Employment problems and diabetes

L-PRF in extra-oral wound care

Leukocyte- and platelet-rich fibrin (L-PRF), a by-product of centrifuged autologous whole blood, contains high concentrations of platelets, leukocytes, and fibrin (the latter spontaneously creating a strong 3-D network (a membrane)). L-PRF membranes possess several characteristics essential in wound healing, including a barrier function, an antibacterial and analgesic activity, and the release of growth factors enhancing tissue regeneration and neo-vasculogenesis. This review investigated the role of L-PRF in treating non-responding chronic wounds such as diabetic foot, venous leg ulcers, pressure ulcers, complex wounds, leprosy ulcers (Hansen's Disease), and other demanding wounds. Chronic wounds affect millions worldwide, negatively impacting their quality of life, productivity, and life expectancy while incurring high treatment costs for themselves and private and public health systems. L-PRF has demonstrated clear adjunctive advantages in treating chronic skin wounds, shortening the time to complete wound closure, and improving patient-reported outcome measures (including reducing pain and minimizing the need for analgesics). Also, in other demanding wounds, L-PRF facilitates healing. To help clinicians, this article also proposes recommendations for the use of L-PRF in the treatment of extra-oral wounds.

Topical Biological Agents as Adjuncts to Improve Wound Healing in Chronic Diabetic Wounds: A Systematic Review of Clinical Evidence and Future Directions

Diabetes is a leading chronic illness in the modern world and 19-34% develop chronic diabetic foot ulcers (DFUs) in their lifetime, often necessitating amputation. The reduction in tissue growth factors and resulting imbalance between proteolytic enzymes and their inhibitors, along with systemic factors impairing healing appear particularly important in chronic wounds. Growth factors applied topically have thus been suggested to be a non-invasive, safe, and cost-effective adjunct to improve wound healing and prevent complications. Comprehensive database searches of MEDLINE via PubMed, EMBASE, Cochrane, and ClinicalTrials.gov were performed to identify clinical evidence and ongoing trials. The risk of bias analysis included randomized controlled trials (RCTs) was performed using the Cochrane Risk of Bias 2.0 tool. We included randomized controlled trials that compared the use of a topical biologic growth factor-containing regimen to any other regimen. Primary outcomes of interest were time to wound closure, healing rate, and time. Secondary outcomes included the incidence of adverse events such as infection. A total of 41 trials from 1992-2020 were included in this review, with a total recorded 3,112 patients. Platelet-derived growth factors (PDGF) in the form of becaplermin gel are likely to reduce the time of closure, increase the incidence of wound closure, and complete wound healing. Human umbilical cord-related treatments, dehydrated human amnion and chorion allograft (dHACA), and hypothermically stored amniotic membrane (HSAM), consistently increased the rates and incidence of complete ulcer healing while reducing ulcer size and time to complete ulcer healing. Fibroblast growth factor-1 (FGF1) showed only a slight benefit in multiple studies regarding increasing complete ulcer healing rates and incidence while reducing ulcer size and time to complete ulcer healing, with a few studies showing no statistical difference from placebo. Platelet-rich fibrin (PRF) is consistent in reducing the time to complete ulcer healing and increasing wound healing rate but may not reduce ulcer size or increase the incidence of complete ulcer healing. Targeting the wound healing pathway via the extrinsic administration of growth factors is a promising option to augment wound healing in diabetic patients. Growth factors have also shown promise in specific subgroups of patients who are at risk of significantly impaired wound healing such as those with a history of secondary infection and vasculopathy. As diabetes impairs multiple stages of wound healing, combining growth factors in diabetic wound care may prove to be an area of interest. Evidence from this systematic literature review suggests that topical adjuncts probably reduce time to wound closure, reduce healing time, and increase the healing rate in patients with chronic DFUs.

Self-employment and cardiovascular risk in the US general population

Background

Studies on self-employment and cardiovascular risk are very limited. We examined the relationship between self-employment and cardiovascular risk among the general population in the United States from 1999 to 2016.

Methods

Using the National Health and Nutrition Examination Survey (NHANES), we identified all patients with hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), stroke, heart failure (HF), and coronary artery disease (CAD) between 1999 and 2016. Type of job was defined based on the participant's response to the survey question as “an employee of a private company, business, or individual for wages, salary, or commission” or “self-employed in own business, professional practice or farm”. Multivariable logistic regression analyses were performed to adjust for confounders.

Results

Of 30,103 patients, 2835 (9.4%) were self-employed in their own business, professional practice, or farm and 27,268 (90.6%) were employed by a private company, business, or government. After adjusting for age, race, sex, BMI, marital status, educational level, health insurance status, smoking status, sleep duration and lipid profiles, self-employed individuals had a higher prevalence of HTN (OR: 1.12; 95% confidence interval [CI] 1.05–1.20), HLD (OR: 1.10; 95% CI 1.07–1.31), stroke (OR: 1.45; 95% CI 1.27–1.67), HF (OR: 1.17; 95% CI 1.03–1.32), and CAD (OR: 1.26; 95% CI 1.13–1.35) (all P v< 0.05).

