Diabetes in healthcare workers is a major driver of medical insurance costs, as the chronic blood sugar disorder can set off a range of health problems and increase risk of stroke and heart disease.

Diabetes is a primary cause of kidney failure, and can cause nerve damage that affects vision and leads to foot ulcers and problems in other extremities. However, the disease can be managed through interventions like diet and exercise, which can also prevent “pre-diabetes” — early signs of blood sugar and insulin problems — from progressing to a chronic condition.

“We have a lot of people who are not pre-diabetic anymore because they adopted healthier wellness habits, have been exercising, and have gone to a lot of our classes on eating,” says JoAnn Shea, ARNP, MS, COHN-S, director of employee health and wellness at Tampa General Hospital (TGH). “We have had a lot of success with both our pre-diabetic populations and with our diabetics.”

Review of medical claims at the hospital indicated that diabetes was the highest-cost chronic disease in covered employees and spouses. Biometric data reviewed by Shea and colleagues found that 26% of TGH employees had pre-diabetes and about 7% had developed full-blown diabetes. Thus, healthcare workers have blood sugar and insulin disorders in much the same range as the general population. Nationally, an estimated 29 million people, or 9.3% of the U.S. population, have diabetes and 8 million people are undiagnosed.

“We are actually in line with the state stats on diabetes,” Shea says. “In Florida it’s around 9%, and we are probably around 7% now. Pre-diabetes averages about 26% to 28%, so we are right in line with the CDC age-adjusted statistics.”

Medical care for diabetic TGH employees is much more expensive than for non-diabetics.

“For pharmacy costs alone, it is about $1,300 per year for a diabetic compared to $300 for a non-diabetic,” Shea says. “We spend $12,000 more per claim on a diabetic than a non-diabetic. So we spend almost $10 million per year on diabetes alone.”

To lower costs and improve the health of employees, Shea and colleagues have developed a series of incentive-based wellness programs, including one called Living with Diabetes, that have led to improved outcomes in the hospital’s diabetic employees and spouses. Program components include the A1C blood test, which shows average levels of blood glucose over the past three months. It also includes an exercise program, regular eye and foot exams, and consultations with a pharmacist, nutritionist, and diabetes nurse.

“We probably have about 900 or close to 1,000 diabetics, and in 2013 we had almost 300 enrolled in the program,” Shea says. “This year, it is probably a little over 200. We have had some good results — we just need to increase A1Cs. People have to engage in it, so it is always a challenge.”

Incentives to participate are well worth the bang for the buck, as they can prevent the higher medical expenses of a worsening prognosis. Diabetic employees and spouses who participate in 2016 can earn from $100 to $800. To receive the incentives, employees and participating spouses must take steps like taking the A1C blood test.

“The program requirements are that they go to their primary care provider twice annually, and get two AIC tests during the year and one foot exam,” she says.

The first $400 earned through participation goes toward the employee’s future copays for all family members. “Anything above $400 they earn, we put on their paycheck at the end of the year,” Shea says.

Additional programs include Moving with Diabetes, an eight-week workout program at the hospital fitness center. Employees and spouses who complete the program can earn $200. Of 95 healthcare workers enrolled in 2015, all rated the program as good, very good, or excellent, she notes. They also indicated they would continue exercising on their own after completing the program.

“Living with Diabetes is only for our diabetics, but pre-diabetics are also identified through our biometric screening and a lot of them have joined our fitness and wellness programs,” Shea says. “We had a lot of success at getting them enrolled. We also have a lot of wellness programs that are for all employees.”

Self-management is the Key

There is also a diabetes self-management class, a 10-hour program that pays $300 in incentives for those who complete the course.

“That’s a big deal,” Shea says. “If anything, that class is what they all should do.”

The self-management class covers nutrition, medications, insulin, symptoms, exercise, shopping, foot care, and dental care.

There are incentives for dental exams because high blood sugar levels lead to greater levels of sugars and acids in the mouth, increasing risk of tooth decay and gum disease, Shea explains. Diabetics have more severe gum disease because diabetes lowers the body’s ability to resist infection and slows healing. That, in turn, makes it hard to control blood glucose levels and may contribute to disease progression.

Is all this money well spent?

“We think so,” Shea says. “We have some people who have lost a lot of weight and other pretty good outcomes, but the problem is keeping people enrolled. People who were in one year do not necessarily stay in the second year. It’s hard to change people’s health behaviors. But we feel good about this, and every year we tweak the program to see if we can get more high-risk people enrolled.”