An employer’s guide to Type 2 diabetes in the workplace

We explore the impact of this increasingly prevalent global condition and what organisations can do to help their staff avoid or manage it.

This article is in three parts:

• Part 1: Two-minute takeaways. The key facts and stats about diabetes.
• Part 2: An examination of the global situation, the impact of T2 diabetes on the workforce and how organisations can help support employees to avoid or manage the condition
• Part 3: Eight T2 diabetes prevention and support strategies to consider

Part 1: Two-minute takeaways:

• Since nearly 9 percent of adults have diabetes, diabetes is a fact of life in most large workplaces
• Diabetes affects organisations’ health care costs and productivity, so supporting workers with diabetes is both the right thing to do and a smart business decision
• Implement risk assessments: although many factors lead to the development of diabetes, the major controllable risk factors are body weight and physical activity. Understanding the profile of your workforce can help you design a holistic approach to health and wellness
• Tackle the “sitting disease”: fighting diabetes in the workplace means changing the corporate culture. When you make it easier for workers to eat right and be physically active, you help them control their diabetes — or even prevent it occurring in the first place
• Put mental health and total wellness support in place: diabetes distress and stress are two of the potential consequences of diabetes, causing the individual’s holistic health to worsen
• Removing barriers — real or perceived — for employees around taking time off to look after their health, and communicating company policies, could have a significant impact on well-being
• Guarding against discrimination: while you shouldn’t discriminate against employees with diabetes, you should provide them with the support they need to be effective on the job while managing their condition
• It’s important to communicate workplace policies regarding:
  • Day-to-day diabetes management, including accommodations that make diabetes management easier
  • Health care prevention programs and health care benefits, services and initiatives
  • Time off/sick leave policies
• Encourage communication with employees around self-care, prevention, disease management and treatment
• Successful programmes require leadership buy-in, long-term commitment and authentic employee communications
• Aetna International can support with prevention, early intervention and condition management; our vHealth offering can help members manage their condition virtually, without frequent in-person doctor visits

Diabetes and the workplace

Early intervention saves lives

When his fatigue and severe dry mouth became unbearable, Chet Ripple, a night shift leader for snack maker Utz Quality Foods in Hanover, Pennsylvania, visited a clinic for a routine check-up. Dr Ronald Pyram ordered a blood test and sent him for an eye exam, but soon called him back to the office. Ripple, it turned out, had diabetes and needed an immediate insulin injection. “Dr Pyram saved my life,” Ripple told Employee Benefit News. “If he hadn’t called me and insisted that I return to the clinic — first of all, what doctor does that? — who knows what I would have eaten after my appointments? Dr Pyram has given me back my life.”¹

What makes Ripple’s story somewhat unusual is that he received his diagnosis at work, in a clinic that, ironically, shares a wall with a production line where salty, fat-laden treats are packaged for distribution.² His company, one of the largest food producers in America’s self-proclaimed Snack Food Capital, opened the clinic in October 2016 to serve some 2,000 local employees and their dependents. Within three years, the clinic had saved the company $1.3 million in health care costs and, in Chet Ripple’s opinion, at least one life.³

Diabetes basics

Of course, diabetes doesn’t just affect people who work for snack-food companies. According to the World Health Organization, 8.5 percent of the world’s adults now have diabetes, nearly double the percentage in 1980. And the trend lines are moving in the wrong direction, with the global prevalence expected to increase by 37 percent over the next 20 years. That’s in part because diabetes is no longer just a problem in wealthy countries; today, it is becoming increasingly prevalent in low- and middle-income countries, which account for two-thirds of cases worldwide.^4,5,6

Diabetes is a disorder of the body’s metabolic system, whereby there’s a disruption in the production of insulin or the body’s use of insulin, or both. As a result, there’s a surplus of glucose in the blood and a deficit in the body’s organs. Elevated blood glucose levels can, over time, cause blood vessels to become clogged and hardened, which can lead to heart disease and stroke, the primary causes of death for people with diabetes.⁷ In fact, diabetes doubles the risk of heart attack and stroke, and heart attacks experienced by people with diabetes tend to be more serious and more likely to lead to death.⁸ But uncontrolled diabetes can also result in kidney failure, vision loss and amputations.

