Type 2 Diabetes Prevention and Control

Once a company has conducted assessment and planning for type 2 diabetes prevention and control programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.  

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program. 

Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes, and is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.

Type 2 diabetes develops slowly over months and years, so screening programs for early detection and treatment are important in employee populations. Screening for type 2 diabetes allows the disease to be diagnosed and treated before it causes certain complications such as heart disease, stroke, blindness, kidney disease, neurologic disease, and leg ulcers and amputations.

Lifestyle interventions such as increased physical activity and weight reduction can also delay the development of diabetes. Obesity is a major risk factor for type 2 diabetes, so workplace emphasis on nutrition and physical activity are crucial ways employers can reduce the frequency and the effects of type 2 diabetes in their workforce.

Diabetes is among the top 10 most costly physical health conditions for employers in various industries in terms of direct medical expenditures, absenteeism, short term disability, and presenteeism. People diagnosed with diabetes incur average medical expenditures of $11,744 per year in 2007 which are on average 2-3 times higher than expenditures for persons without diabetes.¹

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Worker productivity measures for type 2 diabetes prevention and control^2-9

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use to determine whether health programs are increasing worker productivity.

Baseline

• Determine the average number of sick days per employee over the previous 12 months related to the complications of diabetes, including heart disease, stroke, blindness, kidney disease, neurologic disease, and leg ulcers and amputations
  • This measure may be less useful if there has been a large increase or decrease in numbers of employees over the past 12 months
• Determine the costs of worker absenteeism related to the complications of type 2 diabetes, including costs of replacement workers, costs in training replacement workers, and loss and delay in productivity
• Determine time employees spend during working hours participating in type 2 diabetes screening or education-related worksite programs
• Additional validated surveys have been developed to provide employers with information about the indirect costs of untreated or undertreated employee health issues such as diabetes. Employers who use these health and productivity surveys on an ongoing basis can begin to evaluate the return on investment (ROI) of offering type 2 diabetes prevention and control programs on employee absence or productivity. These surveys may be proprietary and may require a modest fee to use. Two examples are provided below:
  • Health and Work Performance Questionnaire (HPQ) is a short, easy to administer self-report survey designed to estimate workplace indirect costs (absenteeism, reduced productivity, and injury due to accidents) of employee health problems developed by the World Health Organization (WHO) and the Harvard Medical School
  • The Work Limitations Questionnaire (WLQ) developed by the Health Institute at Tufts Medical Center is an easy to use questionnaire that addresses general work limitations which can be built into other health assessment tools such as a health risk appraisalAn assessment tool used to evaluate an individual’s health. An HRA could include a health survey or questionnaire (see Employee Health Survey); physical examination, or laboratory tests resulting in a profile of individual health risks often with accompanying advice or strategies to reduce the risks.  or employee health survey

Process

• Re-assess the average number of sick days per employee at the first follow-up evaluation
  • If employee education programs are successful, these measures may increase in the short term as screening and detection rates increase
• Periodic repeats of other baseline measures

Outcome

• Assess changes in the average number of sick days per employee in repeated follow-up evaluations
• Assess changes in the time employees spend during working hours participating in type 2 diabetes screening or education-related worksite programs
• Assess changes in costs from baseline

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Health care costs measures for type 2 diabetes prevention and control^2-5

In contrast with the worker productivity costs described above, health care costs are measures of the direct expenses of providing employee health care and preventive health programs.

Baseline

• Determine costs and use for health care, such as benefits, short or long term disability, counseling, and medications for diabetes-related illness and disability
• Determine the health care use and costs of program participants before a screening or education program are initiated and after operation of these programs

Process

• Periodic repeats of baseline measures

Outcome

• Assess changes in health care use and costs from baseline
• Compare health care use and costs of participants before screening or education programs are initiated and after operation of these programs

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Health outcomes measures for type 2 diabetes prevention and control^2-5

The effectiveness of type 2 diabetes prevention and control programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline

• Determine levels of employee blood glucose screening and self-reported diabetes from employee health survey or health risk appraisalAn assessment tool used to evaluate an individual’s health. An HRA could include a health survey or questionnaire (see Employee Health Survey); physical examination, or laboratory tests resulting in a profile of individual health risks often with accompanying advice or strategies to reduce the risks. . Examples include:
  • What percentage of employees have been screened
  • Measures of the percent of employees who currently achieve diabetes screening guidelines by employee health survey
• Determine baseline percentage of employees with obesity, which increases the risk of developing type 2 diabetes
• Determine levels of diabetes diagnostic and treatment procedures from health care and pharmaceutical claims data
• Determine employee knowledge, attitudes, and beliefs about type 2 diabetes prevention and control
  • Evaluate employees’ current knowledge of the health benefits of type 2 diabetes screening
  • Measure employees knowledge of current type 2 diabetes screening guidelines
  • Evaluate employees’ current knowledge of the risks for type 2 diabetes as well as behaviors such as increasing physical activity or weight management that may reduce diabetes risk
  • Assess employee awareness of existing workplace type 2 diabetes prevention and control programs, policies and benefits

