Diabetes

Once 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 for diabetes include the public health evidence-base 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 29 million people or 9.3% of the US population. Another 86 million people have prediabetes.

Diabetes is the seventh leading cause of death in the United States. Diabetes was mentioned as a cause of death in a total of 234,051 certificates in 2010. It is estimated that over 1/4 of people who have diabetes may be undiagnosed.1

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.2

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.2

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.2 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.2

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.2

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

  • In 2012, Total (direct and indirect) costs of diabetes were $245 billion. Direct medical costs were $ 176 billion. After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes.  Indirect costs were $ 69 billion (disability, work loss, premature death).3

The American Diabetes Associationexternal icon 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.4

The U.S. Preventive Services Task Force (USPSTF)external icon recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Effective behavioral interventions combine counseling on a healthful diet and physical activity and involve multiple contacts over extended periods.

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
References

1.  Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008. Available from: https://www.cdc.gov/diabetes/library/factsheets.html.

2.  Centers for Disease Control and Prevention. Diabetes Report Card 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2015. Available from: https://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014.pdf pdf icon[PDF-5.5M].

3.  Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2014. [online]. 2014. [cited 2015 October 29].

4.  American Diabetes Association. Screening for type 2 diabetes. Diabetes Care 2004; 27:S11-S14.