As the diabetes epidemic sweeps across the nation, impacting over 37 million Americans, how can employers cultivate a health-centric and inclusive work environment?
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Millions of employees clock in daily, facing a hidden struggle: managing their diabetes while delivering their best at work. Type 2 diabetes and prediabetes affect over a hundred million people in the US, and the workplace is no exception.
Given that the workplace often mirrors broader societal trends, it’s no wonder that employers throughout the United States are grappling with a significant number of employees, dependents, and retirees who have diabetes.
In 2017, the American Diabetes Association estimated that the cost of diabetes is a staggering $237 billion in medical expenses and $90 billion in lost productivity.
But the workplace itself can become the ultimate battleground for managing diabetes, offering challenges and unique opportunities for employees and employers.
As we enter November, designated as National Diabetes Month, employers have an opportunity to assess the effectiveness of their diabetes programs and wellness benefits in helping employees maintain their health and productivity.
Diabetes in the Workplace
Once a disease of the rich, diabetes is now a global epidemic, affecting people from all walks of life. The rapid surge in diabetes cases is due to several factors, including improved detection methods, demographic changes, and lifestyle changes.
There are three main types of diabetes to consider:
- Type 1: Affects 5-10% of individuals with diabetes, develops rapidly, and is typically diagnosed in children, teenagers, and young adults.
- Type 2: Affects 90-95% of individuals with diabetes, develops gradually over time, and is generally diagnosed in adults.
- Gestational diabetes: It can occur during pregnancy.
Type 2 diabetes (T2D) is the most common form of diabetes, accounting for 90-95% of all cases in the United States. While type 2 diabetes can develop at any age, it is more common in older adults.
However, the increasing number of children with obesity has led to more cases of type 2 diabetes in younger people.
Within the United States, diabetes statistics reveal a concerning trend, with one in four young adults aged 19 to 34 living with prediabetes, placing them at a heightened risk of progressing to Type 2 diabetes without vigilant health management.
If current trends persist, projections suggest that diabetes could affect one out of every three Americans by 2050.
However, Type 1 diabetes (T1D) is also experiencing an annual increase of approximately 3%. While the exact reason for this rise remains uncertain, it is clear that diabetes in the workplace will continue to be a significant concern for many years.
People with diabetes can live long and healthy lives, but they may need to make some adjustments to manage diabetes in the workplace effectively.
Managing Diabetes at Work
Diabetes is a metabolic disorder that disrupts the body’s ability to produce insulin and regulate blood sugar levels effectively.
Hence, people living with diabetes face the challenge of monitoring their blood sugar levels throughout the day, carefully selecting their meals, attending regular doctor appointments, and, in some cases, administering between two to four insulin injections daily as the condition progresses.
It also requires careful planning, from anticipating how factors such as illness, exercise, and stress affect blood sugar levels to ensuring that wearable and injection devices work correctly.
And yet, despite the availability of numerous treatment options with different mechanisms, only 45% of patients with Type 2 diabetes and 25% of those with Type 1 diabetes can achieve their target blood sugar goals, according to the CDC (Centers for Disease Control and Prevention).
1) Occupational Concerns Related to Diabetes
Managing diabetes demands continuous attention to blood sugar levels, even during working hours.
It’s crucial to recognize the potential occupational concerns associated with diabetes, as they can significantly impact health and job performance.
Individuals dealing with diabetes may encounter a range of occupational challenges, including:
- Hypoglycemia (Low blood sugar)
- Hyperglycemia (High blood sugar)
- Long-Term Diabetes Complications can include heart disease, stroke, kidney disease, and vision impairment.
When experiencing hyper or hypoglycemia (sudden spikes or drops in blood glucose levels), people with diabetes commonly endure symptoms such as fatigue, blurred vision, slowed speech or thought processes, and occasionally, mental confusion.
Additionally, people with diabetes in poor health may experience fatigue more frequently than others.
Some jobs may be restricted for people treated with insulin, especially if they require the person to operate machinery or vehicles or to work in safety-sensitive positions.
