Workplace wellness programs are helping thousands across the country to prevent chronic diseases such as type 2 diabetes, but what impact are they making on those who already have the disease? Wellness programs are currently focused on diabetes prevention, underserving a large segment of employees who are on an accelerated course toward body-wide destruction.
It is imperative that we improve medical outcomes for those who already have diabetes. According to the National Institutes of Health, diabetes treatment costs the U.S. a total of $174 billion annually; $58 billion of which includes indirect costs such as disability payments, lost productivity, and premature death.[1]
The Complexities of Diabetes Treatment
The National Institutes of Health 2008 Fact Sheet on Type 2 Diabetes offers guidance towards making workplace wellness programs effective for persons with diabetes.[2] They encourage personalized treatment strategies to tighten control on glucose, blood pressure, and hyperlipidemia. These goals are a challenge to implement in the workplace.
Type 2 diabetes is a multi-faceted disease requiring layers of interconnecting treatment strategies, the synthesis of which provides patients with the knowledge and tools they need to properly manage their disease and to prevent disease advancement. To better understand the complexities, consider the following self-care behavioral goals covered in ten hours of diabetes self-management training.[3]
- Healthy Eating
- Being Active
- Monitoring
- Taking Medications
- Problem Solving
- Reducing Risks
- Healthy Coping
Most workplace wellness programs attempt to offer both supportive counseling and education sessions to help employees who have type 2 diabetes, but their interventions and effectiveness are limited. How do we personalize treatments, as suggested by the National Institutes of Health? We can encourage members to discover their individualized glucose self-monitoring goal range, but how many will follow through with a phone call to their physician?
We can inform employees that glucose levels result from a combination of food intake, stress, illness, lack of physical activity and medication, but can we, in a practical sense, assist them in juggling these factors effectively? We can encourage them to eat less food for weight loss, but do we provide them with customized carbohydrate and fat controlled meal plans to help them succeed?
And if we do provide such practical guidance, how much meal planning and label reading practice do we provide so that members feel confident in their skills? We can assist employees in behavioral goal setting, but do we get to know these people well enough to know their priorities? These are but a few of the limitations with which our workplace wellness educators struggle in their efforts to improve medical outcomes for their members with diabetes.
Self-Management Training Limitations
Since comprehensive diabetes self-management training offers customized education, why do so few people know how to manage their disease? The proportion of Americans receiving diabetes education is between 1% and 50%, according to estimates documented by the American Association of Diabetes Educators.[4] Barriers to patients receiving diabetes self-management training and education are outlined in Dr. Mark Peyrot's 2007 American Association of Diabetes Educators end of year report:[5]
- 38% of patients cannot fit self-management training into their schedules
- 21% of patients have to pay out-of-pocket while 11% stated education is too expensive (average $633.00, according to this author's informal national survey, 2009)
- 41% of physicians think their patients are not interested in receiving education
- 41% of physicians do not have enough self-management training referral resources
- 17% of physicians do not believe that self-management training works
- Both physicians and educators underestimate patient scheduling issues and costs
Overly restrictive reimbursement and accreditation requirements can be blamed for many of the learning barriers experienced by those who receive diabetes training. In practice, these requirements translate into the use of ineffectual instructor-centered approaches. Patients generally experience barriers to learning such as inconvenient class schedules, limited teaching locations, learning bylecture, lack of skill practice, inconsistent program quality, inadequate time to apply learning, and lack of long-term emotional support.
The current environment does not offer the flexibility required to properly meet patients' educational needs. Diabetes is a complicated disease requiring that patients learn and obtain the skills needed to apply volumes of information. When taught over a short period of time, patients easily become confused. For example, patients learn that glucose levels fluctuate minute-by-minute based on one set of factors, while diabetes and its related blood vessel diseases progress due to an entirely different set of causes.
The treatment modalities and self-management skills for each of these topics takes three to four hours to teach, and much longer to learn. Treatments become easily confused in patients' minds. The sheer magnitude of information coupled with the need to synthesize the information into a cohesive whole makes it difficult for patients to learn how to control their disease unless given adequate time to learn.
Fear of diabetes and the need for hope lead many who have diabetes to deny having the disease and to seek magical, instant cures. They can also easily fall prey to charlatans who espouse easy answers and ways of turning back the clock. Fad diets and miracle supplements are focused on the diabetes population and have become a multi-billion dollar industry.
The plethora of non-research based cures and treatments are both enticing and confusing. Added to this is the confusion wrought by early research data being made public before conclusions are tested for reliability and validity. It is a confusing world for people who have diabetes, even when they have received formal education.
Improving Outcomes in Diabetes Treatment
How do we improve medical outcomes for employees who already have diabetes? Coaching those who do not already understand the relationship between their disease, treatment regimens, and lifestyle is an ineffective strategy for improving health outcomes. Providing seminars can add benefit, but classes such as these best serve to summarize the main points and provide motivation after members have already received thorough training in diabetes and its ramifications.
Electronic learning for diabetes education is a beneficial tool for workplace wellness companies. Dr. Mark Peyrot's report documents that 59% of diabetes patients reported they would learn diabetes self-management training on the internet.[6] Unlike traditional classes, online learning is reasonably priced and allows for group price reductions. Diabetes members can receive interactive skill practice and learning with all of the tools and support needed to defeat pre-diabetes, type 2 diabetes and metabolic syndrome from the convenience of their own homes.
The diabetes self-managementtraining portal can even be customized to your company name and added to your company's website, appearing seamless to the member. Online learning for the treatment of diabetes provides the foundation upon which your work becomes effective. While there are many fractured educational offerings online, genuine diabetes self-management training programs that can partner with corporate wellness companies are not easy to find.
Most of these programs remain focused on providing face-to-face patient evaluations in order to obtain insurance reimbursement, preventing them from offering a complete service online. As the reimbursement environment changes, so too will e-learning options. Workplace wellness companies seeking to significantly improve their medical outcomes must find diabetes self-management training programs with which to partner in order to make a difference in the lives of employees with diabetes.
Since associating with traditional classroom-style programs is only an interim solution leaving undesirable geographical gaps, the only way to achieve this is through constant monitoring of new program offerings on the internet.
References
[1] National Diabetes Education Program. US Department of Health and Human Services. January, 2011. http://www.ndep.nih.gov/diabetes-facts/index.aspx
[2] National Institutes of Health Fact Sheet, Type 2 Diabetes. US Department of Health and Human Services. June, 2008. http://www.nih.gov/about/researchresultsforthepublic/Type2Diabetes.pdf
[3] AADE 7 Self-Care Behaviors. American Association of Diabetes Educators. January, 2011. http://www.diabeteseducator.org/ProfessionalResources/AADE7/Background.html
[4] Diabetes Education Fact Sheet. American Association of Diabetes Educators. January, 2011. http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/Diabetes_Education_Fact_Sheet_09-10.pdf
[5] Peyrot, Mark. AADE DSMET Access Grant Project, 2007 End of Year Report. American Association of Diabetes Educators. January, 2011. http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/AADE_DSMET_Access_Grant_Project–07_EOY_Report_M._Peyrotx_PhD.pdf
[6] Ibid.
About the Author
Laurie Van Wyckhouse, MS, RD, LD/N owns NutriTutor.com, the world's first online diabetes self-management training programs. She holds a Bachelor degree in Nutrition from the University of Rhode Island and a Master degree in Health Education from Nova Southeastern University. Laurie has managed and taught diabetes self-management training classes and provided diabetes education for over 30 years.
