Diabetes — where endocrinology and occ-health collide
It’s not infectious, and it’s not very obvious because its signs often are hidden. Nonetheless, diabetes is being called an epidemic, and the workplace is an ideal place to fight it, say experts who’ve seen positive results. CDC figures indicate that some 18 million people in the United States, or 6% to 7% of the population, have diabetes.
But more worrisome is the fact that about one-third of those have diabetes and don’t know it, says Pamela Allweiss, MD, MSPH, an endocrinologist with the University of Kentucky in Lexington and a researcher with the National Diabetes Education Program (NDEP), a joint initiative between the CDC and NIH.
“The numbers are increasing — diabetes made the cover of Time and Newsweek, which both called it an epidemic — and 6 or 7 million people are walking around and don’t know they have it,” she says. “They might have had it for as long as 10 years before they’re diagnosed, and they present to their primary care physicians already with complications.”
Complications of Type 2 diabetes (formerly called adult-onset diabetes) include blindness and end-stage kidney disease as well as hypertension and hyperlipidity that put diabetics at an increased risk for cardiovascular disease.
Attention turning to workplace
Allweiss points to the on-line Diabetes at Work collaboration (www.diabetesatwork.org), created by NDEP, and the fact that an entire day of workshops at this year’s American Association of Occupational Health Nurses (AAOHN) expo has been devoted to diabetes, as examples of the growing conviction that diabetes interventions at work are critical to bringing the disease under better control.
“We want to find [at-risk] people in the workplace,” says Allweiss. “Occupational health professionals in the past worried about acute things that happened at the work site, like exposures, repetitive motion injuries, occupational asthma, and [injuries to] backs and knees.
“But now we’re looking at capital investment. [The U.S. work force] is getting older. Chronic diseases represent a major chunk of our health care expenses, and chronic diseases can be managed.”
Besides the savings in health care costs, businesses can realize other benefits if employees can avoid developing diabetes, and if employees who are diabetic get support at work for controlling their blood glucose levels.
“People at high risk who lose 10 to 15 pounds and exercise can prevent developing diabetes,” says Allweiss. “And it has been shown that if you can control your blood glucose levels, you are more productive.” (See Table 1.)
Assessing risk, reaping benefits
Some simple tests and history — body mass index (BMI, a ratio of height to weight), blood pressure, family history of diabetes, history of gestational diabetes — can tell if a person is at risk for developing diabetes.
Predicting diabetes risk is an area of ongoing study. A newly released Swedish study, based on data indicating that waist circumference can show an independent risk factor for cardiovascular disease, reports that people with a waist circumference of fewer than 39 inches may be safe from developing insulin resistance and Type 2 diabetes.1
GE Energy used the traditional indicators to base its Diabetes at Work program on, and the program’s goals and successes earned it a National Business Group on Health award this year. “GE identified employees at high risk, did interventions, and tried to prevent people from developing diabetes, and the data [from participants in the six-month program] are just wonderful,” says Allweiss.
GE Power’s health promotions group estimates the program — which incorporates cardiovascular screening as part of its diabetes risk assessment — has saved two dozen employees from having heart attacks. “For every [myocardial infarction] avoided, the company saved thousands of dollars,” Allweiss points out.
Lands’ End direct clothing merchants introduced a similar program to identify employees at high risk for diabetes and to intervene before they become true diabetics. In February 2003, Lands’ End conducted a companywide diabetes screening. Participating employees received a $50 incentive, and of the 3,329 employees who participated, 689, or 20%, had fasting blood sugar levels above 110mb/dL (normal levels are 70-110 mb/dL). The company introduced a health improvement strategy focusing on diabetes, including:
- support groups and talks on general health and diabetes-specific topics;
- disease management module;
- regular blood glucose level testing.
According to Elizabeth Weibe, health promotions manager for Lands’ End, the results have been promising. Between 1997 and 2001, Lands’ End’s health care costs rose 16.7%, strongly outpacing sales. In 2002, the company’s health care costs rose 3%, and in 2003, the increase was just 2%.
Allweiss says incentives are important in getting employees to participate in a screening and intervention program for diabetes or any other chronic disease. She says some of the incentives that have been useful have included:
- guaranteeing no increases in out-of-pocket insurance costs for participants;
- cash incentives for undergoing the initial screening;
- extra vacation days;
- on-site clinics and gyms, or free or reduced-cost memberships in local health clubs.
“However they implement a program, they can do little things that don’t require a big investment — like the CDC program says, ‘Small Steps. Big Rewards,’” Allweiss points out. “Some have made sure they serve healthy food options in places where food is served or at lunch meetings; some have made stairwells user-friendly, with music and pictures on the walls. It can be very simple, but it has to be on the company’s radar screen, be important enough to make the changes.”
An employer does not have to be large to provide measures that can pay off for employees with diabetes or at risk for the disease, she adds. (See Table 2.)
Keys to making it work
Weibe reports that Lands’ End’s program, despite its success, identified some challenges to getting employees excited about the program. Some were reluctant to acknowledge that they were at risk for diabetes, and others were just simply not motivated to take the time to come the on-site gym to exercise. She said the $50 incentive given to employees who participated in the screening was a popular tool; other components that generated participation included free screenings and classes, the on-site medical center and gym, and the clear support from upper management.
Allweiss says occupational health professionals will likely encounter preconceived notions about diabetes from management and employees. “There’s still some stigma about diabetes, and some misinformation about fad diets, safe sugar levels vs. symptoms and which is more important,” she says. “The occupational health professional can put things in perspective. Diabetes is truly where the occupational medicine world and endocrinology world collide.”
Reference
1. Wahrenberg H, et al. Use of waist circumference to predict insulin resistance: Retrospective study. BMJ Online First April 15, 2005. Available on-line at http://bmj.bmjjournals.com/onlinefirst_date.shtml.
For more information, contact:
- Pamela Allweiss, MD, MSPH, Director, Outpatient Clinic, University of Kentucky, Lexington. E-mail: [email protected].
- Elizabeth Weibe, Health Promotions Manager, Lands’ End Direct Merchants, Dodgeville, WI 53595. E-mail: [email protected].
- CDC Diabetes at Work Program, www.DiabetesAtWork.org.
- NIH National Diabetes Education Program, www.ndep.nih.gov.
It’s not infectious, and it’s not very obvious because its signs often are hidden. Nonetheless, diabetes is being called an epidemic, and the workplace is an ideal place to fight it, say experts who’ve seen positive results.
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