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Diabetes is a major concern for employers.
Research out of Harvard Medical School has shown that diabetics have absenteeism and “presenteeism” (i.e., impaired while at work) rates in excess of other, healthier employees: annual excesses total 6.4 days absenteeism and 7.3 days presenteeism. Combined, that sums to 14 work days (nearly three work weeks) per diabetic per year in lost productivity.

Moreover, uncontrolled or poorly managed diabetes results in emergency room visits if not inpatient stays that cost employers even more. It is therefore no surprise that most large employers engage the services of disease management vendors to reach out to the high risk diabetics to encourage them to follow their doctors’ recommendations and encourage them to better monitor and self-manage their condition. Other employers are also engaging lifestyle coaching services in hopes that –– through early detection via health risk assessment and assistance with lifestyle changes such as improved diet and exercise habits –– members will be able to lead personal and occupational lives that keep them happy and productive and avoid altogether the serious medical events that trigger disease management efforts in the first place.

The aim of companies such as Gordian Health Solutions is to assist physicians in better understanding diabetes incidence rates compared to employer-paid medical (non-pharmaceutical) costs for diabetes in hopes that observed differences will spark innovative treatment ideas. In our extensive work over the past 11 years with large national employers, we have accumulated claims data from 61 organizations totaling nearly $5 billion that can inform this discovery process. And because these cost data come from claims paid by employers, results are very relevant to their corporate bottom lines.

The CDC’s Health Data for All Ages reports diabetes incidence rates by age and gender. Younger women (18-44 years) show twice the diabetes incidence rates (4 percent) of men (2.1 percent) of similar age, but men outpace women 15 percent to 10.7 percent within the 45-64 age band. Whereas women’s diabetes incidence rates increase a full 267 percent with age, men’s increase more than 714 percent, all within the typical working age span.

The U.S. Surgeon General declared obesity a national epidemic in 2001 in part because its prevalence more than doubled in just 20 years, from approximately 15 percent in 1980 to more than 30 percent in 2000. Some researchers suggest obesity has already surpassed smoking as the preventable risk factor most costly to Americans. Although obesity is linked to several chronic medical conditions, it is perhaps most directly tied to diabetes.

It is little wonder, then, that we have observed employer-paid diagnosed (non-drug) medical costs for diabetes also increasing steadily from 2000 to 2004, suggesting that obesity rates may still be on the rise. In 2004 inflation-adjusted dollars, per member per month, diabetes costs increased from $1.98 in 2000 to $3.25 in 2004. That’s a 64 percent increase in employer-paid diabetes costs in just five years, an increase that is independent of medical services inflation … a scary trend for any employer, but especially for those with older and aging members.

Unlike some other chronic conditions such as asthma, incidence rates and per member costs for diabetes follow the same patterns by age and sex. For example, women’s diabetes incidence rates increase 267 percent (from 4 percent to 10.7 percent) with age (19-44 vs. 45-64 years), and their per member per month diabetes costs likewise increase 256 percent (from $2.13 to $5.45) with age. While men’s incidence rates increase an amazing 714 percent (from 2.1 percent to 15 percent) with age, however, their costs increase “just” 309 percent (from $1.90 to $5.88).

As with other chronic medical conditions, this pattern is perhaps best explained by gender differences in healthcare consumption behavior. Men generally avoid the healthcare system until they need it most, which likely results in higher-cost care per episode. For example, men are more likely than women to be hospitalized for conditions related to diabetes and typically present with extreme blood glucose levels. When also appreciating that healthcare costs for diabetics tend to be particularly high in both the pre-and post-hospitalization periods, it’s not hard to see the economic benefit to employers for providing self-care aids to their members. These and other research suggests men more than women need their employer’s push to meet with their physician regularly and adhere to their recommendations, such as self-monitoring blood glucose levels and taking prescribed medications, so that symptom severity is controlled.



Adam Long, PhD, is vice president of research and informatics at Gordian Health Solutions, a national lifestyle health and productivity improvement company based in Nashville, Tenn.





November 2007

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