“In 2016, slightly more people globally died as a direct result of diabetes than died as a result of road accidents: 1.6 million vs. 1.4 million. And in both cases, most of the deaths could have been prevented. We just have to have the will to take action,” says Senior Medical Director Lori Stetz, M.D., Aetna International.⁹

Diabetes and mental wellness

Diabetes can also affect the mind. According to the U.S. Centers for Disease Control and Prevention (CDC), people with diabetes are 2 to 3 times more likely to suffer depression than people without diabetes — and only 25 to 50 percent of people with diabetes and depression receive treatment for their depression.¹⁰ Untreated depression impacts quality of life, of course, but it also impacts people’s ability to function at work. One study found that depression costs U.S. employers US $44 billion a year in lost productivity.¹¹

“Even people who don’t become depressed can face serious levels of stress, which can actually affect blood glucose levels, creating a vicious cycle,” says Dr Stetz. “Moreover, some people develop a condition called diabetic distress, which looks a lot like depression or anxiety. Access to counselling and other mental health services can be very important.”^12,13

The most common form of diabetes is type 2 diabetes, which accounts for up to 95 percent of adult cases. (Type 2 diabetes was once known as adult-onset diabetes but is now increasingly found in children due to lifestyle choices.) While race, age and family history all play a role in whether someone develops type 2 diabetes, the major controllable risk factors are body weight and physical activity. In fact, between 60 and 90 percent of patients are significantly overweight. That’s why diabetes is often called a lifestyle disease.^14,15

But just as lifestyle can contribute to the development of diabetes, it can also contribute to control of the disease. Through diet and exercise, many patients are able to maintain their target blood sugar levels (although others do require diabetes medication or insulin therapy).¹⁶ A recent study by researchers at the University of Cambridge suggests that it’s important for people  to lose excess weight soon after diagnosis. Specifically, they found that patients who lost 10 percent or more of body weight within five years of being diagnosed doubled the odds that their disease would go into remission.¹⁷

The impact of diabetes on organisations

Whether it’s controlled or not, diabetes has a major impact on the lives of the people it affects. But the impact is much broader. Between 2011 and 2030, global GDP losses due to diabetes are projected to total US $1.7 trillion.¹⁸ And according to a report from EY Global, some 12 percent of global health spending goes toward diabetes treatment.¹⁹

That last figure hints at the impact of diabetes on organisations and at one reason companies like Utz Quality Foods are creating onsite clinics and offering wellness programs. When employers take steps to improve the health and well-being of their employees, it benefits the organisation as well.

In the U.S. alone, diabetes accounted for US $245.5 billion in health care spending in 2017, according to the Gallup-Sharecare report The Cost of Diabetes in the U.S.: Economic and Well-being Impact. On top of that, the report found, full-time workers with diabetes miss an extra 5.5 workdays per year, while part-time workers miss an additional 4.3 days. Those absences mean a hit on productivity of some $20.4 billion annually.²⁰

Another study, this one by the American Diabetes Association, found a similar direct impact ($237 billion) but a much higher impact from reduced productivity ($90 billion), in part because the study included the burden of reduced employment, presenteeism and premature mortality, not just absenteeism. It also found that the economic costs of diabetes grew a troubling 26 percent from 2012 to 2017.²¹

“The impact of diabetes on the economy is real,” Dan Witters, research director for the Gallup-Sharecare Wellbeing Index, told The American Journal of Managed Care. “It affects the lives of those who have it, but it also impacts the bottom line of employers, because there is a not insignificant portion of their workforce that is carrying around this disease state.”²²

Preventing and managing diabetes in the workplace

Given the growing impact of diabetes, organisations have a vested interest in helping their employees prevent or manage their condition. That can be a challenge, however, since modern workplaces often encourage behaviours that are counterproductive. Consider food, for example. Even if your organisation doesn’t produce crisps and cheese balls like Utz Quality Foods does, it probably stocks them in vending machines. Moreover, it’s a lot harder to stop people snacking on the job than it is to stop them smoking on the job. As Dave Fried, CEO of Tricore Human Capital Management, has noted, “Unlike smoking, food is not taboo, and it will be much more difficult to control.”²³

Tackling the “sitting disease”

