Each year, November 14 marks the start of World Diabetes Day, a global event dedicated to raising awareness about one of the fastest growing chronic diseases in the world and its impacts on personal and populational health.
As analysts at Shortlister note, diabetes is a severe health problem with “epidemic proportions,” already affecting more than half a billion people worldwide—or more than 10 percent of the global population. With prevalence rates expected to surpass 12 percent (~960 billion people) in just the next couple of decades, it’s no wonder that more organizations are looking to prioritize diabetes management in their benefits offerings within the next year.
Unfortunately, however, while it is more than possible to prevent, reverse (Type 2 only), or manage diabetes, pervasive stigma and a lack of knowledge on the topic make it a much harder disease to combat. It is for this reason that the Pan American Health Organization (PAHO) has declared the theme for this year to be, “Education to Protect Tomorrow. [Calling on] the need to strengthen access to quality education on diabetes both for the health team and for people living with diabetes, their caregivers, and society in general.”
Thus, in order for employers to successfully promote diabetes prevention, management, and treatment in their workplace, they will need to first turn their focus toward education and awareness initiatives to ensure that all employees—including themselves—have the opportunity to learn what it is they need to know about the disease, including its causes and risk factors, the effects it has on a person’s health and wellbeing, how it is treated and/or managed, and how much of a role the person afflicted and that person’s family and friends, team of care providers, employer and coworkers play in diabetes management.
Diabetes 101
The clinical definition of diabetes is that it is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), caused either by the pancreas’ inability to produce insulin (Type 1) and/or the body’s inability to use it sufficiently (Type 2). Subsequently, this condition makes it difficult to maintain stable blood sugar levels, which over time can damage the body’s cardiovascular, nervous, sensory nervous, and urinary systems, resulting in risk of cardiovascular disease (including heart attack or stroke), neuropathy, kidney damage or failure, retinopathy/blindness and more. In most severe cases, this can also contribute to risk of coma or death.
For various reasons, including the fact that some people with diabetes (PWD) may experience no symptoms until they are in the later stages of a serious diabetic episode or health emergency; that monitoring blood glucose levels is a very time-consuming, costly, and difficult task; and the fact that proper education on the ins and outs of diabetes is hard to come by, diabetes is a very challenging condition to manage for most, let alone prevent—which is why diabetes is one of the fastest-growing health issues around the world. As the latest findings suggest, as high as 70 percent of PWD have uncontrolled blood glucose levels alone, which really paints a picture of how poorly those who are undiagnosed, pre-diabetic, or who are at risk are likely monitoring and managing their blood sugar.
Diabetes in Numbers
Further exacerbating PWD’s risk of more serious health complications is the prevalence of stigma still in today’s culture. As many health experts and advocates, the stigmatic belief that diabetes is a choice or a direct consequence of being overweight/obese or “eating lots of junk food” can result in a number of unfortunate scenarios; namely:
(i) that people who are overweight or obese who do have diabetes will avoid disclosing their illness at work and/or seeking help in order to manage the disease;
(ii) that those who are not overweight and/or who otherwise do not excessively or routinely eat “junk” or unhealthy foods will avoid disclosing their illness at work and/or seeking help in order to manage the disease due to the fear that they will be labeled as “unhealthy” and judged by others for being so;
(iii) that people who do not fit the stereotype of being overweight/obese, physically unfit, and/or an unhealthy eater will fail to properly consider and assess their risk of developing diabetes and thus will go undiagnosed should they have the disease.
Diabetes and Its Impact On the Workplace
And this can have considerable repercussions on the workplace—including no less than lost productivity, inflated healthcare spending, and overall poorer profits. In the US alone, healthcare spending for people with diabetes is projected to cost employers over $20 billion each year; while the global health expenditure due to the disease is expected to reach over one trillion by 2030. Meanwhile, dQ&A, an organization founded to support those living with diabetes, recently found that workers with Type 2 diabetes reported anywhere from an 11-19 percent loss in productivity due to their illness, while additional findings from SHRM reveal that, on average, full-time employees with diabetes miss an extra six workdays each year, while part-time workers miss an extra four days.
But monetary losses aren’t all that workplaces suffer from at the hands of diabetes: a recent study of benefits decision-makers found that nearly a third cite diabetes as a major cause of poor morale within an organization. While this is in large part a result of coworkers having to fill in for their absent peers, this is also, to some extent, a result of diabetic employees feeling as though they do not matter, are not cared for, or are not supported by their teams and employers. This is most likely the case within organizations that do not offer the appropriate benefits, accommodations, and training for their diabetic staff–and for good reason.
