(Editor's note: Scroll down to see 3 videos from this special roundtable.)
It’s a condition widespread enough to be almost commonplace, yet many employers still aren’t doing much to address one of the most prevalent health problems in the workforce: Diabetes.
So Canadian HR Reporter hosted a special roundtable in Toronto, moderated by lead editor Sarah Dobson and sponsored by Sun Life Financial, to take a deep-dive look at the issue.
“When we know that 3.4 million Canadians are suffering from diabetes, that’s a huge number,” said David Satok, corporate medical director at Rogers Communications in Toronto during the roundtable.
When you account for those with pre-diabetes as well, the total jumps to a startling nine million people, he said.
“That’s a huge burden to society — and to the individual, it’s an incredible impact. So we have to think about the individual, about society, about the workplace and all kinds of (factors).”
It’s clear this is a significant national problem, said Shana Kapustin, director of human resources at SYNNEX Canada in Toronto, a wholesale computer distributor — and it’s also quite a pricey one.
“For the last five to seven quarters, it’s consistently been our highest drug use,” she said. “And if we don’t start doing things such as education, prevention, maintenance, this will only get worse.”
There has already been an increase in cases of diabetes, according to Seema Nagpal, director of public policy at the Canadian Diabetes Association in Ottawa.
“The stats would show that between 2000 and 2010, the population with diabetes doubled in Canada from 1.3 million to 2.5 million. And today, it’s at 3.3 million,” she said.
“So it’s increasing every day. Twenty-nine per cent of the population has diabetes or pre-diabetes, and we expect that to continue to rise — unless we continue to pursue these prevention programs which have been shown to decrease the impact of diabetes.”
What exactly is diabetes?
So, what does diabetes actually do to the body? Simply put, diabetes means there is chronically elevated sugar in the bloodstream, said Satok.
“I think about sugar as the fuel for the cell, and everything we eat turns into sugar that can actually power the cell so that we can function,” he said.
“The problem with diabetes is there’s actually too much fuel circulating through the system. And the way I describe this to patients is if you think about sugar in your blood vessels, in your blood, as kind of like brine, so salt in water… if you put a cucumber in brine for long enough, you get a pickle. Well, diabetes is like that. When we have constant and chronic high sugar levels, that affects our tissues… we essentially pickle our organs.”
Generally speaking, there are two main types of diabetes: Type 1 and Type 2, he said.
“We think about Type 1 diabetes, which is the insulin-dependent diabetes that is really related to a lack of insulin in the system,” he said.
“So if we don’t have enough insulin in our system and we can’t get sugar into the cell, it’s a really weird situation, because it’s like we have all this fuel but it can’t get into the engine. We need that key, that insulin, to allow it in. So Type 1 diabetes, we don’t have that insulin to allow it into the cell.”
Type 2 diabetes unfolds differently, he said.
“Type 2 diabetes is that type of diabetes (where) there’s a lot of insulin and there’s a lot of cells, but they don’t interact well. It’s kind of like the key and the lock don’t really work very well — so there’s a sense of resistance.
“And for some people, there’s actually a lack of insulin as well. So there’s a bit of a problem in two areas for Type 2 diabetics.”
In terms of the breakdown of diabets types by population, the number of people with Type 2 diabetes far outweighs the number of people with Type 1, he said.
“It’s probably about 90 per cent, 95 per cent Type 2 and five per cent, 10 per cent Type 1.”
There are other variants of diabetes as well, said Nagpal. There’s also a temporary condition called gestational diabetes.
“(That) occurs in about 18 per cent of pregnancies. It’s a temporary condition that affects women and it goes away after the pregnancy is complete. But it places women and the children at higher risk for Type 2 diabetes in the future.”
Impacts include fatigue, absenteeism, mental health issues
The impacts of diabetes can manifest in the workplace in terms of productivity, said Valerie Taylor, chief, general and health system psychiatry at the Centre for Addiction and Mental Health in Toronto.
“You’re fatigued, you can’t concentrate as well, you just have a lot of physical difficulties and you can just get a lot of burnout. People start to become really frustrated with the fact that they have this chronic condition that we have good treatments for, but we certainly have no cures,” she said.
Employees will probably also need to take steps to manage the condition throughout the workday, said Nagpal.
“A person (may need) to monitor their blood glucose — that can be self-monitoring in the workplace — as well as take insulin by injection or through an insulin pump. A person may also need to have regular snacks throughout the day at the workplace. Sometimes, in cases of hypoglycemia, they need to treat their blood sugar throughout the day.”