For example, people with diabetes may not be able to work as commercial pilots, commercial drivers, or certain military positions.
2) Occupational Factors Affecting Diabetes
Although diabetes rarely restricts career choices, individuals working conventional nine-to-five jobs frequently encounter challenges maintaining dietary and exercise regimens to keep their blood sugar within a healthy range.
Some occupational factors can affect diabetes management, including:
- Working long or irregular hours can make it difficult to follow a healthy diet and exercise regularly.
- Cortisol levels, or stress, can raise blood sugar levels and make it difficult to manage diabetes.
- Jobs that require heavy lifting or other strenuous physical activity.
- Adequate breaks and access to food are essential for proper diabetes management.
- Frequent travel or long commutes can disrupt routines and make maintaining consistent blood sugar control challenging.
3) Workplace Interventions & Accommodations for Diabetes
Considering that employees spend more than 40 hours per week in the workplace, employers have a unique opportunity to play a crucial role in helping their employees manage these health conditions and succeed at work.
Some workplace interventions and accommodations that can be helpful include:
- Flexible work hours allow employees to schedule their work around their diabetes needs, such as taking breaks to check blood sugar levels or eating healthy meals.
- Telework, or working from home, can be a good option for employees with diabetes who need to take more breaks or avoid exposure to hazardous substances.
- Employers can provide employees with access to healthy food and drinks in the workplace by offering healthy options in the cafeteria and vending machines or providing a space for employees to bring their lunches.
- On-site fitness facilities can make it easier for employees to exercise regularly.
- Employers can offer diabetes education programs to employees to help them learn more about their condition and how to manage it effectively.
Tailoring workspaces and workdays to include opportunities for physical movement could enhance employees’ health, concentration, and overall performance.
Diabetic Employee Rights
Diabetic employees in the US are protected from discrimination under the Americans with Disabilities Act (ADA). In other words, it means an employer cannot fire, refuse to hire, or demote employees because of diabetes.
The ADA also requires employers to provide reasonable accommodations to diabetic employees who need them to perform their duties.
Reasonable accommodations are changes to the work environment or routine that help a diabetic employee manage their diabetes.
Examples of reasonable accommodations for diabetic employees include:
- Allowing the employee to keep food and diabetic supplies close at hand.
- Allowing employees to take regular breaks to check their blood sugar, eat a snack, take medications, or use the restroom.
- Providing a private place for employees to test their blood sugar and give themselves insulin.
- Providing a safe place for employees to rest until their blood sugar normalizes after a hypoglycemic episode.
- Giving the employee time off to receive medical treatments for their diabetes or recuperate from complications related to their diabetes.
- Modifying the employee’s work schedule if their expected shifts interfere with their ability to manage their condition.
- Allowing the employee to use a special chair or stool or take a shortcut if they have trouble standing or walking due to diabetic neuropathy.
- Providing the employee with a large-screen computer monitor or other assistive devices if they have visual impairments caused by diabetes.
If an employer refuses to provide reasonable accommodation to an employee with diabetes, the employee may have a legal claim under the ADA.
Employees can file a complaint with the Equal Employment Opportunity Commission (EEOC) if they believe they have been discriminated against because of diabetes.
When the employer has over 50 employees or is a government employer, eligibility for leave under the Family and Medical Leave Act (FMLA) exists under diabetic employee rights.
FMLA permits employees to take up to 12 weeks of unpaid leave annually for specific medical reasons, which include serious health conditions, including diabetes-related conditions or complications.
Diabetic Discrimination at Work
Despite laws protecting people with disabilities from discrimination, people with diabetes still face discrimination in the workplace every day.
One UK survey found that one in six people with diabetes feel that their employer has discriminated against them because of their condition.
Diabetic discrimination at work can be subtle but can also lead to uncomfortable situations, unfair treatment, and even endanger the employee’s life.
For example, 19% of people with diabetes were disciplined for needing time off, 25% were questioned about their time off, and 12% were not allowed time off at all.
Some people with diabetes said that they felt ashamed of their diabetes and felt guilty for having to take time off.