Employer’s Role in Diabetes Management
Employers play a vital role when it comes to the prevention and management of diabetes. As many health experts and diabetes advocates will note, what stigma and stereotypes about the disease get most wrong—or what they most often overlook when it comes to risk factors of type 2 diabetes (T2D)—is the role that environmental factors, or rather, social determinants of health, play in determining risk. While being overweight/obese and physically inactive does, in fact, increase people’s risk of developing T2D, this is not necessarily on account of people’s laziness or poor lifestyle choices. Instead, research finds that working conditions, such as high job demand and work-related stress, long hours or shift work, sitting at a desk for long periods of time, and a lack of on-site access to healthy foods, have a major impact on employees’ susceptibility to the disease. Furthermore, the unchecked presence of stigma coupled with a lack of affirming care and benefits can further increase employees’ likelihood of more severe illness.
Luckily, however, just as the workplace can serve as a major cause of diabetes, it can also serve as a solution. In the same study of benefits decision-makers, a whopping 90 percent professed that an employer-sponsored diabetes management and support program would help employees to feel empowered and better manage their blood sugar at work. Proving their point, survey findings from Zippia also reveal that over 80 percent of employees say that it is both helpful and important to their wellbeing and engagement at work when their employers take an active role in their wellness—and that it also makes them more likely to stay at their organization.
It is no surprise then, that some of the leading health and benefit strategies that organizations are adopting heading into 2024 include targeted programs and virtual care solutions aimed at improving diabetes management. While providing an employer-sponsored diabetes management program is certainly one very large piece of the puzzle when it comes to supporting employees with diabetes in the workplace, that’s certainly not all that employers can do to create a more supportive environment—especially when it comes to improving workplace culture and awareness.
That said, outlined below are just some of the many strategies that employers can adopt to transform their workplace into one that is affirming, supportive, and considerate of diabetic employees:
Conduct screenings. Integral to the cultivation of a safe, supportive environment for diabetic employees is the implementation of appropriate assessments, screenings, and surveys to (i) determine each workplace’s level of risk for diabetes, (ii) identify employees who have or could potentially have diabetes and (iii) spot potentially hazardous or harmful work conditions that could contribute to employees’ risk of disease or more severe complications. As discussed in one of WPO’s new toolkits, “Incentives to Keep Employees Heart Healthy in the Workplace,” providing employees with access to on-site biometric screenings—which cover not only blood sugar but blood pressure, cholesterol, BMI, and waist circumference—can be a huge help in both allowing and encouraging employees to look after their physical health, especially those with Type 2 diabetes.
Design and execute educational and awareness campaigns. As the prevalence of stigma suggests, education is necessary for the promotion of a physically and psychologically healthy workplace—especially when it pertains to diabetes. It’s important that employers eliminate jokes and misconceptions about diabetes from their workplace in order to ensure that their employees have a better understanding of the risks, causes, and consequences associated with the disease. One effective way to do this is through educational interventions or awareness campaigns aimed at improving employees’ understanding of the disease, their awareness of different resources and services that they have access to should they have or develop the condition, and their repertoire of healthy recipes, workouts, and other healthy lifestyle habits that will help them to manage or altogether prevent diseases like diabetes.
Because diabetes is so often an “invisible illness,” educational interventions are also an important opportunity to increase employees’ awareness of what can happen when blood sugar levels become too high or too low and explain why their diabetic peers receive certain accommodations like breaks, early dismissals, or private rooms for insulin injection/blood sugar monitoring. At WPO, for instance, part of our Wellness Coaching program includes three online diabetes training programs, “Diabetes: It’s Not the End of the World!” “Where is the Sugar?” and “Staying Healthy with Diabetes,” in which employees can:
- Define diabetes and learn about the causes, treatment, and prevention of the disease.
- Learn how to manage their own diabetes and discover how support from family and friends can help with treatment.
- Identify sugar in everyday foods, be aware of what constitutes high blood sugar levels, and learn how they can reduce those levels through monitoring and dietary changes.
- Discern what nutritional and exercise habits are best for diabetes management or prevention.
Offer targeted and organization-wide training, including blood sugar management tips and techniques. Not only is it important that all employees are educated about what can happen when blood sugar levels become too high or too low for stigma’s sake, but also so that they can help their employees when they experience these incidents—specifically when it comes to experiencing drops in blood sugar. That is because, while high blood sugar can cause dehydration, headaches, and other annoying ailments, it typically poses no emergent threat, whereas low blood sugar, on the other hand, can cause confusion, shakiness, disorientation, and eventually seizures, comas, or death—making it imperative that the person receives sugar as soon as possible.
As Matthew Vande Vegte, the co-founder of a health coaching company for diabetes, explains, “If I’m [experiencing] high blood sugar, I have the awareness in most cases to deal with it. If I’m [experiencing low blood sugar], I might not know where I am. I might not know what’s going on, so just give me sugar. That’s all you need to know—if I’m acting [strange], that’s going to be the solution.” Thus, trainings that cover how employees can respond to warning signs or symptoms of low blood sugar among employees who consent to disclosing their condition to their peers can be a huge help when it comes to creating that supportive environment for diabetic employees.
