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Manage Diabetes Through a DE&I Lens

Health and financial burdens from diabetes disproportionately affect some groups

A woman sitting on a couch holding a blood glucose meter.

When helping at-risk employees avoid developing diabetes, or to help those with diabetes stay healthy and productive, employers can ensure that the needs of historically disadvantaged groups are not overlooked by using a strategic diversity, equity and inclusion (DE&I) framework.

In the U.S., more than 34 million people are living with diabetes, generating estimated annual costs that include $237 billion in medical expenses and $90 billion in reduced productivity, according to the American Diabetes Association. Black and Indigenous individuals as well as other people of color, however, experience obesity and diabetes—and poor outcomes from these diseases—in disproportionate numbers, making it critically important to pursue strategies aimed at reducing inequities in care and treatment, according to the nonprofit Northeast Business Group on Health (NEBGH), a coalition of employers that sponsor health benefits.

In March, NEBGH posted Obesity, Diabetes and Racial Health Equity: What Employers Can Do, to help HR and benefits leaders develop strategies to achieve racial equity in obesity and diabetes prevention, treatment and outcomes.

"While effective treatments for obesity and diabetes exist, equitable access to these treatments doesn't exist across racial and ethnic populations," said Candice Sherman, CEO of NEBGH. "In some cases, benefits coverage for effective treatment may not be adequate and people may have difficulty paying for the care they need."

Action Steps

NEBGH suggests steps that employers can take to achieve racial equity in preventing and treating obesity and Type 2 diabetes, which is characterized by high blood sugar and insulin resistance and is linked to unhealthy diets and a lack of regular exercise. Recommended employer actions include the following:

  • Address racial disparities in health access and outcomes. Collaborate with your organization's DE&I leadership, leverage employee resource groups, and identify inequities in benefits and programs.
  • Design benefits that support best practices in obesity and diabetes care. Address the underuse of effective obesity and diabetes treatments. Think about behavioral treatments that encourage entire families to engage in healthier behaviors around diet and physical activity.
  • Improve health and benefits literacy. Educate employees about obesity and health. Make sure benefits information is accessible and understandable.
  • Reduce financial barriers to care. Offer value-based insurance designs that lower or remove financial barriers—such as high deductibles and co-pays—for high-value clinical services, including preventive visits and medications for managing chronic diseases.
  • Ensure access to racially sensitive mental health support. Depression and anxiety are common among people experiencing obesity and Type 2 diabetes. Offering racially sensitive and culturally relevant mental health resources to employees can enhance their ability to manage these conditions.
  • Evaluate health care vendors on DE&I practices. Ask questions to assess adherences to DE&I best practices. Press for diverse provider networks.

Addressing Obesity Without Stigma

"We shouldn't confuse cultural takes on what average body size is for obesity," said Dr. Nadia Ahmad, medical director at pharmaceutical firm Eli Lilly's diabetes business unit, who is among the health experts quoted in the NEBGH guide. However, while there are cultural differences in body shapes and sizes, and in how bodies are accepted, "with very few exceptions, there are no cultures in which a BMI [body mass index] of 50 is OK," she noted, referring to extreme obesity.

She added, "There's a fundamental biological basis as to why someone develops obesity, and there is a social stigma around this," which can create barriers to people accessing care to prevent and treat diabetes.

To help employers offer effective and inclusive wellness programs, the guide includes a list of resources on weight-bias issues as well as a list of organizations that provide culturally sensitive health and wellness services.

Employers "want to do the right thing when it comes to providing all employees with equitable access to high-quality physical and mental health care," Sherman said. "Highlighting the inequities that exist in the prevention, treatment and outcomes of obesity and diabetes in BIPOC [Black, Indigenous and people of color] populations creates an opportunity for employers to begin to address them, and to improve access to effective interventions across their entire employee populations."

Digital Tools Reduced Diabetes Risks

Therapeutic apps can help adults diagnosed with prediabetes reduce body weight and increase physical activity, and thereby improve their odds of staying healthy, according to a peer-reviewed research report.

The study was published earlier this year in the journal JMIR Diabetes.

Researchers from Memorial University of Newfoundland, Canada, and wellness program provider Virgin Pulse analyzed data from 1,095 adults with prediabetes enrolled in a program using a smartphone app connected to patient-monitoring and behavior-tracking tools, with health coaching and online peer support. Over a 12-month period, participants achieved moderate and sustainable weight loss and increased levels of physical activity, the researchers found.

"The results strengthen the case that digital health innovations can make a meaningful, sustained difference to those trying to make behavior changes" to reduce the risk of developing diabetes, said Dr. Zhiwei Gao, associate professor of clinical epidemiology at Memorial University of Newfoundland and lead author of the study.

Related SHRM Article:

Managing Diabetes Is a Workplace Health Priority. Digital Tools Can Help, SHRM Online, October 2019


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