Bridging the gap: Strengthening shared care for diabetes in Japan

Dear Editor, We welcome the increasing global emphasis on the “Language Matters”1, 2 movement in diabetes care, which seeks to reduce stigma, promote inclusion, and encourage person-centered communication. The Language Matters movement emphasizes that word choice influences patients' perceptions, behaviors, and relationships with healthcare professionals, and therefore advocates for person-first language and the avoidance of stigmatizing expressions. We highlight an under-recognized challenge in Japan: The limited development of structured shared care frameworks for diabetes management, despite their potential to improve outcomes and promote patient-centered care. Addressing this gap requires a common and respectful linguistic framework among healthcare professionals, which can reduce hierarchical barriers, clarify roles, and foster mutual trust. Improved language and communication can enhance care coordination and continuity, while helping to reduce diabetes-related stigma3. In Japan, specialist-led diabetes care remains concentrated in tertiary urban hospitals, whereas most people with diabetes are managed in primary care settings. With approximately 11 million adults suspected of having diabetes and only about 7,100 certified specialists nationwide, many patients—particularly in regional areas—are managed by nonspecialists, highlighting the need to strengthen shared care frameworks4. However, formalized shared care arrangements—where endocrinologists and primary care physicians engage in coordinated, longitudinal management—are rarely implemented. Integrated care models, which extend collaboration into psychosocial, community, and public health domains, remain an even more distant aspiration. This fragmented approach leaves primary care providers overburdened, isolates specialists from the community, and contributes to preventable complications and persistent health disparities. The roots of this gap are multifactorial, encompassing fragmented medical and administrative systems, competitive rather than collaborative professional cultures, and the absence of institutional or financial incentives to sustain partnerships. Without establishing shared care as a robust foundation, policy goals for integrated, holistic care will remain aspirational rather than actionable. In parallel, digital tools such as continuous glucose monitoring (CGM) and telemedicine support diabetes care, but their integration into routine primary care remains limited. This highlights the need for shared care frameworks, in which structured tools such as the Collaboration Notebook and Card System (Japan Association for Diabetes Education and Care) can complement digital technologies through practical, longitudinal information sharing. We propose elevating shared care for diabetes as a national health priority. Key actions include defining leadership and accountability structures at national and regional levels, embedding shared care pathways into health policy, and instituting formal agreements and secure communication channels between hospitals and clinics. Leveraging digital health tools such as telemedicine platforms and AI-driven clinical decision support systems can further facilitate seamless communication, optimize resource allocation, and support evidence-based management across care levels. Aligning payment models to reward collaboration, expanding interprofessional education, and implementing public awareness campaigns informed by “Language Matters” principles can help shift provider and patient attitudes, fostering trust, mutual respect, and shared responsibility. As diabetes-related stigma and inequities persist in Japan, strengthening shared care—complemented by digital innovation—offers a scalable, pragmatic path toward integrated, equitable, and dignified care for all individuals living with diabetes. None. The author declares no conflict of interest. Approval of the research protocol: None. Informed consent: None. Registry and the registration no. of the study/trial: None. Animal studies: None. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.