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Type 2 Diabetes Prevention and Control

Older woman checking blood sugarOnce assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing interventions for type 2 diabetes prevention and control, and links to examples and resources.

Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of type 2 diabetes prevention programs.

Diabetes is estimated to affect almost 24 million or 8% of the U.S. population. Another 57 million people have pre-diabetes. Diabetes is the seventh leading cause of death in the United States contributing to a total of 233,619 deaths in 2005.1 It is estimated that almost 1/3 of people who have diabetes may be undiagnosed.

Type 1 diabetes is usually diagnosed in children and young adults, though it can occur in older people as well. Type 1 diabetes develops when the body's immune system destroys cells in the pancreas. The pancreas is the only body organ that makes insulin, which regulates blood glucose. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may include autoimmune, genetic, and environmental factors. The symptoms of type 1 diabetes develop quickly and include excessive thirst and hunger and high urine output, so people affected with this type usually seek medical care immediately and population screening is not required.1

Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. In type 2 diabetes, the pancreas continues to secret insulin but the body cannot use insulin properly; this condition is called insulin resistance. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.1

Type 2 diabetes develops slowly over months and years, so screening programs for early detection and treatment are important in employee populations. Complications of diabetes (types 1 and 2) include heart disease, stroke, blindness, kidney disease, neurologic disease, and leg ulcers and amputations.1 BMI/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.

People with prediabetes have a blood glucose level that is elevated but is not high enough to be classified as diabetes. People with prediabetes are at high risk for developing type 2 diabetes.1

Gestational diabetes is a form of glucose intolerance that occurs in some women during pregnancy. Routine prenatal care includes screening for gestational diabetes, so worksite screening is not necessary.1

Diabetes in all its forms is costly in the working population.

  • In 2007, the total estimated costs of diabetes were $174 billion, including $116 billion in medical expenditures and $58 billion in lost productivity2
  • In 2007, medical costs attributed to diabetes included $27 billion for care to directly treat diabetes, $58 billion to treat diabetes-related chronic complications attributable to diabetes, and $31 billion in excess general medical costs2
  • In 2007, people diagnosed with diabetes incur average medical expenditures of $11,744 per year which are on average 2-3 times higher than expenditures for persons without diabetes2
  • Indirect costs include absenteeism ($2.6 billion), reduced productivity ($20 billion) for the employed population, reduced productivity ($0.8 billion) for those not in the labor force, unemployment for disease-related disability ($7.9 billion), and lost productive capacity due to early mortality ($26.9 billion)2  

The American Diabetes Association recommends blood glucose screening for all persons 45 years of age or older, particularly in those who are overweight (BMI>25kg/m2), repeated every three years. People less than 45 years old should be screened if they have certain other risk factors, such as a relative with diabetes or a personal history of high blood pressure.3

The United States Preventive Services Task Force recommends screening for type 2 diabetes in adults with high blood pressure.4

For diabetes, the same tests are used for screening and for the diagnosis of diabetes and prediabetes.

  • People with diabetes can lower the occurrence of complications by controlling blood glucose, blood pressure, and blood lipids
  • Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and exercise program, losing excess weight, and taking oral medication. Some people with type 2 diabetes may also need insulin to control their blood glucose
  • To survive, people with type 1 diabetes must have insulin delivered by injection or a pump
  • Many people with diabetes also need to take medications to control their cholesterol and blood pressure
  • Self-management education or training is a key step in improving health outcomes and quality of life. It focuses on self-care behaviors, such as healthy eating, being active, and monitoring blood sugar

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Health-related programs for type 2 diabetes prevention and control 5-6      

Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.

Employee health surveys in the workplace provide assessment and implementation opportunities
  • Information from employee health surveys can be used to identify the percent of employees that have received appropriately timed type 2 diabetes screening (e.g., blood glucose testing)
  • Survey information can be used not only in obtaining baseline group data on employee health but also to educate individual employees to their needs for counseling and follow-up for specific health concerns 
  • Assessment should also include employees’ responses regarding lifestyle issues such as obesity, nutrition, and physical activity
  • Blood glucose testing should be carried out within the health care setting because of the need for follow-up and discussion of abnormal results. Community screening outside a health care setting is not recommended

