Chances are, you have at least a few employees with Type 2 diabetes, and many more will develop the lifelong condition at some point. It's a pervasive disease in today's day and age, and you'll want to know how to deal with it in the workplace.

A Health Epidemic

Type 2 diabetes (formerly called adult onset diabetes) is a worldwide epidemic. Diabetes is all related to how the body reacts to sugar. The exact nature varies by type of diabetes, however. In one form, the pancreas, the organ that produces insulin (the hormone required to maintain a stable blood sugar level) loses its ability to produce enough insulin. Insulin is necessary to deliver energy from the blood to the body’s cells. The pancreas simply becomes overworked and wears out. In Type 2 diabetes, the cells develop insulin resistance, so blood sugar — necessary for energy — can’t get to the cells. Instead, the blood sugar remains in the blood system, causing serious medical complications.

Types of Diabetes

Employees may have one of two types of diabetes:

• Type 1 diabetes: Formerly called Juvenile Diabetes, Type 1 diabetes is a rare type of diabetes that often starts in childhood. With employees suffering from this type of diabetes, the pancreas has been attacked and destroyed by the body’s own immune system. There is no insulin produced, so daily injections are necessary to survive. Only 5-10% of diabetics have type 1 diabetes. Since type 1 diabetes must be carefully monitored, these employees are knowledgeable about their disease and how to manage it.
• Type 2 diabetes: This type of diabetes is much more common. 90-95% of all diabetes cases are type 2. Type 2 diabetes is sometimes referred to as "lifestyle diabetes," because it is often related to personal health choices (although the full pathology of how it begins is not completely clear and may also be related to genetic factors). Onset of type 2 diabetes typically happens in adulthood. Initially, the treatment is a combination of diet, exercise, and oral medication. Over time, a person may need to add insulin injections to supplement oral medications. Employers are more likely to encounter workers with type 2 diabetes. By age 65, almost 26% of Americans will develop type 2 diabetes.

Type 2 Statistics

The statistics for type 2 diabetes are staggering. According to the American Diabetes Association (ADA), in 2012, about 9.3% of Americans had diabetes — over 29 million individuals. Of the 29 million, one third of diabetics did not know they had the disease. Another 86 million people, aged 20 years and older, have pre-diabetes. Diabetes is the seventh leading cause of death in the United States.

Just what is behind this surge in type 2 diabetes? There are two factors:

1. Genetics. Type 2 diabetes genes can be inherited. If family members have it, there is a greater likelihood that an individual will get it. This doesn’t mean an automatic diagnosis, but people who have type 2 diabetes in their families, especially if a mother or father has it, need to take steps to prevent the disease.
2. Lifestyle. The modern, often sedentary lifestyle has contributed to the millions of people who develop type 2 diabetes. They find themselves taking diabetes medications, checking their blood sugar (glucose) levels, and sometimes giving themselves insulin injections. Employees with type 2 diabetes may:
   1. Get an insufficient amount of exercise. Most people drive rather than walk and lead an overall sedentary lifestyle. Neglecting minimal physical activity — just 150 minutes a week — is enough to slow the transfer of energy into the cells.
   2. Have poor diets. Many meals are often deceptively unhealthy. High fat and high sugar levels may be hidden in unlikely places, so that employees don't even realize they are eating unhealthy food. For example, many restaurant salads have more sugar and fat in them than a small steak and baked potato. Getting the recommended grain, fruit, and vegetable intake rarely happens, meaning that not enough fibre is eaten. Over time, the risk of type 2 diabetes increases.
   3. Be overweight or obese. It’s no secret that obesity is on the rise. The Centers for Disease Control and Prevention (CDC) reports that over one-third of American adults are obese. This trend is costly to employers. Complications of diabetes can affect the body’s circulation, vision, kidneys, and nervous system.

The Financial Cost of Type 2 Diabetes

A diabetic employee has about 2.3 times more medical costs than an employee who does not have diabetes. The disease without question has a major impact on direct medical costs and productivity, including:

• $176 billion in medical costs, including $43 billion in inpatient hospital expenses
• $69 billion in lower productivity
• About $8,000 per year for diabetes-related medical care

What about indirect costs? Sadly, the news isn’t positive:

• Absenteeism costs $5 billion a year
• Presenteeism is $21 billion a year
• Disability due to type 2 diabetes is about $22 billion a year

Diabetes Accommodations

As employees disclose their type 2 diabetes diagnosis, you may be asked to provide accommodation for their condition. According to the Job Accommodation Network (askjan.org), there is not a specific list of diseases that lead to a disability ruling. The ADA provides guidelines for a case-by-case decision. The Equal Employment Opportunity Commission (EEOC) regulations of 2011 state: ”A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment.”

What types of reasonable accommodations can you expect for employees with type 2 diabetes? Some of the actions the ADA advises for people with the disease include:

• Rest breaks to check blood sugar (glucose) levels
• Approved containers for safe disposal of needles and testing materials
• Refrigerators and microwaves to store and prepare food
• For employees with nerve damage (neuropathy), allowing them to sit rather than stand
• Time away from work for doctors appointments or dialysis
• If an employee requires dialysis, they may need extra rest breaks following the procedure, as they will likely be fatigued

With advanced diabetes, an employee may develop kidney failure, requiring dialysis to remove toxins from their body. Some employees will need time to go to a dialysis center 2-3 times a week, for up to 4 hours each session. Other employees may choose peritoneal dialysis, which is a different way of cleansing the blood. No matter which method an employee chooses, they will require time away from their job, and may need recovery time after the procedure.

Diabetes Education

If your company has a wellness program (Learn more in "Do Workplace Wellness Programs Save Employers Money?"), consider offering workshops or courses on diabetes prevention and management. You may also find it beneficial to:

• Include information about diabetes in company emails or newsletters
• Invite your company’s healthcare providers to do a lunch-and learn about diabetes (Learn more in "8 Tips for a Successful Company Health Fair")
• Ask a local fitness center to set up a display in the cafeteria
• Work with a provider or laboratory to do basic glucose screenings
• Offer workshops or programs on weight loss

November is Diabetes Awareness Month. It’s an international effort to educate people on all types of diabetes. This is a good opportunity to offer information on prevention, signs, and treatment of the disease.