Diabetes prevention and employee health
Epidemic becomes 7th leading cause of death
Diabetes and prediabetes are huge problems in the United States, with national data showing marked increases in the disease in all groups, but especially among middle-aged women.
This is an important area for occupational and employee health programs to prioritize because of the disease’s impact on both workers and resources. Data suggest workers with diabetes are costing employers and the public health system $245 billion each year.
"Diabetes is the seventh leading cause of death in the United States," says Sherry Bumpus, PhD, FNP-BC, a visiting professor at the University of Michigan Cardiovascular Outcomes Re-search and Reporting Program in Ann Arbor, MI. Bumpus also is an assistant professor of nursing at Eastern Michigan University.
Among U.S. adults, 29.1 million — 12.3% — have diabetes, and nearly 28% of those with the disease have not been diagnosed, according to the National Diabetes Statistics Report, 2014.1
Statistics related to prediabetes are even more startling: an estimated 86 million Americans, age 20 or older, have prediabetes, based on their fasting glucose or A1C level.
Identifying employees with prediabetes is a crucial step toward preventing diabetes, research suggests. (See related story, p. 105.)
For more than a decade, research has shown that prediabetic patients who lose a little weight and increase their physical activity sharply reduce their chances of developing diabetes. Bumpus offers these strategies for how employee health programs can develop a successful diabetes screening and prevention program:
Screen for both prediabetes and diabetes: Hospital wellness programs should include screening for prediabetes and diabetes prevention in their goals, Bumpus suggests.
One very effective way to do this is to offer onsite, free diabetes screening. Employee health nurses and staff can provide diabetes educational material, but it’s even more effective if they follow-up on screening with behavior change strategies, Bumpus says.
A first screening decision involves which numbers to collect. One blood test, the hemoglobin A1C, measures a three-month average of a person’s blood glucose levels.
"This gives us an idea of how well a person’s blood sugar is despite highs and lows," Bumpus says. "A person who is normal will have less than 5.7; a diabetic will have an A1C greater than 6.5, but in between 5.7 and 6.5 is the prediabetic."
Another option is the fasting blood glucose level from a finger prick or blood draw. According to the American Diabetes Association, for a fasting glucose test, a nondiabetic will be less than 100 mg/dL. A diabetic’s level will be 126 mg/dL, and the gap between 100 mg/dL and 126 mg/dL is prediabetic, Bumpus says.
The third test is a glucose stress test, which is what typically is done with pregnant women at risk for gestational diabetes.
"You have them drink a sugary solution and measure their blood sugar levels two hours after that," she explains. "A level of 140 or less is normal; over 200 is diabetic, and 140 to 200 is pre-diabetic."
Until recently, public health officials paid little attention to the prediabetic gap between normal blood glucose results and diabetes results, Bumpus notes.
"It’s only a recent event that we’ve labeled these gaps as prediabetes," she says. "Previously we’d say that over 126 is diabetic and below it is not. So we’ve gotten a lot more concerned about these numbers and have a stronger desire to lower these numbers."
Focus on what it takes to get employees to become healthier: "You have to expect behavioral change in those things that help prevent diabetes, and the two biggest are weight loss and physical activity," she says.
The best proven method is to have a work site program that encourages and reinforces healthy lifestyle behavior through education and making it easy to make lasting changes, Bumpus says.
Employers have learned that simply giving employees gym passes or paying for weight loss programs is not enough incentive for change. They need a more active program, she says.
"One statistic I’ve read is that most workers in health care work 50 hours a week in a health care setting," she says. "During their awake hours they’re at work more than they’re at home, so they need access to healthy food while at work."
Some hospitals have fast food chain restaurants and bakeries on their campuses. Instead, health care systems should promote healthy food throughout their facilities, and have all food labeled with calorie content, fat, carbohydrates, and other information so employees can make healthier choices, she adds.
Choose programs that are efficient and have proven track records: A company that’s known for its successful healthy employee program is Safeway Grocery, which has even put exercise facilities within the employment area, Bumpus notes.
But even that strategy will not work well if it’s not coupled with employers giving workers time to exercise, she says.
"If you go back a couple of decades you see that employers partnered with fitness centers but employees wouldn’t use them because the hours weren’t convenient or there weren’t shower facilities available," Bumpus says. "A lot of time and money were spent on facilities that employees didn’t use."
In more recent years, wellness programs have returned in popularity because of data showing that every dollar spent on wellness has a three dollar return in reduced and fewer absentee days and worker’s compensation claims, she adds.
But data suggest wellness programs work best when employers understand their worker population. For instance, some wellness programs have done a fine job at encouraging behavior change among their professional and more affluent workers, but have not done as well with their under-served populations, including low income and people of color, Bumpus says.
One strategy that will address this disparity is to give employees a 30-minute break to exercise in an onsite facility, she adds.
Educate about diabetes complications: "The biggest complication we worry about is cardiovascular disease, which is a vascular component of diabetes that is often fatal," Bumpus says.
The American Heart Association’s research shows that heart disease is the leading cause of death in the United States for women, she adds.
"Heart disease still kills more people than every form of cancer," Bumpus says.
Other complications of the disease include hypoglycemia that results in emergency room visits, high blood pressure, high blood LDL cholesterol, blindness and eye problems, kidney disease, amputations, nerve disease, hearing loss, and depression.
About half of people with diabetes have nerve damage, called diabetic neuropathy, according to the American Diabetes Association.
The ADA also notes the prevalence of skin complications. These include bacterial and fungal infections, localized itching caused by a yeast infection, dry skin, or poor circulation. Diabetes also can lead to diabetic dermopathy, which looks like light brown, scaly patches on the skin — typically on the front of the legs.
- National Diabetes Statistics Report, 2014. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Published online: http://templatelab.com/national-diabetes-report-2014/.
Risk factors related to prediabetes and diabetes
Obtaining history isn’t enough
The American Diabetes Association advises health care providers to recommend testing for diabetes or prediabetes to individuals who have symptoms for the disease and/or these risk factors:
• Overweight or obese;
• Physically inactive;
• Age 45 or older;
• Having parent, brother, or sister with diabetes;
• Having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander;
• Diagnosed with gestational diabetes or giving birth to a baby weighing more than nine pounds;
• Having high blood pressure of 140/90 mmHg;
• Having HDL cholesterol below 35 mg/dL or a triglyceride level above 250 mg/dL;
• Having polycystic ovary syndrome (PCOS);
• Having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on previous testing;
• Having a history of cardiovascular disease, and
• Having insulin resistance conditions, such as morbid obesity, acanthosis nigricans.
