other variations of this acronym exist. Acronym choice can vary depending on the groups or issues being discussed and the available evidence. The acronyms used in this resource reflect the research conducted.

There is no single LGBTIQA+ community, rather a plurality of identities and experiences (National LGBTI Health Alliance, 2013b).

Further reading

If you are interested in reading more about diabetes in the LGBTIQA+ community, check out: Diabetes Management Journal August 2024.

References

1. McNeil, JA Jr, Wolfe, A & Xie, H 2025, ‘Diabetes disparities in sexual and gender minorities: a call for tailored clinical strategies’, Diabetes, vol. 74, suppl. 1, p. 1476‑P, doi:10.2337/db25-1476-P, viewed at https://diabetesjournals.org.
2. Department of Health and Aged Care. (2024). National Action Plan for the Health and Wellbeing of LGBTIQA+ People 2025–2035. Canberra: Department of Health and Aged Care. www.health.gov.au/resources/publications/national-action-plan-for-the-health-and-wellbeing-of-lgbtiqa-people-2025-2035
3. Carman, M., Rosenberg, S., Bourne, A., & Parsons, M. (2020). Research matters: What does LGBTIQ mean? Melbourne: Rainbow Health Victoria. www.rainbowhealthvic.org.au/media/pages/research-resources/research-matters-what-does-lgbtiq-mean/4107366852-1605661767/research-matters-what-does-lgbtiq-mean.pdf
4. Lusk, J et al. 2025, Diabetes treatment patterns and outcomes among transgender, nonbinary, and gender diverse adults with type 2 diabetes, paper presented at the American Diabetes Association Scientific Sessions, June, Chicago, IL, viewed at <https://www.medcentral.com> and https://www.urbanhealthtoday.com.
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7. Shadid, S, Abosi‑Appeadu, K, De Maertelaere, AS et al. 2020, ‘Effects of gender‑affirming hormone therapy on insulin sensitivity and incretin responses in transgender people’, Diabetes Care, vol. 43, no. 2, pp. 411–417, doi:10.2337/dc19-1061.
8. van Velzen, DM, Wiepjes, CM, Nota, NM et al. 2022, ‘Diabetes mellitus in transgender individuals undergoing hormone therapy’, Journal of Clinical Endocrinology and Metabolism, vol. 107, no. 5, pp. e2000–e2007, doi:10.1210/clinem/dgab934.
9. Hill‑Briggs, F, Adler, NE, Berkowitz, SA et al. 2021, ‘Social determinants of health and diabetes: a scientific review’, Diabetes Care, vol. 44, no. 1, pp. 258–279, doi:10.2337/dci20-0053.
10. Garcia, JF, Majidi, S, Mungmode, A et al. 2025, ‘LGBTQ+ supportive and inclusive care practices in diabetes services’, Diabetes Spectrum, vol. 38, no. 2, pp. 124–132, doi:10.2337/ds24-0025.
11. Veale, JF et al. 2023, ‘Transgender‑related stigma and gender minority stress‑related health disparities in Aotearoa New Zealand’, The Lancet Regional Health – Western Pacific, vol. 39, article 100816, doi:10.1016/j.lanwpc.2023.100816.
12. NSW Ministry of Health 2022, NSW LGBTIQA++ Health Strategy 2022–2027: Summary of evidence, NSW Health, Sydney, viewed at https://www.health.nsw.gov.au/LGBTIQA+-health.
13. Diabetes Australia 2026, Our Language Matters: Improving communication with and about people with diabetes – Position statement, Diabetes Australia, Canberra, viewed at https://www.diabetesaustralia.com.au/wp-content/uploads/Language-Matters-Diabetes-Australia-Position-Statement.pdf.
14. Ayhan, C. H. B., Bilgin, H., Uluman, O. T., Sukut, O., Yilmaz, S., & Buzlu, S. (2019). A systematic review of the discrimination against sexual and gender minority in health care settings. International Journal of Health Services, 50(1), 44–61. doi:10.1177/0020731419885093
15. National LGBTI Health Alliance. (2013a). Gender inclusive language guide. Newtown: LGBTI Health Alliance.
16. National LGBTI Health Alliance. (2013b). LGBTI Cultural Competency Framework: Including LGBTI people in mental health and suicide prevention organisations. Newtown: LGBTI Health Alliance. www.lgbtihealth.org.au/sites/default/files/Cultural%20Competancy%20Framework.pdf
17. Australian Institute of family Studies LGBTIQA+ glossary of common terms accessed on 22/05/2026 through https://aifs.gov.au/resources/resource-sheets/lgbtiqa-glossary-common-terms