It’s estimated that over 30 million Americans — approximately 1 in 10 — have diabetes. About 1.25 million have Type 1 Diabetes, and the remainder have Type 2. Of the 30 million with diabetes, over 7 million have yet to be diagnosed.

Diabetes is the 7th leading cause of death in the U.S., with over 300,000 death certificates citing the disease as an underlying or contributing cause. And more cases are on the way: 1.5 million new diabetes diagnoses are made in the U.S. every year, and in 2015, 84.1 million Americans 18 and older had prediabetes.

According to the Health Care Cost Institute, the annual cost for diabetic care is significant: over $10,000 more per year than without the disease. For employers, employees and dependents, the annual costs continue to rise:

• $14,999 annually for people with diabetes;
• $4,305 annually for people without diabetes;
• $15,456 for children (0–18) with diabetes;
• $16,889 annually for pre-Medicare adults (55–64) with diabetes;
• $1,922 annual out-of-pocket medical spending for people with diabetes; and
• $738 annual out-of-pocket medical spending for people without diabetes.

In 2012, the annual cost of diagnosed diabetes in the U.S. for employers amounted to $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. About 1 in 3 adults has prediabetes (86 million Americans), but 9 out of 10 are not even aware they have it. Prediabetics can develop the disease within five years.

For most people, Type 2 diabetes occurs later in life, typically after age 40. But gestational diabetes can be a precursor for women to develop Type 2 diabetes after the birth of their child.

Employers as a resource

While coverage for diabetes is included in virtually every employer-sponsored health plan and is protected under the Americans with Disabilities Act, there are other ways employers can help staff who face the challenges of diabetes, particularly to help identify those with prediabetes and to assist Type 2 diabetics in the workplace.

Keeping prediabetes from becoming Type 2, as well as managing Type 2, can be part of a company’s overall wellness initiatives. Beyond the responsibility to accommodate those with the disease, employers can create an inclusive work environment that helps with disease management and avoidance. Taking steps to ensure staff has the ability to manage their condition (or keep it from becoming one) at work is key, including:

• Access and time to monitor blood sugar and/or take injections: provide disposal receptacles for used needles;
• Healthy food options at work, in vending machines and at work functions;
• Provide and promote education and awareness programs for early detection and disease management; and
• Offer flu/pneumonia shots at work; people with diabetes are three times more likely to die from the flu or pneumonia than those without the disease.

High tech solutions

Laurel Pickering is President and CEO of Northeast Business Group on Health, an employer-led coalition that helps employers make decisions about healthcare spending and puts their collective purchasing power to work in improving healthcare delivery. As employers look to drive health and wellness for staff, they can ask employees to consider digital disease management tools.

Pickering cites one of many such tools available for diabetics. “Livongo is a digital diabetes management tool that diabetics can use to manage their blood glucose levels, as well as their weight, blood pressure, nutrition and exercise," she said in an interview. 

"In addition to a digital tool, Livongo offers coaches who will talk to participants and help them manage their diabetes and get the most out of the program. The technology enables the recording of blood glucose data that is made available to both users and others, including providers.  A major feature is the alerts that are sent to users to stimulate action.”  

Pickering notes that employers can be instrumental in helping educate staff: “Targeted marketing and communications are critical. Employers can use relevant workplace opportunities like wellness events on nutrition or weight loss, or annual health risk assessments, to educate employees on the availability of digital health tools for diabetes. Employers can also work with their vendors like health plans and PBMs to help identify employees who can most benefit.”

The benefits to employers promoting education and supporting healthy lifestyles can be significant. As a leading cause of heart attack, stroke, kidney failure and amputation, diabetes leads to higher sick time use and lower productivity on the job. The American Diabetes Association's (ADA) workplace cost calculator estimates that for a company with 1,000 employees:

• 120 employees have diabetes;
• 34 are undiagnosed;
• 370 have prediabetes;
• $4 million is spent annually in insurance costs for employees with diabetes and prediabetes; and
• 58% of people with prediabetes can lower their risk for diabetes (71% if over 60) with a structured lifestyle change program.

A quiz from the ADA can help employees assess their risk and learn how to minimize the chance of prediabetes advancing.

Committing to change

Employers may not be aware of a few of the resources available to them in this effort. One example: the Centers of Disease Control's Prevent T2 Program, a 12 month lifestyle change program aimed at preventing Type 2 diabetes. Sammy Courtright, founder of Fitspot, talked about the program and the obstacles that get in the way of employees who try to complete it. 

“Fitspot figured, why not bring diabetes prevention programs to where most people spend their time during the day — at work?" Courtright said. The company brings the recommended 150 minutes of activity, educational workshops focused on nutrition and managing stress to the workforce. All classes are hosted by Fitspot’s certified wellness experts and equipment is provided when needed. Fitspot also tracks activity and improvement metrics through wearables and a technology portal.

"In many cases, Prevent T2 can be covered under wellness programs that are funded by insurance," Courtright added. "Companies typically have access to something called a Wellness Fund. A Wellness Fund is money set aside by insurance providers to help subsidize the cost of wellness programs. Insurance providers are willing to give these funds to clients because healthier employees mean clients claims will be reduced therefore reducing company health care costs."

Self-management education and training focuses on behaviors, such as healthy eating, being active and monitoring to help those with or at risk for diabetes gain solutions to avoid or manage the disease.

Prevention is possible

As companies recognize the benefit, as well as the cost saving, of promoting overall employee wellness, diabetes and prediabetes should be high on their list of priorities. It isn’t often company wellness programs can actually help employees reduce or eliminate their risk of illness, but with prediabetes screening and education, they can.

For employees who already have the disease, helping them manage their illness could lead to higher quality of life and reduced sick time and expense.