Dive Brief:

• Low-wage workers are at increased risk of developing diabetes, but employers can aid prevention and care efforts in several ways, according to an employer guide published Feb. 12 by the Northeast Business Group on Health (NEBGH).
• NEBGH recommended that employers grant paid time off, or even a half day each year, for an annual check-up. Employers can also offer transportation services or reimbursement for public transit or rideshares used to travel to appointments. In addition to providing wellness programs and resources, employers can encourage awareness of the disease by providing access to on-site or near-site biometric screenings, or by encouraging senior leaders to get screened, NEBGH said.
• Employers can also optimize benefits plans for workers with diabetes, namely by designing plans that ensure free or very low-cost access to preventative services like check-ups, vaccinations and screenings, NEBGH said. Employers might also consider adding insulin and other glucose-lowering agents to a preventative drug list exempt from deductibles.

Dive Insight:

Diabetes is seventh on the list of leading causes of death in the U.S., according to 2017 data from the Centers for Disease Control (CDC). The CDC's "crude estimates for 2018" show a total of 26.9 million people in the U.S., or about 8%, had diagnosed diabetes. But the agency also estimated an additional 7.3 million adults ages 18 and older who met criteria for diabetes were not aware of or did not report having diabetes.

The risk of developing prediabetes and Type 2 diabetes is affected by a variety of factors, which can be exacerbated by low income, according to NEBGH. The group's guide pointed to research showing that low wages "are frequently associated" with living in poorer communities, food options that are high in salt and sugar, and working in "food deserts" where healthier food options are scarce.

Such factors go by another name, according to the NEBGH guide: social determinants of health. These social determinants play a role in the success or failure employer-sponsored wellness programs and benefits, sources previously told HR Dive. Many employers may not properly account for social determinants when evaluating their benefits.

"Diabetes is a challenging illness to manage in the best of circumstances, but for lower-wage workers, it can be especially daunting because of financial stress, family caregiving burdens, and living conditions in their communities," Candice Sherman, CEO of NEBGH, said in a statement accompanying the announcement. "Employers really need to be aware of the obstacles their lower-wage workers are facing and take steps to help them."

To combat diabetes and other chronic conditions, larger employers are increasingly turning to virtual care solutions, according to a 2019 report by the Business Group on Health. The report found 44% of large employers already offered virtual solutions for diabetes care management in 2019, while one-quarter were considering offering additional such solutions in 2021 or beyond. This tracks with a 2019 survey from Mercer that found more employers were offering targeted solutions for chronic conditions including diabetes.

There are a plethora of other strategies at employers' disposal, including existing wellness programs. A 2018 study by Quest Diagnostics found that participation in an employer-sponsored wellness program, combined with digital intervention, returned a third of study participants who initially tested as diabetic or pre-diabetic to normal blood glucose levels.

Employers also have a duty to accommodate employees with a disability under the Americans with Disabilities Act. An appropriate accommodation for an individual with diabetes may include, for example, permitting access to a snack or drink.