Employers have a legal and moral obligation to create workplaces that are free from discrimination of all kinds. What’s more, an inclusive and supportive workplace can lead to improved work outcomes and employee well-being.
Costs of Diabetes
In addition to the emotional and physical challenges the disease poses to employees, diabetes also has a significant financial impact on employers and the economy.
A survey of health benefit managers at companies that self-fund their health plans found that diabetes is a significant concern within the workplace. Most employers surveyed ranked diabetes within the top three conditions that should be addressed through wellness and disease management programs.
1) Economic Costs of Diabetes
The economic impact of diabetes is substantial.
Despite a consensus among healthcare professionals on effectively managing the disease, practical implementation often falls short.
Diabetes treatment is inherently intricate, as it necessitates a combination of behavioral adjustments and medication.
Patients often have to make substantial changes to their lifestyle, including diet and exercise, which demands diligent self-management and regular involvement from healthcare providers to monitor and oversee the treatment.
But when diabetes is poorly managed, it tends to lead to various complications, including cardiovascular issues, neurological disorders, renal problems, and vascular conditions, among others.
These complications result in heightened healthcare expenditures, including increased hospital admissions, frequent outpatient visits, and escalating medication costs.
To illustrate, in 2012, one out of every three hospital inpatient days related to complications such as neurological, cardiovascular, and renal issues could be directly attributed to diabetes.
The financial burden of complications resulting from inadequately managed diabetes is notably higher when compared to individuals effectively managing their diabetes.
Research has shown that, in comparison to those with well-managed diabetes:
- Diabetic kidney, cerebrovascular, and peripheral vascular disease each result in a 10-30% cost increase.
- Insulin treatment, angina, and myocardial infarction contribute to a 60-90% cost increase.
- Dialysis for severe kidney issues leads to an astonishing 11-fold cost increase.
2) Direct & Indirect Costs of Diabetes
As a result of poor diabetes management, employers face extensive direct costs from diabetes-related medical claims. There are also substantial indirect costs from employee absenteeism, reduced productivity, early retirement, and diabetes-related disability.
Direct costs of diabetes include the cost of hospitalization, medical care, treatment and supplies, and other healthcare costs. In 2017, the estimated direct cost of diabetes in the United States was $237 billion.
Indirect costs of diabetes are more difficult to measure, but they are estimated to be significant.
A 2017 study by the American Diabetes Association found that the indirect costs of diabetes in the United States totaled $90 billion and include:
Reduced productivity among employed individuals: $26.9 billion
Inability to work due to disease-related disability: $2.3 billion
Reduced productivity for those not in the labor force: $37.5 billion
Lost productivity due to 277,000 premature deaths attributed to diabetes: $19.9 billion
Therefore, the combined direct and indirect cost of diabetes adds up to a staggering $327 billion.
3) Productivity Costs of Diabetes
The productivity costs of diabetes are particularly concerning.
One study found that people with type 1 diabetes reported a 23% loss in work productivity due to the demands of the disease. Those with type 2 diabetes on insulin reported a 19% loss in productivity, and those with type 2 diabetes who don’t take insulin said they lost 11% of their work productivity.
These findings have important implications for organizations’ healthcare policies.
Given the high prevalence of diabetes and its significant economic impact, investing in early intervention and prevention programs is essential. This could help to reduce the number of people who develop diabetes and the associated costs of the disease.
Strategies for Diabetes Management at Work
Managing diabetes at work has traditionally involved various strategies aimed at prevention and control.
These approaches include conducting health risk assessments to identify employees already diagnosed with diabetes, on-site biometric screenings to uncover undiagnosed cases, education and counseling to promote healthier behaviors, and implementing weight loss and fitness lifestyle modification programs to mitigate ongoing risks.
Today, employers are implementing various strategies to effectively address the challenges of managing diabetes at work.
This includes identifying means to incentivize employees, their dependents, and retirees through benefits design and adopting new business models that add value to employee care and reduce avoidable costs.