Because the treatments for diabetes have improved so much, there are many more people with the condition in the workforce, said Taylor. And that can cause significant costs in terms of absenteeism and presenteeism.
“They’re going to be at work, because their medications have allowed them to be and that’s great, but if we haven’t done other things to help them function at an optimal level, we haven’t helped them to get their illnesses under control, they’re going to be there but they’re not going to be focused. They’re not going to be able to work at their full level of capacity,” she said.
“Those are significant costs to the employer, but also detrimental to the employee as well because people don’t want to be at work and be fatigued, and not be able to produce the way that they know they’re capable of. So that impacts morale, it causes difficulty within teams if one person’s not seen to be pulling their weight.”
People with Type 2 diabetes may often feel a sense of guilt or frustration, and there are some links with depression, said Taylor.
“There’s lots of links between depression and diabetes — both Type 1 and Type 2 — and again, that’s partly related to (the stress of) managing illnesses,” she said.
“We also know that unfortunately a lot of the treatments for people with mental illness cause weight gain and Type 2 diabetes. So sometimes, diabetes comes first and then they develop difficulties with depression; sometimes the depression is first, and the treatments that we need in order to help somebody function with depression or another mental illness unfortunately causes weight gain and increases the risk of Type 2 diabetes. We don’t really understand exactly how that association works yet.”
There’s also the whole issue of compliance with treatment, which can become a challenge with people who are feeling depressed, overwhlemed or frustrated.
“Compliance is a big issue,” said Satok. “I don’t want to take medication, so maybe what I do is I do denial.
“We know that about 57 per cent of people don’t take their medication regularly — so what are we doing about that?”
Employers can help by providing simple, inexpensive accommodations for employees. Those accommodations will vary from individual to individual, said Nagpal.
“Some of the common things that we hear about are that people would ask for a private or a safe place to test their blood sugar, a private or a safe place to administer insulin, regular breaks so they can have snacks. And consistent throughout the day, they have asked for access to fast-acting sugar in case of a hypoglycemic event, or a place to rest if they experience hypoglycemia,” she said.
Often, employers are afraid of the costs of accommodating, said Patrizia Piccolo, partner at Rubin Thomlinson in Toronto.
“They’re often surprised when I say to them ‘The average cost of accommodation of a disability, including diabetes, is $500 or less…’ so if you think of that, those are minimal-cost accommodations that are so easy to incorporate into the workplace to allow that individual to be a productive member of that workplace, and to really allow them to flourish in the role.”
However, along with accommodation is, of course, the related challenge of self-disclosure, said Piccolo.
“What we find happens in most workplaces is the issues (aren’t often self-reported), it’s not usually a self-disclosure. It usually happens where we have someone who is suffering silently, and the issues manifest as performance issues — absenteeism, they’re taking longer to do their work, they’re constantly tired, they’re not concentrating and so on. So management sort of brings it forward as a performance-related issue and deals with it on a performance basis,” she said.
“(But) trained management will stop and say, ‘Is there something going on here that you need some help with?’ Because failure to ask that question presupposes that it’s solely a performance issue, and we walk down that discipline path, and then it balloons into so much more than it should have been.
“So there’s all of those steps, that training that needs to go into the management side to recognize signs and symptoms of someone who might be suffering, whether it be from depression or diabetes or other disabilities within the workplace, and a duty to do so under our human rights legislation.”
Prevention best cure
As with most health conditions, prevention and proactive measures are the best approach, said Kapustin.
“A lot of organizations are missing very key marks that are very easy to put into place, that are very inexpensive, and most of it is around prevention, maintenance, education.”
Investing in wellness really does pay off, although it is an upfront investment and that scares some people away a bit, said Joana Oliveira, HR business partner, people and growth at Softchoice in Toronto.
“There’s still some uncertainty in the actual returns and ROI, but it’s definitely a huge opportunity.”
There are some great interventions that work, but they’re going to take a culture shift, said Taylor.
To that end, it’s about creating a context in which health can be the natural outcome, said Nagpal.
“People really blame themselves when they become overweight, or they develop Type 2 diabetes,” she said.
“And while you could say that that is true, people behave within the broader contexts of where they live. So if you’re in a workplace that offers healthy options..., that’s what you will consume. If there’s vending machines everywhere and you’re on a quick break, that’s what you’ll consume. If you’re in a peer group that doesn’t exercise or doesn’t take regular breaks, that’s what you will do.
“So it is really mobilizing health behaviours that I think will win in this battle that we’re having, and trying to change our social norms.”
Part 1: Diabetes at work - physical and mental health challenges
Part 2: Diabetes at work - legal implications
Part 3: Diabetes at work - costs and absenteeism
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