Healthcare, Absenteeism Costs of Diabetes Reach $266B in US

Diabetes is a multibillion-dollar drag on the US economy, driving $245.5 billion in healthcare costs and costing employers $20.4 billion in missed work days this year, according to an analysis drawn from 135,000 interviews, prepared for the Gallup-Sharecare Wellbeing Index and released in a report for World Diabetes Day.

The Cost of Diabetes in the U.S.: Economic and Well-Being Impact, is based on interviews in all 50 states that put the US adult diabetes rate at 11.5%. Among adults who are working, the diabetes rate for 2017 is 6.3% among full-time workers and 9.1% among part-time workers, the report found.

Although diabetes is less prevalent in the workforce than in the overall population, it’s still a costly problem for employers: the report found that full-time workers with diabetes miss an average of 5.5 extra workdays per year and part-time workers miss an additional 4.3 days, after adjusting for half-day estimates. Nationwide, this means employers are losing 58 million unplanned work days among employees who have been diagnosed with diabetes, compared with those not diagnosed. Gallup-Sharecare uses a calculation of $354 per day to reach its total cost of $20.4 billion, including $16 billion for full-time workers and $4.4 billion for part-time workers.

In an interview with The American Journal of Managed Care^®, Dan Witters, research director for the Gallup-Sharecare Wellbeing Index, said previous work allows Gallup to derive the number of missed work days based on the number of unhealthy days a person with diabetes reports from the previous month. The researchers also controlled for age, gender, race/ethnicity, income, education, marital status, the number of children in the household, the region of the country, and body mass index (BMI) weight class. This was key, Witters said, to isolate the effects of diabetes from those of obesity, although rising obesity rates have contributed to levels of diabetes.

“This is no joke,” Witters said. “There are other ways to evaluate lost productivity, but this is one that is tangible,” because it can be assigned a dollar amount. The figure was consistent with other numbers the Gallup-Sharecare index has developed in examining the impact of diabetes in the United States, he said.

There is some good news. Both Witters and Sheila Holcomb, RD, LD, CDE, vice president, Sharecare Diabetes Solution, say employers are recognizing that the progression to diabetes can be stopped—and because lost productivity affects them directly, more employers see diabetes prevention as a worthwhile investment.

Ten years ago, employers did not necessarily see diabetes as their problem, Holcomb said, but today “prediabetes” is part of their vocabulary. “I can tell you the trend has changed over the years,” she said. “As these very large companies have become self-insured, they see the benefit of keeping people healthier longer to mitigate the risk of prediabetes, and eventually diabetes.”

Dave Fried, CEO of Tricore Human Capital Management, works with employers across the country and said getting employees to eat healthy will be much harder than it was to get them to quit smoking, which happened when employers banned cigarettes from the building. Unhealthy food choices are everywhere, which Fried said makes healthy eating a challenge even when employees know it’s the right thing to do.

“Unlike smoking, food is not taboo, and it will be much more difficult to control,” Fried said. “So, what can employers do? We can run wellness programs, and we can promote healthy eating by having fruit in the breakroom instead of candy and chips. Healthy eating is the answer, but unhealthy eating is so easy.”

How can communities turn the tide? Sharecare’s Blue Zones project offers ideas—this initiative studies places with natural health and longevity and develops lifestyle interventions patterned after the world’s healthiest places. Half the city workers in Spencer, Iowa, eliminated at least 1 disease risk factor this way. Witters works directly with a Blue Zones project in the Beach Cities district in California, where smoking rates have dropped, fewer people are overweight, and exercise levels have increased.

The project has discovered that living in an area with low diabetes rates comes with other good health indicators—these areas also tend to have lower rates of obesity, smoking, and heart disease; there is less high blood pressures, fewer heart attacks, and lower rates of low-density lipoprotein cholesterol. Along with these indicators comes better access to care and belief systems about health. Such communities “are more likely to have residents who are productive and vital based on key purpose and community well-being metrics including using strengths every day, learning or doing something interesting daily, and feeling pride in their community,” the Gallup-Sharecare report said.

Holcomb said apart from major initiatives like Blue Zones, employers are also doing things like bringing certified diabetes educators into the workplace. “It’s not just for people who’ve been diagnosed with diabetes—it’s also for people who have prediabetes,” she said. The idea here is to slow the progression, saving healthcare costs and avoiding lost productivity.

A Georgia carpet manufacturer that deployed this strategy boosted its attendance rate and lowered the participants’ glycated hemoglobin (A1C) rates by 8% at 3 months, Holcomb said. “At 12 months, 52% of the participants are still having follow-up sessions, and their A1Cs still show a 6% improvement,” she said.

How does healthy behavior become part of a company’s culture? Witters said research by Gallup reveals 4 essential ingredients, regardless of programs that are offered:

• A strong, sustained voice from leadership.
• Leadership that defines well-being consistently over time.
• Use of both the bully pulpit and financial rewards.
• People must feel their well-being is authentically cared about.

“The impact of diabetes on the economy is real,” Witters said. “It affects the lives of those who have it, but it also impacts the bottom line of employers, because there is a not insignificant portion of their workforce that is carrying around this disease state.

“But,” he said, “it can be modified. We can take common sense steps to embed wellbeing culture inside of our organization.”

Changing the culture works for everyone, Holcomb said. When a lifestyle program works, “think about what that’s doing for the lives of the patients,” she said. “If you can slow down the progression—or stop the progression—of type 2 diabetes, that’s not only good for the employers, it’s good for the employees as well.”