Employers can takes steps to help staff live with diabetes.

Employers can takes steps to help staff live with diabetes

With the potential for diabetes to lead to stroke, heart attack, blindness, amputation and kidney damage, patients need a carefully monitored medical regime. However, since they must also maintain control of everything from sugar and cholesterol levels to weight and blood pressure, drugs are only part of the management system.

For those with type 2 diabetes – which has a range of risk factors, including age, ethnicity and weight – drugs may not necessarily be needed. “Initially, you can follow a healthy diet, get regular activity and lose weight – that may enough to manage the condition for some time,” says Libby Dowling, a clinical adviser at Diabetes UK, the British charity.

However, she explains, the progressive nature of diabetes may mean medication is required at a later stage. “There are a number of different tablets and some non-insulin injections – and finally, if all those tablets don’t control your blood sugar levels, then you would go on to insulin.” For type 1 diabetes – which arises when the body’s immune system destroys the insulin-producing cells – the treatment is insulin, taken either through regular injections or by using an insulin pump.

However, while new drugs, pocket glucometers and mobile apps have made managing diabetes easier, what is often underestimated is the non-medical support patients require. Companies can play an important role in this, argues Jennifer Lovejoy, senior vice-president of clinical and quality support at US-based Alere Wellbeing, which provides tobacco cessation and weight loss programmes for employers.

“Work is where most adults spend the majority of their time,” she says. “And when you look at behaviours like nutrition, physical activity and stress management, a big part of that is the environment, so employers can do a lot to make it easier to stay healthy.” Since physical exercise is an important element of diabetes management, companies can help prevent employees from becoming sedentary by, for example, offering standing or treadmill workstations.

Alternatively, they can encourage employees to take the stairs, rather than the lift. This, says Ms Lovejoy, might mean redecorating the stairwell, hanging art on its walls, making the lighting more inviting or even introducing piped music. “You can combine that with messages about how many calories people burn by taking the stairs once a day,” she says.

For companies in buildings where the landlord will not permit changes to the stairwells, Ms Lovejoy suggests creating social events such as a regular employee stair walk. Employers can also help staff prevent and manage diabetes by making changes to the food available in the office – whether in the snacks provided for meetings or what is in the vending machines, canteens or break rooms.

This is not always easy, however. If healthier foods prove unpopular among staff, food vendors may not want to offer the healthy alternatives. “That can be a real challenge,” says Ms Lovejoy. “But if companies can’t get their vendors to offer an alternative, they can label the foods to show the fat, calories and sugar they contain and combine that with some educational messages.”

The other important support system for those with diabetes is the family, particularly in the case of children. “When a child is diagnosed with type 1 diabetes, the whole family is diagnosed with type 1 diabetes,” says Ms Dowling. Family participation is also critical since, after diagnosis, the input of medical professionals may be minimal. “Ninety-five per cent of it is self care,” says Ms Dowling. “So ongoing support is important.”

Technology can play a role. Diabetes monitoring technology is available via smartphones and other devices, which can display blood test results, analyse glucose patterns and offer data to help users monitor and manage the condition.

Technology also makes it far easier for patients to communicate regularly with their doctors. However, in some places, such as the US, the remuneration system for healthcare does not encourage this remote approach to care. “The only time I’m paid for any interaction with the patient is when they’re sitting in front of me,” says David Harlan, co-director of the Diabetes Centre of Excellence at UMass Memorial Medical Centre.

“We believe it would be much better to interact with patients frequently, electronically to encourage them and assess where they are,” he says. “But right now, if you do that, you’re doing it as an act of charity.” He also argues that healthcare providers could encourage patients to help each other manage their condition through support groups that might operate in a similar way to Alcoholics Anonymous or Weight Watchers.

In fact, there is a growing recognition that healthcare systems need to adapt in order to manage the increasing prevalence of long-term conditions such as diabetes. “Our healthcare system evolved to fix broken bones and take out appendices,” says Dr Harlan. “Now that what we do has shifted much more to chronic disease management, we have to rethink the whole system.

Prof. HL