The Problem: A Super-Sized Nation

No matter how successful or profitable a business is, it cannot afford bad health. Businesses everywhere are ready to put an end to soaring health care costs. But the silver bullet isn't higher premiums, decreased benefits, capitated services or more drugs. The real solution requires changing our focus and tackling the real problem—unhealthy employees.

Experts estimate that nearly two-thirds of the United States population is overweight. Since 1991, the incidence of obesity has risen from 12 percent to more than 25 percent. While some call it an epidemic, U.S. Secretary of Health and Human Services Tommy Thompson calls obesity the fastest growing disease in America.

Now, imagine what will happen to employer health care costs over the next three to five years when many of those who are "now simply overweight" become diabetic. Then look ahead five years when these diabetics develop kidney failure requiring dialysis, and coronary artery disease requiring complex heart surgery.

Consider these staggering facts from the American Diabetes Association (ADA):
	Each day, approximately 2,700 people in the U.S. are diagnosed with diabetes. About 1 million people aged 20 years or older will be diagnosed this year. Nationwide, 17 million people have diabetes.
	Diabetes is the fifth leading cause of death in the U.S.
	More than $1 of every $10 spent on health care services in the US is attributable to diabetes.
	Heart disease is the leading cause of diabetes-related deaths.
	The risk for stroke is two to four times higher among people with diabetes.
	73 percent of adults with diabetes have high blood pressure
	Diabetes is the leading cause of new cases of blindness among adults 20-74 years old.
	Diabetes is the leading cause of treated end-stage renal disease.
	About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage.
	More than 60 percent of nontraumatic lower-limb amputations in the US occur among people with diabetes.

As the graying of America continues and the population grows in size and becomes more racially and ethnically diverse, the diabetic population will grow, even if current diabetes prevalence remains unchanged. Using diabetes prevalence rates applied to Census Bureau population projections, the national costs of diabetes could grow to $156 billion by 2010 (in 2002 dollars) and to $192 billion by 2020, according to the ADA.

S-E-T for Success Project Overview
"Give diabetes an inch and it will take a foot," the highway billboard simply stated. It's graphic, yet true. Diabetes is a complex disease and its management is more than just control of blood glucose. Employees with diabetes must be extra vigilant. They must monitor their levels of blood glucose, blood pressure, cholesterol and watch for symptoms of diabetes while remaining productive at work.

Employees with diabetes are at greater risk of temporary incapacity, permanent disability, and premature mortality. The economic impact of temporary incapacity due to diabetes can be measured by both workdays lost and number of inpatient bed days.

Direct medical and indirect expenditures attributable to diabetes in 2002 were estimated at $132 billion, according to the ADA.
	Attributable indirect expenditures resulting from lost workdays, restricted activity days, mortality, and permanent disability due to diabetes totaled $39.8 billion.
	Per capita medical expenditures totaled $13,240 for people with diabetes and $2,560 for people without diabetes.

Although diabetes is incurable, it can be prevented in many employees. For diabetic employees, it may be controlled through multifaceted diabetes management programs provided at the worksite. Diabetes management programs can drastically reduce a company's skyrocketing health care costs.

Controlling diabetes translates to controlling health care costs. Based on data from the ADA, employers could save $21,360 annually, by keeping just two at-risk employees from developing diabetes.

Managing Diabetes in the Workplace
Millions of people spend the largest part of their waking hours at work. As a result, employers are in a unique position to help employees with diabetes gain a better understanding of their disease and find ways of managing it. Employees at risk for diabetes can be educated in the prevention of the disease and avoid unnecessary complications.

In an effort to empower employees to self-manage their risk for diabetes, the Dallas-Fort Worth Business Group on Health (DFWBGH) initiated a nine-month multifaceted worksite diabetes management program for its employer members: SET for Success (Screening, Education, Treatment) — Diabetes Education and Management Program. This program also provided employers tools to control diabetes-related health care costs and improve day-to-day worker productivity.

The purpose of this innovative program was to:
	Provide a health-management tool to help employers build a framework for prevention and treatment programs
	Develop and customize a screening, education and follow-up program for employees that could help reduce diabetes risk factors and improve treatment
	Help employers take action toward reducing the threat of diabetes in the workplace

Supported by an unrestricted educational grant from GlaxoSmithKline, with additional support from Bayer Corporation and Roche Diagnostics, this demonstration grant was successful in creating greater awareness of diabetes risk factors and self management tools and potentially saving millions of dollars in future health care costs.

Click here for project report.

Click here for project presentation.

Click here for Fort Worth Star-Telegram Article featuring a FRBD "SET for Success" participant.