An individual with or at risk for developing diabetes likely spends at least one-third of their day on the job. In many cases, the worksite may present special challenges.1,2 Primary care providers may be able to identify patients’ work-related problems and provide information and guidance. But a team approach is optimal to help an employee with diabetes tackle these challenges. The team may include providers from the primary care/endocrine world, such as a physician, advanced practice provider (nurse practitioner or physician assistant), and diabetes educator, as well as providers from the occupational medicine world, which includes physicians, nurses, and health coaches.1,3-8
Some worksites have onsite clinics while others may contract with occupational medicine providers.9 Team members from both worlds should work with the employee and with each other to promote optimal health and productivity. Fewer complications translate into fewer days lost to absenteeism and disability, and future savings on health care expenditures.10-12
What are some worksite issues to address?
Some issues to consider include: Type of job, physical activity, physical environment, handling of special equipment/possible need for a special license or qualifications, and hours of work. Knowing the details about the specific workplace situation can help the team individualize possible medication regimens, job placement, and accommodations as needed. For example:
• Type of job: Desk job, physically active job or hybrid of both, handling moving or hazardous equipment (forklifts, assembly lines, cutting equipment), safety-sensitive activities. (Is there a situation where incapacitation of the employee performing the activities could place the employee or others at risk of harm?)
• Physical activity: Active and less-active days, type of activity (constant versus episodic), lifting required (weight, frequency).
• Physical environment: Location (outside, inside), temperature (intense heat or cold), possible exposures (need for protective equipment, respirators etc.), heights, hazards, working alone or with others, areas available for breaks, food storage, space to monitor blood glucose, sources of meals and/or snacks.
• Special license or qualifications: Commercial driver’s license (CDL), law enforcement officers, firefighters, long haul truckers.
• Hours of work: Length of work day, shift work (regular shift versus rotating shift, first second or third shift), hours of meals and/or snacks.
Case in point
A construction worker may work a few days a week. Some may be 10-hour days outside with intense physical activity involving heavy lifting. Other days, the worker may be off or gathering supplies.
Long-haul truckers may need a special license, may spend some days driving and some days loading, may have limited choices of healthy food.13
Law enforcement officers need special training, may work unexpectedly long shifts while on surveillance, and are in safety-sensitive jobs.
What can health care providers and workplaces do?
• Provide individualized assessment. Many jobs require an assessment (history and physical examination and sometimes other lab tests) before a specific job placement. This may be done by the primary care provider, worksite health provider, or designated provider (in the case of CDLs). The providers should collaborate with each other and with the employee with diabetes. The occupational medicine provider may need more information about specific insulin regimens (pumps, basal bolus schedules for shift work). The primary care provider may need more information about the job’s specific functions.14,15 Remember, however, that confidentiality regarding personal health information is essential.
• Require reasonable accommodations for breaks, glucose monitoring and other diabetes care tasks. Ensure a safe place for disposal of needles, pens, infusion sets and glucose monitoring supplies.
• Work with the employee and other providers to provide temporary or permanent restrictions as needed. These restrictions may be short- or long-term. Examples: An employee has just started using insulin and is in a safety-sensitive job and may need a short-term placement in another job, if possible, until glucose levels are stable. An employee may have autonomic neuropathy with postural hypotension, so may not be able to work at heights.
• Provide or refer to a Diabetes Self-Management Education and Support Program (cdc.gov/diabetes/dsmes-toolkit/index.html) for people who already have diabetes or to a National Diabetes Prevention Program for those at risk for type 2 diabetes or with prediabetes (cdc.gov/diabetes/prevention/index.html). Work with the health plans to provide coverage or refer /offer an onsite or virtual program though a vendor or community partner (hospital, clinic, health department, YMCA or pharmacy).
• Annual health screenings to help employees know their risk. Screenings may include blood pressure, blood glucose, hemoglobin A1c (A1C), cholesterol, weight or a foot check as well as vision screening.
• Offer lunch and learns. These may be through the worksite clinic, wellness programs, vendor, volunteers or community organizations. Diabetes-related topics may include: healthy eating, being active, monitoring, taking medication, problem solving, reducing risks and healthy coping.16 Family members and retirees should be included when possible. Employee focus groups may provide information on topics of interest or even if the employees are interested in participating in worksite diabetes education programs. Be sure and know laws associated with worksite wellness.17,18 The Americans with Disabilities Act (ADA) requires employers with over 15 workers to provide “reasonable accommodation” for disabilities, including diabetes. The Family Medical Leave Act (FMLA) assures that workers get unpaid time off for health needs such as doctor appointments and self-management training, but it only applies to companies with 50 or more employees within 70 miles of your place of work
The primary care/endocrine and occupational medicine worlds can work together to promote a healthy and productive workforce especially for people with or at risk for diabetes. These two groups can educate each other. Work with the local chapters of the American College of Occupational and Environmental Medicine (acoem.org), American Association of Occupational Health Nurses, (aaohn.org), American Association of Diabetes Educators (diabeteseducator.org), local chapters of the Endocrine Society (endocrine.org) and the American Association of Clinical Endocrinologists (aace.com). Forge new partnerships and educate each other. Worksite wellness matters.
Access additional resources and practical information to enhance the care and treatment of your diabetes patients.
src=”//cdn.diabetesselfmanagement.com/2019/08/Brittany-Bruggeman-150×150.jpg” alt=”Brittany Bruggeman, MD, FAAP” width=”150″ height=”150″>About our experts:
Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDE, FAADE, Associate Director, Education & Quality Services, University of Kentucky HealthCare, Barnstable Brown Diabetes Center, Lexington, Kentucky
Reviewed by Pamela Allweiss, MD, MPH, Medical Officer, Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia