Diabetes Solutions In The Workplace
By: Erin Dick & Denise Balch
The increasing incidence of Type 2 diabetes will have an impact on the workplace as employees try to manage this serious medical condition. Erin Dick and Denise Balch, of Connex Health Consulting, explain how GM Oshawa is handling this situation.
Type 2 diabetes (also known as adult onset) is a serious medical condition that affects a growing number of Canadians. It is likely the largest single threat to the health of Canadians in the next 20 years and, at the same time, is perhaps the most preventable. The number of Canadians diagnosed with type 2 diabetes is projected to increase at an alarming rate of 31 per cent over the next five years. This prediction is likely to become a reality unless individual lifestyle habits – such as physical activity and healthy eating – improve drastically in the near future. Experts are further concerned with the approximate 750,000 undiagnosed cases which, without appropriate management, are more likely to develop complications such as heart disease, retinopathy, and kidney disease.
Employers face many of the cost consequences of these statistics through increased healthcare benefit premiums due to rising drug and medical supply costs, disability costs, or the costs of lost productivity. A person with diabetes incurs medical costs that are estimated to be two to three times higher than that of a person without diabetes, says the Canadian Diabetes Association. However, they are also ideally suited to provide solutions to employees.
Individuals who manage their condition appropriately can mitigate some of the costs employers face and reduce the likelihood of co-morbidities1. In most cases, type 2 diabetes can be prevented through healthy lifestyle choices. Employers are in an ideal position and can benefit financially if they implement workplace programs that facilitate positive health behaviors that can prevent or delay the onset of the disease, provide early detection services, and help those diagnosed to better manage their condition.
To test this premise out, in 2003, representatives from key stakeholder groups – including pharmaceutical, insurance, diagnostic, and workplace health – met to discuss the opportunity to pilot a workplace program on diabetes with a large employer in southern Ontario. Project partners included GlaxoSmithKline, GreenShield Canada, Bayer Inc., and Connex Health Consulting. They identified General Motors Oshawa as ideally suited for the project. It is a large, regional employer, whose population is demographically suited to benefit from this initiative. As well, it has recently launched its wellness strategy.
The result of the partnership is a flagship workplace program that can be repeated at other organizations – large or small – to provide a range of resources on diabetes to employees.
The objective of this study was to measure the impact of a workplace program on several aspects of diabetes related to the employee population including early detection, disease management, and lifestyle changes to those employees at risk or previously diagnosed with type 2 diabetes. It also provided prevention and risk factor awareness to the larger population at GM Oshawa.
The first phase of this 12-month project involved the delivery of education materials and screening clinics to those at risk or with a prior diagnosis. Results for the first phase of this pilot project indicate that the protocols administered were successful at reaching the populations targeted including those at risk or those previously diagnosed but with management issues, and encouraging them to attend screening clinics.
The initial challenge of this pilot was to find communication vehicles that would reflect the comprehensive nature of the program, thereby engaging employees and encouraging a greater awareness of essential facts about diabetes and promoting participation in screening clinics. This meant reaching as many of the 10,862 employees at headquarters and plant locations as possible within a short period of time.
Employees were engaged through a series of multi-functional pieces developed to provide education and awareness on type 2 diabetes and promote the screening clinics. Written communications appeared in GM Oshawa’s weekly newsletters to plant employees and via email for all Corporate Headquarters staff. Over several weeks, the communications provided employees with:
- information on risk factors
- signs and symptoms
- treatment and management
- a self-assessment for type 2 diabetes
At the same time, they were used to promote the initiative and help employees selfidentify the need to attend clinics. These pieces were supplemented with promotion posters.
Screening and Referral
Screening clinics are an ideal vehicle to directly interact with those individuals who are at risk for developing diabetes or whose existing diagnosis of diabetes is not in control. Through intervention at clinics, both of these groups can be screened and counseled, providing an opportunity for further medical intervention as necessary to improve prevention, early detection, and management.