And most modern workplaces don’t make it easy for people to engage in robust physical activity. For example, one survey found that the average office worker in the UK sits for 10 hours a day, with nearly 70 percent of that sitting taking place at work. In fact, some experts now argue that “sitting disease” is as harmful as smoking.^24,25

Guarding against discrimination

There’s another important factor at play as well: organisations must be careful not to discriminate against job applicants or employees on the basis of diabetes. In the UK, the Equality Act 2010 makes it illegal to ask applicants about their health before offering a position. In the United States, the Americans with Disabilities Act prevents employers from asking applicants about medical conditions and requires reasonable accommodations for employees with diabetes. Accommodations can be as simple as having a private place to test blood sugar levels or as complicated as reassigning a worker to a vacant position if he or she is no longer able to perform in the current role.^26,27

Implementing risk assessments

In the UK, Fit for Work recommends employers undertake a risk assessment, with the employee’s input, to forestall any problems. Considerations would include: 1) how stable the person’s condition is and what treatment he or she is receiving, 2) whether the person has regular meal breaks and the chance to test blood glucose levels at work, 3) how work activities and schedules could impact the person’s blood glucose levels, 4) what work activities might place the person at risk in the event of hypoglycaemia, or low blood sugar, and 5) whether certain activities, like driving or working alone, can be safely undertaken.²⁸

A personalised view of job performance

It’s worth noting that diabetes shouldn’t be an automatic disqualifier for activities like driving. As Wendy Strobel Gower, of the Northeast Americans with Disabilities Act Center, has pointed out, “Diabetes can be very mild and it can be very significant. It really depends on how you experience it and how you manage it.” In fact, blanket bans are becoming rarer, even in careers like law enforcement.²⁹

“Organisations shouldn’t stigmatise or discriminate against workers with diabetes, but they shouldn’t shy away from offering support to those workers,” says Dr Mitesh Patel, Medical Director, Aetna International. “Their well-being is too important.”

Changing the company culture

One way to support employees who have diabetes, or are at risk of developing it, is to change the company culture to support better nutrition and increased physical activity. Of course, these changes can help everyone in the office since few of us eat or exercise like we should.

Environmental scanning

A good first step is to conduct an environmental scan to determine just how helpful or harmful the work environment is. The CDC has created a toolkit for creating healthier hospital environments in terms of food, beverages and physical activity, but that toolkit would actually apply to most worksites. By conducting environmental scans of your company’s cafeterias, vending machines and physical space, you can quickly identify problem areas.³⁰

You may discover, for example, that your building’s stairwells have poor signage or lighting which discourages workers from taking the stairs. A study published in the journal Preventive Medicine found that workers were about three times more likely to use the stairs when they saw signs reminding them to “burn calories, not electricity.”^31,32

Health and wellness benefits

Of course, signs alone won’t reverse decades of bad health habits. That’s why organisations are increasingly offering wellness programs that provide incentives for eating better and becoming more physically active. According to one survey in the U.S., 82 percent of large organisations and 53 percent of small organisations now offer at least one wellness program.³³

Using tech to nudge healthy behaviours

As EY Global has noted, “Health care applications can already use sensor-enabled activity trackers to provide well-timed incentives to nudge healthy behaviours for consumers who want to set themselves activity targets. But by combining these trackers with electronic health records, this technology could be leveraged to support people at risk of diabetes or obesity, by suggesting changes such as walking the few blocks to a bus stop or biking. Such small changes, made across a lifetime, can mean the difference between active, healthy aging and a middle-to-late life filled with chronic diseases.”³⁴

Behavioural counselling

While short-term results from some of these programs have been mixed, there’s solid evidence that efforts like behavioural counselling can reduce the incidence of diabetes and thus the cost of treating the disease. One study comparing the cost of lifestyle interventions with the cost of diabetes medicine found that the lifestyle programs paid for themselves within three years — and presumably continued to pay dividends in future years in the form of reduced health care costs.³⁵

Without intervention, the costs of diabetes — borne by individuals and employers alike — will surely continue to grow well into the future. That’s why employers ought to take action on behalf of their workers and themselves.

Part 3: Eight T2 diabetes prevention and support strategies to consider

It’s all but certain that your organisation employs people who either have diabetes or who are at risk of developing it. Here are some suggestions for providing them support.