Use multifaceted employee lifestyle change participation programs

  • Obesity, nutrition, and physical activity programs in the workplace are critical elements in addressing type 2 diabetes
  • Research suggests that the progression from prediabetes to type 2 diabetes can be prevented or delayed. In 2001, results from landmark clinical trials, including the Diabetes Prevention Program (DPP), showed that sustained lifestyle changes that included modest weight loss and physical activity substantially reduced progression to type 2 diabetes among adults who were at very high risk
  • The lifestyle intervention worked equally well for men and women and all racial/ethnic groups, and it was most effective among people aged 60 or older. A healthy diet (see nutrition and modest physical activity) can help people cut their risk for type 2 diabetes
  • The American Diabetes Association recommends that people with prediabetes  should be counseled on lifestyle changes with goals similar to those of the DPP
Community education programs on diabetes self-management are effective in controlling diabetes
  • The Guide to Community Preventive Services recommends Diabetes Self-Management Education Interventions which can be provided in community settings such as worksites
  • However, there were too few studies to determine whether such programs are effective in workplace settings specifically
  • Self-management education or training is a key step in improving health outcomes and quality of life. It focuses on self-care behaviors, such as healthy eating, being active, and monitoring blood sugar. It is a collaborative process in which diabetes educators help people with or at risk for diabetes gain the knowledge and problem-solving and coping skills needed to successfully self-manage the disease and its related conditions
  • For individuals who have been diagnosed with diabetes, disease management programs are recommended to improve diabetes care. Disease management is an organized, proactive, multicomponent approach to health care delivery for specific diseases such as diabetes. Disease management programs involve tracking and monitoring individuals with diabetes by a coordinated care team to prevent complications and the development of comorbid conditions such as cardiovascular disease
Offer employees on-site services such as pneumococcal vaccination and yearly flu shots
  • People with diabetes are almost 3 times more likely to die with influenza (i.e., the flu) or pneumonia. Flu vaccines are available at little or not cost and can be easily given at the worksite

Tools and Resources (more)

  • Diabetes at work is a tool designed to engage the business community and help them make decisions about diabetes. This easy-to-use website helps businesses understand diabetes; assess the impact of diabetes in the workplace; and provides resources and tools to create and implement worksite education programs to prevent and control diabetes. The website was developed in collaboration with the National Diabetes Education Program, the National Business Group on Health, the National Business Coalition on Health, and America’s Health Insurance Plans
  • The Centers for Disease Control Prevention (CDC) has developed If You Have Diabetes, A Flu Shot Could Save Your Life [PDF - 723KB] for consumers in English and Spanish [PDF - 700KB]. Posters and postcards are also available in both languages on the CDC Diabetes Program website
  • CDC has developed Diabetes and Pneumonia: Get the Facts [PDF - 224KB] for consumers in English and Spanish [PDF - 219KB]
  • The U.S Department of Health and Human Services has developed the Small Steps website with tips and ideas for eating better and getting physically active

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Health-related policies for type 2 diabetes prevention and control

Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”

Policies that enhance worksite lifestyle programs such as physical activity or nutrition are important in preventing and controlling diabetes
  • The health-related policy strategies and interventions listed for Obesity, physical activity, and nutrition include major lifestyle activities recommended to address diabetes

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Health benefits for type 2 diabetes prevention and control4,7-8

Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.

Including coverage of blood glucose screening at regular intervals in preventive health examinations allows early detection of prediabetes and type 2 diabetes. Special clinical programs for managing diabetes care improve health outcomes
  • The Guide to Community Preventive Services recommends diabetes management programs, and case management of diabetic patients: Disease Management Programs to Improve Diabetes Care and Case Management Interventions to Improve Glycemic Control in Diabetes
  • For individuals who have been diagnosed with diabetes, disease management programs are recommended to improve diabetes care. Disease management is an organized, proactive, multicomponent approach to health care delivery for specific diseases such as diabetes. Disease management programs involve tracking and monitoring individuals with diabetes by a coordinated care team to prevent complications and the development of comorbid conditions such as cardiovascular disease
  • The plan should take into account several factors such as the patient’s age, school or work schedule and conditions, physical activity, eating patterns, social situation and personality, cultural factors, and presence of complications
Offer regular free or low cost on-site screening, counseling, and follow-up for type 2 diabetes in adults with high blood pressure (i.e., hypertension)
  • The U.S. Preventive Services Task Force found that people at risk for cardiovascular disease benefit most from diabetes screening. Screening people with high blood pressure (i.e., hypertension) for type 2 diabetes allows the disease to be diagnosed and treated before it causes certain complications

Tools and Resources (more)

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Environmental support for type 2 diabetes prevention and control

Environmental support provides a worksite physically designed to encourage good health.

Environmental support that addresses the risk factors for type 2 diabetes is effective in improving health outcomes
  • The health-related environmental support strategies and interventions listed for obesity, physical activity, and nutrition include mayor lifestyle activities recommended to address diabetes

Tools and Resources

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Contact Us:
  • Division of Population Health/Workplace Health Promotion
    Centers for Disease Control and Prevention
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