In order to accurately assess individuals entering clinics, diabetes nurse educators were engaged as it was essential to the credibility of this pilot that each individual receive a comprehensive assessment of their risk factors. Screening included measurement of blood glucose levels for those without a prior diagnosis and an on-site A1C test to provide an average blood glucose reading over a three-month period.
In addition to screening, the diabetes nurse educators provided individuals with applicable education and lifestyle counselling. Those at risk of the disease, or those whose condition was poorly managed, were provided with a written referral and summary of their results to present to their physician for further assessment.
Challenges And Successes
There were challenges and successes in this pilot. Partners were challenged to deliver clinics in a shift work environment where the production line could not be compromised by clinic attendance. Clinic locations and unscheduled plant shut downs were also factors that limited employee exposure to clinics.
Despite the challenges, there was significant success with the clinics, as shown through clinic results as well as very positive attendee feedback collected via a participant satisfaction survey. More than 250 employees participated in the diabetes clinics with 62 per cent in the at-risk target group of males over the age of 40.
Of all the clinic attendees, 90 per cent had no prior diagnosis. However, 10 per cent reported a prior diagnosis of type 2 diabetes which is considerably higher than the national statistic of approximately six per cent. Some of the other findings show:
- Clinic communications were successful at allowing individuals to self-identify their need to attend clinics. More than half had three or more risk factors for type 2 diabetes.
- Many of attendees without a prior diagnosis do not have regular blood screening every three years as recommended by the Canadian Diabetes Association’s 2003 Clinic Practice Guidelines. Of the 231 participants without a diagnosis, 57 per cent reported not having their blood sugar tested within the past three years.
- The extent to which those with a prior diagnosis are taking active steps to manage their condition is inconsistent. While 60 per cent of those with a prior diagnosis report that they are visiting their physician regularly to monitor their condition, only 36 per cent test their blood sugar on a regular basis (at least daily). Approximately one quarter reported using meal plan recommendations of a dietitian.
- The biometric and blood screening measures taken at the clinic showed significant numbers of employees with risk factors that will likely be detrimental to their long-term health. These included body mass index and waist circumference results outside the healthy range, blood pressure above the healthy standard, and glucose readings (both blood glucose and A1C results) outside the normal ranges.
Following screening and counseling, the 58 participants, including 44 with no prior diagnosis, were referred to their physician for further assessment.
Almost all of these employees agreed to participate in follow-up to track their progress at regular intervals over the next 12 months. Measurement of post clinic actions is critical to determine the impact of the clinic in terms of whether individuals act on the recommendations made at the clinic.
This pilot has illustrated the challenges of providing this type of program in a shift/line environment to a difficult-toreach population. However, it was successful in targeting individuals at risk for developing type 2 diabetes or currently diagnosed and not in control. Delivery of the program was achieved with virtually no disruption to production.
This pilot merely scratched the surface at GM Oshawa. Results support our opinion that there are significant opportunities to deliver this type of program in the workplace that will make a difference in the lives of individuals who may not otherwise be able to self-identify assessment needs and seek out medical attention.
A comprehensive analysis of an entire workforce using a health risk assessment will quantify the number of individuals at risk and diagnosed for chronic and costly conditions such as diabetes. Furthermore, this kind of analysis can help employers create the business case for a comprehensive strategy in workplace health. It is the implementation of an efficient and targeted combination of preventative/lifestyle and disease-based programs delivered in a positive corporate culture that will result in healthy, productive employees and improve the bottom line for organizations in an increasingly competitive global environment.
Erin Dick is a workplace health specialist and Denise Balch is president of Connex Health Consulting.
1. According to the Canadian Diabetes Association, a person with diabetes (or their employer) can face costs for medication and supplies ranging from $1,000 to $15,000 a year, with additional costs of increased absenteeism and disability and decreased productivity.
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