Assessing Diabetes in Your Company
Many chronic medical conditions vie for a company's
health care dollar. A company's most important asset is its personnel, yet many
businesses do not know how greatly chronic diseases, such as diabetes,
hypertension, and cardiovascular disease, can affect their employees and
thereby influence the bottom line. With people spending more than one-third of
their waking hours on the job, employers are in a unique position to address
some health problems that arise from chronic diseases and that may affect
health care costs, worker productivity, and overall employee health and
wellness. Good health benefits everyone in a company, and, once the scope of
a condition is known, positive interventions can follow.
Why Use This Assessment Tool?
This assessment tool can help businesses get a
general estimate of the potential prevalence and costs associated with diabetes
among their employees. If your company wants to calculate specifically all the
costs related to diabetes for each employee, you should contact your health
care plan to obtain a list of codes for diabetes care from the International
Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM).
The ICD-9 CM coding system is used for signs, symptoms, injuries, diseases, and
conditions. These codes help health care providers, health care consultants,
and insurers to calculate medical costs. (For more information on ICD-9 CM
codes consult the National Committee for Quality Assurance (www.ncqa.org).
Who Can Use This Assessment Tool?
This assessment tool is designed for human resource
managers, health plan benefit specialists, corporate chief executive officers
and chief operations officers, health care providers, and other senior managers
concerned with reducing medical costs, increasing worker productivity, and
improving their companies bottom lines.
There Are Many Chronic Medical Conditions To
Address: Why Should Diabetes Be One of Them?
Because treating chronic medical conditions,
including diabetes, can be expensive, the effort to obtain the best value for
the investment in care becomes a priority. Consider the following questions
about diabetes before you decide to implement programs and funding.
1. Can you identify people in your company
who are at high risk for developing diabetes?
In any company, there may be valued, productive
employees who already have type 2 diabetes or who are at very high risk for
developing it. Assessing factors that contribute to the onset of diabetes can
help companies begin to identify employees at high risk for diabetes. These
factors include age, obesity, and race/ethnicity. Some chronic diseases, such
as diabetes and high blood pressure, are more common among certain ethnic
groups, including African Americans, Native Americans, and Mexican
A recent Centers for Disease Control and Prevention
(CDC) study showed that the prevalence of diabetes increased by 33 percent
between 1990 and 1998 (Mokdad et al., 2001). In fact, the prevalence is still
rising. From 1998 to 2000, the national prevalence of diabetes increased from
6.5 percent to 6.9 percent, an increase of 6 percent for a single year (Mokdad
et al., 2001).* In the working-age population, the prevalence of diabetes
increased by over 70 percent in the 30- to 39-year-old group from
19901998, and by 55 percent in the 40- to 49-year-old group from
Many people do not know that they have diabetes. It
is estimated that 8.2 percent of people in the United States have diabetes.
This includes diagnosed and undiagnosed cases.
2. Are there ways to improve outcomes?
There are many strategies for controlling diabetes.
With a proper diet, exercise, and treatment, persons with diabetes can lead
very productive lives at work and home. These strategies can also assist in the
proper management of other chronic diseases, such as cardiovascular diseases
(heart disease and stroke).
Diabetes is costly. Costs associated with other
chronic diseases, such as heart disease and high blood pressure may coexist
with or result from diabetes. Findings from the following studies show that
good diabetes control can reduce the risk for diabetes-related complications
and thereby potentially reduce health care costs.
- Good blood glucose (sugar) control
decreased severe eye disease by 76 percent and end-stage renal disease
by 56 percent in people with type 1 diabetes (Diabetes Control and
Complications Trial Research Group, 1993).
- Good blood glucose control can also improve
outcomes in people with type 2 (adult onset) diabetes (UK Prospective Diabetes
Study Group [UKPDS], 1998).
- Significant cost savings resulted within 1-to-2
years when adults with diabetes improved control of their average blood glucose
levelsas measured by A1C or glycosolated hemoglobin (Wagner et al.,
- Employees with diabetes who controlled their
blood glucose were more productive on the job (99 percent versus 87 percent)
and missed less work than did employees who did not control and lower their
blood glucose levels (Testa and Simonsen, 1998).
- People who had better control of their diabetes
also had fewer medical expenses over a 3-year period (Menzin et al.,
- The net productivity costs of not preventing
complications once a person has diabetes can range from $3,700 to $8,700 per
year, depending on the demographic group (Ng et al., 2001).
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3. Are there established practice guidelines for
care of diabetes?
Several professional and government agencies have
developed practice guidelines for the care of diabetes, including the American
Diabetes Association (ADA), American Association of Clinical Endocrinologists
(AACE), and the Centers for Medicare and Medicaid Services (CMS), formerly
called the Health Care Financing Agency (HCFA). In addition, there are rating
systems that evaluate the quality of services offered by health plans. For more
information on assessing health care plans, contact the American Health
Insurance Plans Web site (www.ahip.org) or
the National Committee for Quality Assurance Web site (www.ncqa.org).
* Women with gestational
diabetes (abnormal glucose levels during
included in these studies.