Diabetes is a very expensive health problem for employees, people with diabetes, and ultimately everyone. The American Diabetes Association reports in the United States we have 17.5 million people with diabetes. The total estimated cost of diabetes in 2007 was $174 billion, with $116 billion being medical spending and $58 billion coming from reduced productivity at work. (Source: Diabetes Care March 2008) Ultimately diabetes increases costs for everyone due to higher insurance premiums.

How can employers help reduce cost from diabetes? Until we have a cure there are two ways to decrease cost. One is to screen for diabetes at the workplace to catch diabetes in the early stages when it is easier and less costly to manage. The second strategy is to help employees with diabetes get better control of their diabetes to reduce the chance of costly complications.

To explain further these two strategies, we need to understand where the highest costs of diabetes occur. The average cost for a diabetes hospital stay is $1853 per day. Compare that to a doctor visit for diabetes at $132. Which one is more cost effective? Regular doctor visits every 3-6 months are recommended for achieving optimal diabetes care. The physician will ideally have diabetes educators also to help the patient learn how to better manage their diabetes with medication, monitoring, food and exercise. However, what if your employee does not like to go to the doctor? Then they will not be getting the blood tests, exam and education that help them manage their diabetes and prevent costly complications. If they are not feeling well they may miss more work days as well.

What if you have a diabetes nutrition educator at your workplace? Registered dietitians that are also certified diabetes educators are a great resource for the worksite. They have the nutrition, exercise and diabetes knowledge and can set up education and diabetes screening programs. Many dietitians are already contracting with companies to nutrition and wellness programs for worksites.

Early screening for diabetes can catch prediabetes, which is diagnosed when blood sugars are higher than normal but not yet high enough to be diagnosed as Type 2 diabetes. Learning how to make lifestyle changes at this stage can delay the onset of diabetes for years, thus reducing the overall cost of diabetes.

The April 2008 issue of Diabetes Care discusses how nutrition education is linked to fewer hospitalizations. In a study of 18,404 diabetic patients that were followed for 4.7 years on average, 9.1% had at least one nutrition visit. Compared to those patients who had no education, those who had one education visit had 34% lower hospitalization rate. This lower rate was associated with $11,571 less in hospital charges. Nutrition visits were associated with the greatest reductions in hospitalization.

To quote the American Diabetes Association position statement regarding the economic costs of diabetes, "Much of this cost is preventable through improved diet and exercise, prevention initiatives to reduce the prevalence of diabetes and its co-morbidities, and improved care for people with diabetes to reduce the need for costly complications." Dietitians who specialize in diabetes are the experts to look for in helping to accomplish these three tasks because they have a combined knowledge of food, nutrition and diabetes treatments.



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