Diabetic employees get big results from novel program

Workers aren't left to follow up on their own

How would you like to boast that one of your company's wellness programs got these results for diabetics: A 21% increase in employees achieving the American Diabetes Association goal of an A1C level under 7.0, an increase from 43.8% to 57.7% in participants meeting National Cholesterol Education Program goals for LDL cholesterol, and a 15.7% increase in the number of employees meeting recognized goals for systolic blood pressure?

These are some of the health benefits realized by 914 participants in the Diabetes Ten City Challenge, an employer-based diabetes self-management program conducted by the American Pharmacists Association Foundation.1

Since the program launched in 2005, 31 employers in 10 cities have joined forces with hundreds of pharmacists to help over 1000 people manage their diabetes. Currently, 22 employees in the City of Dalton, GA, are participating, comprising about 5% of the full-time workforce.

Employees were informed about the program by e-mail, flyers posted by time clocks, and announcements made at worksite meetings. Also, if employees screen positive for diabetes at the City's annual health fair, a letter is sent suggesting the employee get follow-up care and participate in the diabetes program.

"This program is one of several initiatives that we are doing to decrease the cost of disease processes involving poor health choices," reports Pamela Dugger, RN, the city's employee health nurse. "It's a matter of getting the word out."

Many incentives for employees

By participating, employees get to work with pharmacist coaches to find ways to better manage their diabetes—eating right, exercising regularly, and taking medications as prescribed. During the first visit, the employee sets goals such as weight loss, diet control, checking blood sugar more often, or better compliance with preventative exams, and key indicators are tracked.

Previously, newly diagnosed diabetics received information about their condition, but were otherwise left to follow up on their own. "Our employees like the individual support that this program gives them," says Dugger. "They are learning how to manage their disease more effectively by having that one-on-one communication with their pharmacist coach."

Employees also save money, since co-pays for diabetes medications and supplies are waived — a big motivation for participation in the program. "I would say that 85% of diabetic employees would not have followed up, had there not been this incentive," says Dugger.

The City's diabetic employees report feeling better overall, says Dugger. "Working with their pharmacist coaches, they're learning about nutrition, weight loss or weight gain depending on what's appropriate, and the importance of exercise," she says. "We also make sure they are seeing their doctors, including getting necessary immunizations, foot exams and eye exams."

In the city of Charleston, the program is offered to spouses, dependents and retirees enrolled in the insurance plan. Of an estimated 300 diabetics on the health plan, about 90 are currently enrolled.

"To make it convenient for employees and easy for them to build up that rapport, we have about three pharmacist coaches coming to the worksite now, so employees don't have to go anywhere," says Jan Park, RN, the City's wellness coordinator. "I am also here as an extra resource for them."

Park informs employees about wellness programs that support the program's goals, such as Weight Watchers at Work, Walking at Work and smoking cessation. "Usually I'm the first point of contact for the program," says Park. "I match them with a pharmacist coach based on whether it's more convenient for them to meet with someone closer to home, closer to work, or who actually comes to their office for the consultations if that's what's easiest."

Dramatic ROI is seen

There is an initial increase in costs during the first year, notes Park, due to providing free medications, supplies and doctors visits. "But over the long term, fewer complications are seen which is a big cost savings," says Park.

Productivity is also a factor. "Before, employees were either missing work, or they were coming to work but weren't fully there, possibly because of poorly controlled blood sugar levels or side effects from medications," says Park.

Using projected costs, the City of Dalton calculated an average savings of almost $8000 per person. "Our actual cost savings were approximately $5000 per person," says Dugger. "While our pharmacy costs rose, our medical costs decreased."

In addition, the City's first year data showed an average of 116 fewer sick hours were taken by participants—14.5 days per year compared with 19 days before the program's implementation. "This is most likely related to less sickness as a result of poorly managed diabetes, which can be proven with the medical savings that was shown in our first year data," says Dugger.

Although the city of Charleston doesn't have its own ROI data yet, Park expects it to mirror the program's aggregate data. "We know that when the clinical data is positive, the economic data will follow," says Park. "The first year is the investment year. After that, the numbers just continue to increase, with cost savings going up every single year."


1. Fera T, Bluml BM, Ellis WM, et al. The Diabetes Ten City Challenge: Interim clinical and humanistic outcomes of a multisite community pharmacy diabetes care program. J Am Pharm Assoc 2008; 48:181-190.


For more information on the Diabetes Ten City Challenge, contact:

  • Pamela Dugger, RN, Employee Health Nurse, City of Dalton, GA. Phone: (706) 529-2425. Fax: (706) 529-2492. E-mail: PDugger@cityofdalton-ga.gov.
  • Jan Park, RN, Wellness Program Coordinator, City of Charleston, SC. Phone: (843) 958-6412. E-mail: parkj@ci.charleston.sc.us.