Authors: Jeanne Clay Gus Georgiadis
An ongoing concern for employers, diabetes increasingly strains healthcare budgets. While there's a tendency to oversimplify its effects on patients and how to manage the disease, a holistic approach can improve both health outcomes and population health trends.
Type 2 is the most prevalent form of diabetes and accounts for 90% to 95% of the diabetic population in the U.S. Only 5% have type 1. The risk factors for type 2 vary, but may include a family history, high blood pressure or cholesterol, and increased age. Overall, more than 9% of people in the U.S. have diabetes, which disproportionately affects certain ethnic groups.1
While it's possible for some people with type 2 diabetes to go into remission — which means their blood sugar levels are in a healthy range without medication — the preconditions that lead to the disease never disappear entirely, and it's a lifelong issue.2 Cardiovascular complications are common in patients and still need to be managed even when diabetes is controlled.
Preventing diabetes, improving the wellbeing of those who have it and lowering claims activity are significant cost-saving opportunities. However, when approaching this goal, employers need to recognize that multiple factors often contribute to a disease which is quite complex. Key drivers associated with type 2 diabetes include obesity — which is a common precursor — as well as diet and sedentary habits. Partly due to the effects of the pandemic on health, these markers may recently have moved in the wrong direction.
In each case of diabetes, the patient's unique physiology and metabolic processes combine with mental health and lifestyles. This combination is why varied interventions and well-informed benefits design are most likely to achieve targeted results. Understanding and leveraging the social determinants of health can also help employers identify populations more at risk, as well as specific barriers to care such as eating healthy. All of these factors suggest a greater need for a holistic approach to whole-person health to help achieve better outcomes and sustainable progress.
Slowing unhealthy trends and the systemic growth of diabetes
Managing diabetes is a societal challenge as well as a personal challenge for those who live with this chronic condition. While people can develop diabetes even when their health is otherwise normal, it's typically associated with excess body fat and obesity. Yet organizations may not be in sync with the idea of obesity as a disease or a primary driver of diabetes.
Weight gain among adults during the pandemic mostly affected those who were overweight, had children at home and/or experienced mental health issues such as anxiety and depression.3 Because many people are employed and spend much of their time at work, these factors can contribute to productivity issues, highlighting the business case to help prevent and control diabetes. But only about 1 in 2 employers (52%) offer a weight management program.4
Behavioral health interventions influence the outcomes of efforts to both prevent and effectively manage obesity and diabetes. Although stress is familiar to everyone, it can become problematic if it's not well managed. High levels of the hormone cortisol are associated with the body's stress response, which can induce cravings for food high in salt, fat and other unhealthy substances. Frequently, diet and diabetes are closely linked, especially for those who already have the disease.
A person's belief in their ability to complete a certain task — or self-efficacy — often correlates with their control over personal habits and health. Therefore, educating employees about diabetes and engaging patients in self-care often boosts the success of supporting programs. Environmentally, a work culture that promotes health and wellbeing also helps employers break down stereotypes — and reduces the stigma about this chronic condition.