Conclusions

Self-employment may be associated with greater cardiovascular risk in the US general population. Further prospective studies are urgently needed to establish the optimal preventive strategy to reduce cardiovascular risk in self-employed individuals.

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Self-employment may be associated with cardiovascular risk in the US general

population

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Self-employed individuals may encounter work-related adversity, leading to

cardiovascular risk

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Further prospective studies and clinical trials are urgently needed to establish the optimal preventive strategy for reducing cardiovascular risk associated with self-employment

Type 1 Diabetes in Parents and Risk of Attention Deficit/Hyperactivity Disorder in Offspring: A Population-Based Study in Sweden

OBJECTIVE

To explore whether a family history of type 1 diabetes (T1D) is associated with an increased incidence of attention deficit/hyperactivity disorder (ADHD) in offspring.

RESEARCH DESIGN AND METHODS

Individuals with T1D were identified from the nationwide Swedish National Hospital Discharge Register and Swedish Outpatient Register in Sweden and were linked to the Swedish Multi-Generation Register to identify their offspring. Cox regression was used to calculate the hazard ratio (HR) of ADHD in offspring of patients with T1D compared with the general population.

RESULTS

A total of 15,615 individuals were born after their parents were diagnosed with T1D. After a set of confounding factors was controlled for, offspring of T1D patients had a significantly increased risk of ADHD with an HR of 1.29 (95% CI 1.15-1.42). Maternal T1D was associated with an enhanced risk of ADHD (HR 1.35 [95% CI 1.18-1.55]) compared with paternal T1D (HR 1.20 [95% CI 1.03-1.41]), but the difference was not statistically significant.

CONCLUSIONS

In this retrospective cohort study, we found that a parental history of T1D was associated with a 29% increased risk of being diagnosed with ADHD. However, the underlying mechanisms need to be explored in future studies.

Diabetes-related stigma affects the quality of life of people living with diabetes mellitus in Switzerland: implications for healthcare providers

There is a growing body of scientific evidence that stigma represents a reality for many people living with diabetes (PWD). However, little is known about the impact of experienced stigma. Against this background, the present study aimed to establish, by means of an in-depth consideration of the situation in Switzerland, whether and how experienced and perceived stigma impact the quality of life of those PWD affected. In this cross-sectional study, an anonymous paper-and-pencil self-administered questionnaire (SAQ) was used for data collection. The SAQ drew on a qualitative elicitation study and was distributed in 2013 to the readers of a Swiss journal destined to people living with diabetes. Data were analysed using descriptive statistics and structural equation modelling. The sample included 3347 people (response rate of 16%) with type 1 and 2 diabetes, aged 16-96. Respondents who reported higher levels of perceived stigma reported higher levels of psychological distress (β = 0.37), more pronounced depressive symptoms (β = 0.33) and less social support (β = -0.22). Higher psychological distress (β = -0.29) and more pronounced depressive symptoms (β = -0.28), in turn, predicted lower quality of life. Findings suggest that stigma should be considered as an additional predictor of quality of life in PWD. Therefore, healthcare providers should support PWD's fight against stigma. Especially, social workers are called to engage in advocacy to reduce discrimination against PWD and claim equal chances for them. They are also called to develop and implement interventions to correct stereotypes about PWD.

Control of type 1 diabetes mellitus and shift work

BACKGROUND

People with type 1 diabetes may find diabetic control more difficult when working shifts.

AIMS

To investigate the proportion of people with type 1 diabetes in employment undertaking shift work and diabetic control as assessed by glycosylated haemoglobin (HbA1c) among individuals undertaking shift work compared to those not doing so.

METHODS

A postal questionnaire sent to all those aged 16-65 attending two city hospitals for type 1 diabetes care. HbA1c results were used to assess diabetic control.

RESULTS

Twenty-two per cent (296 of 1370 eligible patients) responded. Sixty-seven (23%) respondents were involved in shift work. Shift workers had higher mean HbA1c values than non-shift workers (9.02 versus 8.35; P < 0.01).

CONCLUSIONS

Poorer control of diabetes was associated with working shifts in this study. Occupational health practitioners should be aware of this association and be able to advise on management strategies to improve diabetic control while working shifts.

Bypassing the selection rule in choosing controls for a case-control study

OBJECTIVES

It has been argued that in case-control studies, controls should be drawn from the base population that gives rise to the cases. In designing a study of occupational injury and risks arising from long-term illness and prescribed medication, we lacked data on subjects' occupation, without which employed cases (typically in manual occupations) would be compared with controls from the general population, including the unemployed and a higher proportion of white-collar professions. Collecting the missing data on occupation would be costly. We estimated the potential for bias if the selection rule were ignored.