Provide appropriate accommodations. As one can probably assume, given the invisibility and elusiveness or “mysteriousness” of the condition, regularly checking one’s blood sugar levels is essential to avoiding spikes or drops. In fact, most individuals with Type 2 Diabetes are strongly recommended to test their blood sugar twice a day. What employers must do, then, is ensure that employees have access to the appropriate accommodations that will allow them to manage their health while continuing to work safely and effectively.
Most commonly, this includes providing access to:
- A private room or area to safely and securely test their blood sugar levels or take insulin
- A private room or area to rest until blood sugar levels stabilize
- Frequent breaks throughout the day to eat, drink, and take medication
- Flexible working hours to allow them to rest as needed, leave early or arrive late for appointments, and recoup after spikes or drops
- Medical leave for treatment
- Access to healthy meal and snack options, as well as the ability to eat at their desks
- Ergonomic workstations or equipment
- Opportunities for stretching, walking, and other types of movement
Expand benefits offerings to include targeted solutions. Arguably, one of the most important strategies that employers can adopt heading into the new year is enhancing their benefits offerings to include solutions aimed specifically at supporting those with diabetes—namely, diabetes management programs. In fact, studies show that investing in a diabetes management program produces a considerable ROI: reducing medical costs, boosting productivity, and reducing absenteeism. In a 12-week study of nearly 600 diabetic employees, for instance, researchers found that employees who received assistance with managing their diabetes were more productive on the job and stayed with the organization longer than those who did not manage their blood sugar levels; and that lost earnings from absenteeism were around $24 per employee, per month, for those who received assistance, compared to a whopping $115 per employee, per month for those who had uncontrolled blood glucose levels.
So with all that said, what exactly is a diabetes management program, and what does it offer? To put it broadly, a diabetes management program is a benefit that employees can utilize to gain access to the skills, information, and resources necessary to support them in the management of their condition. Most often, this includes access to health professionals, including counselors, coaches, clinicians, nutritionists, and more, who can provide timely assistance with diet plans, exercise routines, medication usage, and blood glucose monitoring. And not only do these programs help employees with diabetes, but they can also help employees manage pre-diabetes, high-blood pressure, and other health concerns like managing weight and stress.
Some of the most common services that a diabetes management program offers includes:
- A customizable dashboard with real-time data, insights, and personalized tips for blood sugar, weight, diet, and exercise management
- Access to customizable courses, modules, quizzes, infographics, fact sheets, and other educational information to learn more about related conditions and how to manage them
- Access to a glucose meter, testing supplies, and corresponding digital apps to expedite the monitoring process and analysis of readings
- Referrals to additional specialists, doctors, nutritionists, community resources, and more
Protect against discrimination. While discrimination is also tackled through education- and awareness-based strategies, it’s imperative that employers still make efforts to address health-based discrimination within their policies, employee handbooks, practices, and communications.
As new research shows, as many as four in five people with diabetes have experienced stigma—with nearly a quarter of them experiencing it in the workplace. As a result, nearly half of diabetic employees report hiding their condition from others—a decision that can lead to dangerous outcomes, as outlined above.
Thus, in order to both encourage people to disclose their condition to their employers, managers, and teams and to protect them in their decision to do so, employers would be wise to include explicit anti-discrimination policies in their codes of conduct and ensure that the consequences for harassing or mistreating employees are made known. They should also be mindful of using person-first language in all remarks or statements made that refer to people with the health condition, using phrases like “people living with diabetes,” rather than “diabetics,” which is insensitive and reduces people to their illness.
Cultivate a healthy workplace for all. While part of the accommodations that employers should offer to their diabetic employees include access to healthy foods and opportunities for physical activity, the buck doesn’t need to stop with them. Instead, creating a healthy workplace for all will not only aid in the management of diabetes, but also in its prevention. More importantly, it will also create a sense of solidarity between employees with diabetes and those without.
When it comes to providing diabetes-friendly food options, some good selections include whole grains breads; lean proteins like chicken, turkey, fish, tofu, lentils and beans; as well as nuts and fresh vegetables for some healthy snack options. Managers can also create activities or challenges for their teams centered around physical activity, which can include daily, weekly, monthly, or quarterly walking challenges, push-up or sit-up challenges, planking challenges, and more. They can also provide employees working remotely with ergonomic desk equipment and fitness trackers to ensure that those who are out of the office are still getting the movement that they need.
Interestingly enough, new research presented by Dr. Jonathan Little, Associate Professor at the School of Health and Exercise Sciences at the University of British Columbia, found that Type 2 Diabetes can be partially or successfully reversed when adhering to a low-carb, high-fat diet, followed up by a 15-minute post-meal walk. According to the studies, after just one year following this regimen, 60 percent of participants were able to reverse their Type 2 Diabetes, while 94 percent were able to reduce or eliminate their need for insulin—providing employers with some excellent motivation for investing in enhanced wellness programs ahead of the coming year.