Implementing Diabetes Programs in the Workplace
To successfully implement diabetes programs in the workplace, taking a proactive and comprehensive approach is essential. This involves developing and executing a set of strategies and initiatives that form an effective program for managing diabetes among employees.
These programs aim to not only address the medical aspects of diabetes but also consider the broader work environment and support systems needed to ensure the well-being of employees with diabetes.
Creating a Supportive Work Environment for Employees with Diabetes
Fostering a supportive work environment for employees with diabetes is paramount in helping them manage their condition effectively. This involves accommodating the workplace and understanding the unique needs of employees dealing with diabetes.
Additionally, acknowledging the significance of weight inclusion as part of this support ensures that employees with diabetes have access to resources and accommodations that address their weight-related challenges, promoting holistic and effective diabetes management within the workplace.
Diabetes Management Programs for Employers
Roughly 50% of American employers, specifically those with at least 50 employees, provide health and wellness initiatives aimed at helping employees make lifestyle improvements or manage various health conditions.
Among these programs, diabetes is the most frequently addressed health issue in disease management efforts.
Diabetes management programs for employers typically include a range of activities and interventions, such as:
- Health risk assessments
- On-site screenings
- Counseling services
- Lifestyle modification programs
- Integration of clinical care approaches
These programs aim to promote the prevention, early detection, and effective management of diabetes among employees while minimizing its impact on workplace productivity and healthcare costs.
National studies have shown that for each dollar spent on diabetes management, employers enjoy a $4 return on investment.
Digital Tools and Solutions
Dealing with diabetes is a journey, and it offers a significant opportunity for patients, healthcare providers, and organizations to use technology more efficiently.
The use of connected devices and apps, guided by clinical guidelines and real-time data specific to each patient, can provide valuable insights into patient behavior, improve communication with healthcare professionals, and generate data that supports the development of new and more effective treatments.
In essence, these digital tools and solutions can be powerful allies in helping individuals with diabetes lead healthier and more manageable lives.
As we witness the introduction of newer medications like Ozempic and Mounjaro, designed to simplify treatment regimens and enhance glycemic control, it’s evident that digital technologies are also advancing to enhance the detection, diagnosis, treatment, and self-management of diabetes.
Innovative technologies like “smart pills,” microneedles, continuous glucose monitors (CGM), contact lens-based monitoring systems, and various other scanning devices are currently in development.
These innovations aim to move patients away from the traditional approach of frequent blood sugar testing involving painful pinpricks.
The Future of Diabetes Management & Care in the Workplace
Managing diabetes in the workplace is a complex challenge, but it must be addressed, given the rising prevalence of chronic disease and the aging population.
An excellent place to start is by implementing integrated care models that have been shown to be effective in reducing hospital admission rates for people with diabetes.
Therefore, to be successful, future approaches to diabetes management in the workplace must be:
- Patient-centric: Diabetes management should be tailored to the individual needs of each patient, taking into account their cultural background, ethnicity, and regional differences in resources.
- On-demand and around-the-clock: Diabetes management is a 24/7 endeavor, and patients need access to support and care when they need it most.
- Scalable: Solutions must be able to be implemented at scale to reach the large number of people with diabetes.
- Technology-enabled: Technology can make diabetes management more personalized and effective.
By taking a comprehensive and patient-centered approach to diabetes management in the workplace, we can improve the quality of life for people with diabetes and reduce the overall burden of the disease on society.
Written by Ivana Radevska
Senior Content Writer at Shortlister
- Turning the tide on diabetes management (Deloitte)
- How digital technology is helping lessen the global rise of diabetes (EY)
- National Diabetes Statistics Report 2020 (CDC)
- How technology can help millions of diabetes patients (KPMG)
- Diabetes in the Workplace (CDC)
- Burden of Diabetes on the Ability to Work (NIH)
- Statistics About Diabetes (American Diabetes Association)
- Diabetes Research Highlights Lost Productivity and Impact on Daily Activities of Living with Diabetes
- Health and Economic Benefits of Diabetes Interventions (CDC)
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