Heathcare Cost Checkup

Diabetes: Why Should Employers Care?

By Joe Martin

Winter 2018 Catalyst

According to the Gallup-Sharecare Well-Being IndexTM, the national prevalence of diabetes increased from 10.6 percent in 2008 to 11.5 percent for the first nine months of 2017. If the diabetes rate had remained at its 2008 level, approximately 2.3 million fewer U.S. adults would have the disease today, and healthcare costs due to diabetes would be an estimated $19.2 billion less than current levels. Costs to employers are significant, with more than $20 billion annually in lost productivity, stemming from 57 million additional unplanned missed workdays by workers 
with diabetes.

The federal Centers for Disease Control estimates that as of 2014, approximately 9.3 percent of the U.S. population has diabetes. This equates to nearly 30 million people, and clearly is something that will affect most employers. An individual with diabetes is at higher risk for blindness, kidney failure, heart disease, stroke and more. These increases have had a direct impact on health care costs and health outcomes.  
Further, the residents of the U.S. communities with the highest prevalence of diabetes have higher rates of obesity, high blood pressure, high cholesterol, heart attack and depression and are less likely to engage in healthy behaviors than residents in the lowest prevalence communities.

In November 2017, in conjunction with National Diabetes month, the Pennsylvania Health Care Cost Containment Council reported that hospital admissions for diabetes in 2016 amounted to an estimated $205 million in hospital payments. Using metrics developed by the federal Agency for Healthcare Research and Quality, PHC4 found that about 86 percent of diabetes admissions for adults were potentially preventable; that is, timely diagnosis, effective primary care and appropriate disease management can potentially avoid the need for an expensive hospital stay.

The PHC4 report also notes that in the 17-year period from 2000 through 2016, hospital admissions for diabetes amounted to 401,441 hospitalizations and over 2 million hospital days. During that same 17 year period, almost 40,000 Pennsylvania residents with diabetes underwent a lower extremity amputation.

Younger residents, those under age 45, saw an increase in hospitalization rates for diabetes. Residents in this age group were hospitalized for diabetes at the rate of 10.9 per 10,000 residents — a 38 percent increase since 2000 when the rate was 7.9. While the rate for residents aged 45 and older is still higher at 28.8, that group saw a 12 percent decrease from the 2000 rate of 32.6 percent.

Statewide, there were 24,283 hospital admissions for diabetes in 2016 — up from 21,528 in 2000. Patients under age 45 comprised 32 percent of the diabetes hospitalizations in 2016 — up from 28 percent of the diabetes admissions in 2000. About 5 percent of the 2016 admissions (1,297 admissions) were for children under age 18.

The PHC4 brief also examined population-based rates. Statewide, there were 19.0 hospital admissions for diabetes per 10,000 Pennsylvania residents in 2016. In general, population-based data showed higher rates of hospitalizations for diabetes among black and lower income residents:

    For black (non-Hispanic) residents, the rate was 46.0 per 10,000. The rates for white (non-Hispanic) and Hispanic residents were 16.1 and 13.7, respectively.
  • For lower income residents of all races, the rate was 41.7 per 10,000.
  • The rate was 16.5 for females and 21.6 for males.

County-level population-based rates are also included in the brief.

Given the prevalence of diabetes, it's nearly inevitable that employers will — either knowingly or unknowingly — employ someone who has diabetes at some point. Employers need to be aware of what this means in the workforce. Here are some considerations:

    Employees with diabetes will be covered by the Americans with Disabilities Act and may need accommodations to manage this chronic condition. For example, employees with diabetes may need to be accommodated in terms of taking breaks to eat before their blood sugar gets too low or taking breaks to administer medication during the workday. They may also have more regular medical appointments than other employees or may suffer from complications.
  • Employees with diabetes will also qualify for Family and Medical Leave Act leave (if otherwise qualified). This may come into play with diabetes management (such as when dealing with bouts of high or low blood sugar or for continued treatment), or for handling complications from the disease.
  • Type 2 diabetes can sometimes be positively impacted via lifestyle changes. This is relevant for employee wellness initiatives through an employer-sponsored wellness program. Employer wellness programs could also offer blood glucose screening.

The PHC4 report is available at www.phc4.org. You can also link to it through social media on Facebook and Twitter. In addition, the Lehigh Valley Business Coalition on Health has done a great deal of work on this issue — visit http://www.lvbch.com/ for details. PHC4 Vice Chairman Bob Johnston, benefits manager for East Penn Manufacturing, also chairs the LVBHC.

Joe Martin is executive director of the Pennsylvania Health Care Cost Containment Council.