Business group releases employer guide for managing diabetes in low-wage employees

The employer coalition Northeast Business Group on Health has released a guide for employers looking to better manage diabetes in their low-wage workers.  

Low socioeconomic status doubles the risk of developing Type 2 diabetes, according to the NEBGH guide “Diabetes and Lower-Wage Workers,” released Feb. 12. Income determines what basic necessities like food, housing and education people can access, which may in turn affect people’s health. This is true for both hourly and salaried employees with low wages. 

Managing Type 2 diabetes, which is typically a lifelong disease, involves a lot of coordinated care, including lifestyle changes, treatment, monitoring and periodic care. 

“Even for those earning moderate or high incomes, diabetes can be a challenging disease,” the report stated. “[Low-wage employees] may have myriad financial and social pressures that for them take priority over the steps necessary to control their disease — increasing exercise, changing their diets and getting enough sleep.” 

Social determinants of health have been getting increasingly more attention from employers, as those socioeconomic factors in a person’s life can lead to poor health and higher health care costs. 

These poor chronic health outcomes don’t just include diabetes but also obesity, depression, anxiety and more, said NEBGH Chief Executive Candice Sherman. Still, diabetes was important for NEBGH to address in a guide since it often leads to other illnesses. “If [diabetes is] left unchecked, there are a huge number of serious complications that can ensue,” she said. 

Type 2 diabetes doesn’t just have a negative impact on the health and well-being of employees, it’s also a concern for employers, Sherman said. Chronic health conditions like diabetes impact employee absenteeism, presenteeism and productivity. 

Lower-income jobs may come without benefits like health care or paid time off —  even to address medical issues — and many people must take a second job just to manage expenses, according to the report. “These circumstances leave them little time to prepare healthy meals, exercise and educate themselves about health conditions.” 

The guide listed several practical action steps employers can take to address this reality, including ensuring free access to diabetes retinopathy screening; glucometer and hemoglobin A1c testing; offering resources and health education opportunities; and reviewing the affordability of health insurance premiums for employees in each wage category.

Many employers already are doing many of the suggestions in this guide, Sherman said. These more common practices include preventive screening programs, well-being programs and financial wellness programs. One area of importance for Sherman is the impact of high deductible health plans, she said.

Lower-wage workers tend to choose HDHPs because of their lower premiums or because their employer only offers HDHPs. But these same employees are less able to finance upfront medical expenses like medications and doctors’ visits, Sherman said. Employees sometimes forgo taking their medication or resort to taking it every other day because of financial concerns or because they can’t afford medical costs after paying for essentials like food, housing and transportation.

The NEBGH guide suggests that employers should “add insulin and other glucose-lowering agents to a preventive drug list exempt from deductibles with no patient cost sharing or a low, fixed dollar co-payment.” 

Employees also face transportation barriers in accessing care and making it to health care appointments, the report said. 

Some forward-thinking employers are beginning to address this, Sherman said. Many large employers provide transit benefits, but other employers are looking beyond that. “Some employers are experimenting with things like discounts or vouchers for some of these transportation services for things like doctor visits or if they have a family member who has a serious illness and needs transportation,” she said. 

Sherman also suggests that employers offer employees PTO during working hours. Employers that don’t offer PTO may worry about their bottom line, but Sherman said that this benefit can ultimately help employee productivity by allowing them to get the medical care they need.  

“Employers always need to be thinking about the cost of certain benefits like time off and weigh the potential benefits, certainly for their employees but also for the business in terms of productivity,” she said.