Secondary prevention of diabetes through workplace health screening

Voluntary HIV Testing and Counselling Initiatives in Occupational Settings: A Scoping Review

Voluntary HIV testing and counselling (VCT) in the workplace could reach population groups who may be at risk for HIV but may not readily seek out testing from other services. We conducted a scoping review to understand (a) the nature of evidence related to initiatives and interventions for vocationally active adults on VCT in occupational settings, and (b) any facilitators and barriers to the delivery of and/or engagement with VCT initiatives/interventions in the workplace. JBI scoping review methodology was followed. The protocol was pre-registered. Included studies focused on vocationally active adults (population), VCT interventions or initiatives (concept), and workplaces in any sector or country (context). The review included studies published after 2000, in English, and of any research design. Studies relating to mandatory workplace HIV screening were excluded. MEDLINE, CINAHL, Scopus, PsycINFO, and the Cochrane Central Register of Control Trials were searched. Sources of grey literature included Google Scholar and governmental and organisational websites. One reviewer screened titles and abstracts; a second reviewer independently screened 10%. Data extraction utilised a modified JBI data extraction tool. We identified 17 studies reporting on 12 workplace VCT interventions (20,985 participants, 15-70 years). Studies were conducted in eight countries between 2001 and 2022. Interventions were delivered in organisations of different types, sizes and sectors. Testing included rapid blood tests and oral fluid self-tests. Where reported, the average on-site HIV testing uptake rate was 63%, and the average linkage to care rate was 86.85%. Views of workers, employers and service providers were largely positive. Barriers included being male, masculinity-driven workplace culture, HIV-related stigma, poor knowledge, low risk perceptions, lack of time and low support. Facilitators included on-site testing for convenience and accessibility, rapid and free tests, organisational, managerial and peer support, and embedding HIV tests within general health checks. Evaluation methods varied, although randomised trial designs were uncommon. Despite the limited number of studies, the workplace appears to be a viable route to the delivery of community-based VCT, albeit barriers should be addressed. Reporting quality of interventions and associated evaluations is variable and could be improved with the use of appropriate checklists.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

BACKGROUND

Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories.

METHODS

We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment.

FINDINGS

In 2022, an estimated 828 million (95% credible interval [CrI] 757-908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554-713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401-496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait).

INTERPRETATION

In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), and US Centers for Disease Control and Prevention.

Factors Related to Diagnosis of Diabetes After Detecting High Blood Glucose Levels Through Screening: One-Year Follow-up Among Publicly Insured Adults in Gunma, Japan

This study aimed to assess the diagnosis of diabetes after detecting high blood glucose levels through screening among insured individuals in Gunma, Japan. Data for men and women 35 to 74 years of age were provided by Japan Health Insurance Association, and 4133 individuals with high blood glucose levels while not currently being treated for diabetes were included in the study. About 13% received a diagnosis of diabetes at a subsequent physician visit, and individuals who were under treatment for hypertension were less likely to receive the added diagnosis of diabetes compared with those not being treated for hypertension (odds ratio = 0.42 from a logistic regression model). Fasting blood glucose levels were significantly improved in the next year only among individuals with a confirmed diagnosis of diabetes.

Pre-injury health status of truck drivers with a workers' compensation claim

Truck drivers are a vulnerable population due to the high number of workplace injuries and fatalities predominant in their occupation. In Australia, the road freight transportation industry has been identified as a national priority area in terms of creating preventative measures to improve the health and safety of its workers. With an environment conducive to poor nutritional food choices and unhealthy lifestyle behaviours, many barriers exist to creating a safe and healthy workforce. Thus, the current study aimed to describe the pre-injury hospital-recorded health conditions and health service use of truck drivers with a worker’s injury compensation claim/s when compared to workers in other industries. Data was obtained from a compensation claims database and linked with hospital admissions data recorded five years prior to the injury claim. Health and lifestyle behaviour data for the occupational code of truck drivers was compared to other occupational drivers, as well as to all other occupations. Analysis was conducted via logistic regression. The results found that when compared to other occupational drivers, truck drivers were significantly more likely to have a hospital-recorded diagnosis of diabetes and/or hypertension, as well as being significantly more likely to have a hospital record of tobacco use and/or alcohol misuse/abuse. The findings show that there is a need to review and revise existing health strategies to promote the health and wellbeing of truck drivers, especially given their challenging work environment.