1. Conduct an environmental scan. “Until you identify ways that your organisation makes life harder for people who have diabetes or who are at risk, you can’t know what you need to fix,” says Aetna’s Dr Lori Stetz. The CDC materials mentioned above offer a good starting point, but be sure to seek the input of employees who have previously disclosed that they have diabetes.³⁶

2. Offer support for testing and injections. Some people with diabetes need to test their blood throughout the day, and some need to take insulin injections to regulate their blood glucose levels. Office policies should allow some measure of privacy for these activities, as well as ease of access to refrigeration for insulin supplies.³⁷

3. Fight stigma. “Since diabetes is a lifestyle disease which can often be prevented through diet and exercise, it’s easy to stigmatise people with diabetes,” says Aetna’s Dr Mitesh Patel. “That can make it harder for people with diabetes to get the support they need.” Moreover, one study found that “perceived stigma is associated with increased psychological distress, depressive symptoms, decreased social support and decreased quality of life.” One way to fight stigma is to always use person-first language, saying “employees with diabetes” instead of “diabetic employees.”³⁸

4. Promote physical activity. You don’t have to open an onsite gym to promote physical activity (although that’s certainly not a bad idea). Free onsite fitness classes, incentive programs that use fitness trackers like Fitbits and interdepartmental challenges can all be useful tools. Chris Boyce, CEO of Virgin HealthMiles, is a fan of officewide activities like 5k races, which he believes benefit individuals and the organisation alike. “Doing something fun and personally rewarding builds camaraderie both inside and outside of the company,” he says. “When people establish stronger relationships with their colleagues, they carry that passion into their work.”³⁹

5. Upgrade office food options. When vending machines offer only sugary drinks and salty snacks, that’s what people will purchase. Many are looking for healthier options and are appreciative when they find them. For example, the Chicago Park District actually saw its weekly vending sales quadruple after switching to healthier vending options.⁴⁰

6. Educate yourself. Diabetes UK’s guide Supporting People with Diabetes in the Workplace offers 10 points employers need to understand about the needs of people with diabetes and how those needs can be address in the workplace. Aetna International’s white paper Diabetes: the world’s weightiest problem offers more in-depth information on the disease.

7. Review Aetna’s guidance on workplace nutrition. Food for thought: 11 healthy eating workplace strategies for well-being savvy organisations is full of suggestions for making it easier for people to eat more nutritiously at work.

8. Share tips and advice: Regularly sharing articles and information with employees can prompt them to make small adjustments to their behaviours, gradually helping to improve their well-being over time. As an example, read and share “Diabetic Diet: Superfoods and Foods to Avoid”.

Do employees need to disclose their type 2 diabetes to their employer?

Whether employees are required to disclose medical conditions to their employer varies depending on where you live. You should speak to your HR department to understand what you can and can’t ask, and the process for medical examinations as the appointment process for senior staff. Employers should have a policy that includes these details as well as how anti-discrimination laws apply.

Even if your staff aren’t required to disclose their medical history, you should tell them the benefits of doing so. For example, you should explain that you can work with them to make appropriate changes to their working hours or environment, ensuring they keep well – a benefit to both of you. Keep in mind though, that if they are not legally obliged to tell you about their diabetes or other health issues, then the choice is theirs whether to tell you.

If you are providing health insurance as part of your benefits package, you find out about their data protection policies and how this is shared with your employees. 

How Aetna can help employers and employees

Healthy behaviours and lifestyle coaching: Aetna International’s care and response excellence (CARE) team clinicians can work with globally mobile employees and those seeking advice/support around developing healthy behaviours. Contact the CARE team for more information by calling the number on the back of your Member ID card or logging in to the Health Hub — your secure member website.

Wellness webinars: Aetna International also provides customers and their employees with access to wellness webinars to help employees live well and feel better. To find out how to tap into the webinars, email the Aetna CARE team here.

Corporate health and wellness programmes: From smoking cessation to mindful eating, we often work with customers to design and roll out in-office health and wellness programmes. These are designed to help employees adopt healthier behaviours, thereby improving their overall well-being.

Read “Diabetic Diet: Superfoods and Foods to Avoid” or share it with your employees to provide clear guidance on how people can eat right when pressed for time.

Find more Fit for Duty materials here.

Aetna® is a trademark of Aetna Inc. and is protected throughout the world by trademark registrations and treaties.