Process

• Periodic repeats of baseline measures

Outcome

• Assess changes in rates of employee blood glucose screening or self-reported diabetes such as:
  • Increases in the number of employees screened
  • Changes in the percentage of employees reaching diabetes screening guidelines
• Assess changes in the percentage of employees with obesity
• Assess changes in levels of diabetes diagnostic and treatment procedures from health care and pharmaceutical claims data
• Assess changes in employee knowledge, attitudes, and beliefs about type 2 diabetes prevention and control
  • Evaluate changes in employee knowledge of current type 2 diabetes screening health benefits and guidelines
  • Measure changes in employee knowledge of type 2 diabetes risks as well as behaviors such as increasing physical activity or weight management that may reduce diabetes risk
  • Assess changes in employee awareness of existing workplace type 2 diabetes prevention and control programs, policies, and benefits

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Organizational change measures for type 2 diabetes prevention and control^2-5

Diabetes screening and control requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of blood glucose control should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., changes of food options in the cafeteria, establishing walking trails on the company campus). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing expenditure on ineffective efforts.

Baseline

• Determine workplace barriers to employee’s access to type 2 diabetes screening, prevention and control programs
• Assess current workplace type 2 diabetes prevention and control programs
  • List current options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
    • Number of blood glucose screening and type 2 diabetes prevention and control programs (e.g., education seminars, individual education) and participation in these programs
    • Availability of educational materials on type 2 diabetes prevention and control
    • Number of communications/media campaigns regarding blood glucose screening and type 2 diabetes prevention and control
    • Number of health-related policies and environmental strategies that support lifestyle changes such as increased physical activity or weight management related to type 2 diabetes prevention and control
    • Number of partnerships with community resources for type 2 diabetes prevention and control such as the American Diabetes Association or a local hospital or health department
  • Determine costs of current company type 2 diabetes prevention and control programs such as:
    • Staffing, equipment, and space for education programs
    • Employee time to participate in these programs during work hours
  • Conduct survey of employee satisfaction with current workplace supported type 2 diabetes prevention and control programs

Process

• Reassess barriers to employee engagement in type 2 diabetes screening, prevention and control programs
• Document steps taken and progress toward implementing each intervention selected
  • List numeric goals (e.g., desired increases in employee screening rates) in each form of intervention within a designated time period (e.g., 12 months from startup):
    • Employee reach (e.g., number of educational pamphlets distributed)
    • Employee participation (e.g., number of desired participants in workplace blood glucose screening, number of participants in education classes and seminars)
  • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
  • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, health fairs, etc
  • Identify opportunities for new partnerships with community groups who provide type 2 diabetes screening, prevention and control programs (e.g., the American Diabetes Association, local health department, local hospital, etc.)
  • Reassess employee satisfaction regarding workplace supported type 2 diabetes prevention and control programs

Outcome

• Measure reductions in the number and type of employee barriers to type 2 diabetes screening, prevention and control programs
• Assess changes in workplace type 2 diabetes prevention and control programs including progress in achieving goals and in implementation of each intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
  • Measure changes in the number of blood glucose screening and type 2 diabetes prevention and control program options for employees through the worksite and changes in employee participation using each option before and after the blood glucose screening and type 2 diabetes prevention and control program or campaign. Examples:
    • Number of new programs developed and offered to employees and participation in these programs
    • Number of employees identified with elevated blood glucose who have been referred for clinical follow-up
    • Number of new educational materials developed and made available to employees
    • Number of new workplace policies related to diabetes screening and type 2 diabetes prevention and control developed and implemented compared with baseline
    • Number of new environmental strategies related to increasing diabetes screening rates or lifestyle change developed and implemented compared with baseline
    • Number of new partnerships with community groups created to enhance access and opportunity for type 2 diabetes prevention and control
  • Assess changes in program costs from baseline
    • Increases in staffing or equipment needs due to new program offerings
    • Changes in employee participation time during work hours (e.g., education or screening)
  • Assess changes in survey responses for employee satisfaction following implementation of workplace supported type 2 diabetes prevention and control programs and compare with baseline

Depending on goal success, evaluate the need to adjust workplace programs.

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