Characteristics of participants who take up screening tests for diabetes and lipid disorders: a systematic review

OBJECTIVES

To perform a systematic review on the characteristics of participants who attended screening programmes with blood glucose tests, lipid profiles or a combination of them, respectively.

DESIGN

Systematic review following the Meta-analysis Of Observational Studies in Epidemiology checklist.

DATA SOURCES

PubMed and Medline databases for English literature from 1 January 2000 to 1 April 2020.

ELIGIBILITY CRITERIA

Original observational studies that reported baseline characteristics of apparently healthy adult participants screening for diabetes and lipid disorders were included in this review.

DATA EXTRACTION

We examined their sociodemographic characteristics, including age, gender, body mass index (BMI) and lifestyle habits. The quality of the included articles was evaluated by the Appraisal of Cross-sectional Studies.

RESULTS

A total of 33 articles involving 38 studies in 22 countries were included and analysed in this systematic review. Overall, there was a higher participation rate among subjects who were female in all screening modalities (female vs male: 46.6%-63.9% vs 36.1%-53.4% for diabetes screening; 48.8%-58.4% vs 41.6%-51.2% for lipid screening; and 36.4%-76.8% vs 23.2%-63.6% for screening offering both). Compared with the BMI standard from the WHO, participants in lipid screening had lower BMI (male: 23.8 kg/m2 vs 24.2 kg/m2, p<0.01; female: 22.3 kg/m2 vs 23.6 kg/m2, p<0.01). Furthermore, it is less likely for individuals of lower socioeconomic status to participate in diabetes or lipid screening in developed areas.

CONCLUSIONS

We identified that individuals from lower socioeconomic groups were less likely to take up programmes for diabetes and/or lipid screening in developed areas. These populations are also likely to be at higher risk of non-communicable diseases. Future studies should investigate the barriers and facilitators of screening among non-participants, where targeted interventions to enhance their screening uptake are warranted.

Accessing Voluntary HIV Testing in the Construction Industry: A Qualitative Analysis of Employee Interviews from the Test@Work Study

HIV, globally, remains a significant public health issue and community HIV testing can help to identify those with HIV at an early stage of disease. The workplace offers a prime location for provision of opt-in HIV testing as part of wider health promotion initiatives. The construction industry offers a key opportunity for HIV testing provision in a generally male-dominated group exhibiting some risky behaviors related to HIV. The intervention was an optional one-off individual health check with tailored health advice and signposting, offered to the construction workforce in health check events delivered as part of a large-scale multi-site research program called Test@Work. The events were undertaken at 10 participating organizations (21 events across 16 different sites), none had previously offered sexual health awareness or HIV testing to their workforce. Participants were invited to participate in a semi-structured interview following general health checks which included HIV testing. Out of 426 employees attending the health check events, 338 (79.3%) consented to interview on exit. Accessing HIV testing at work was valued because it was convenient, quick, and compatible with work demands. Interviewees identified HIV risks for construction including drug use, high numbers of sexual partners and job-related exposures, e.g., to used needles. Health seeking in construction was limited by stigma and low support, with particular barriers for non-permanent workers. The organization of the construction industry is complex with multiple organizations of different sizes having responsibility for varying numbers of employees. A disparity between organizational policies and employment circumstances is evident, and this generates significant health inequalities. To combat this, we recommend that organizations in the construction sector offer their employees awareness-raising around health behaviors and health protection in packages, such as toolbox talks. We recommend these be accompanied by annual health checks, including sexual health awareness and opt-in workplace HIV testing. This approach is highly acceptable to the workforce in the industry and removes barriers to access to healthcare.