METHODS

We obtained published estimates of the frequencies of several exposures of interest (diabetes, mental health problems, asthma, coronary heart disease) in the general population, and of the relative risks of these diseases in unemployed versus employed individuals and in manual versus non-manual occupations. From these we computed the degree of over- or underestimation of exposure frequencies and exposure ORs if controls were selected from the general population.

RESULTS

The potential bias in the OR was estimated as likely to fall between an underestimation of 14% and an overestimation of 36.7% (95th centiles). In fewer than 6% of simulations did the error exceed 30%, and in none did it reach 50%.

CONCLUSIONS

For the purposes of this study, in which we were interested only in substantial increases in risk, the potential for selection bias was judged acceptable. The rule that controls should come from the same base population as cases can justifiably be broken, at least in some circumstances.

Association of comorbid depression, anxiety, and stress disorders with Type 2 diabetes in Bahrain, a country with a very high prevalence of Type 2 diabetes

This study examined the association of depression, anxiety, and stress with Type 2 diabetes (T2DM) in Bahrain, an island-country with a very high prevalence of T2DM. This was a cross-sectional study involving administering Depression Anxiety Stress Scales (DASS)-21 structured depression, anxiety, and stress scale to 143 T2DM patients and 132 healthy controls. Higher proportion of T2DM patients were found in the mild-moderate and severe- extremely severe depression (p=0.002), anxiety (p<0.001), and stress (p<0.001) groups. Chronic disease and disease duration were significantly associated with the 3 disturbances, while employment status was associated with anxiety and depression. Logistic regression analysis showed that anxiety, depression, and stress were associated with T2DM after adjusting for all variables, while age was the only significant variable associated with stress. These results suggest a positive contribution of T2DM to increased depressive and/or anxiety and/or stress disorders among the patients examined, thereby recommending counseling for T2DM patients.

Increased sickness absence in diabetic employees: what is the role of co-morbid conditions?

AIMS

Diabetes is thought to be associated with increased risk of sickness absence in working populations. We examined the contribution of co-morbidity to this association.

METHODS

Records of physician-certified sickness absence episodes (> 3 days) over a 1-year period were obtained from employers' records after a survey of chronic diseases and risk factors in 638 diabetic and 32 510 non-diabetic public sector employees in Finland (the Public Sector Study).

RESULTS

Diabetic employees had a 2.15-fold (95% confidence interval 1.92-2.40) age- and sex-adjusted excess risk of sickness absence compared with their colleagues with no chronic disease. In absolute terms, diabetes was related to 59 extra absence episodes per 100 person years. Of this excess risk, 55% was attributable to co-occurring non-cardiovascular diseases, such as depression, prolapsed intervertebral disc and bronchitis. The contribution of cardiovascular complications to the excess sickness absence was small (7%).

CONCLUSIONS

In this occupational cohort, the excess risk of sickness absence in diabetic employees was largely accounted for by non-cardiovascular co-morbidity. Intervening multiple chronic conditions may be important in programmes to reduce sickness absence in diabetic employees.

Lost productive time and costs due to diabetes and diabetic neuropathic pain in the US workforce

OBJECTIVE

Estimate the impact of diabetes and neuropathic pain on the US workforce.

METHODS

Data on lost productive time (LPT) was collected by telephone interview in a random sample of the US population (N=36,634). Of 19,075 occupation-eligible working adults included in the analysis, 1003 reported a physician diagnosis of diabetes; 38% of these reported numbness or tingling in feet or hands due to diabetes (symptom group). We compared diabetes respondents with and without symptoms to other respondents for LPT and related cost.

RESULTS

Health-related LPT was 18% higher in the symptom (P<0.05) and 5% higher in the non-symptom (P<0.05) groups versus for those without diabetes. The symptom group lost 1.4 hours of work per week more than the non-symptom group (P<0.05).

CONCLUSIONS

Workers who have diabetes with neuropathic symptoms lose the equivalent of $3.65 billion/yr in health-related LPT.

Population-based analysis of obesity and workforce participation

OBJECTIVE

To describe the relationship between obesity class and workforce participation and the influence of demographic, socioeconomic, and comorbid disease states on this relationship using population-based Canadian data.

RESEARCH METHODS AND PROCEDURES

Responses from 73,531 adults surveyed in the Canadian Community Health Survey 2000 to 2001 who provided complete information regarding variables of interest were analyzed. Workforce participation was defined as individuals reporting that they held and were present at a job or business in the week before survey administration. The association between obesity and workforce participation was explored using logistic regression after adjusting for demographic, socioeconomic, and obesity-related comorbidities.

RESULTS

In univariate analysis, obese individuals had lower odds of participating in the workforce. In the fully adjusted model, increasing obesity was associated with decreasing odds of workforce participation, with Class I, II, and III obesity having odds ratios (95% confidence interval) of 0.94 (0.89 to 0.99), 0.85 (0.77 to 0.94), and 0.66 (0.57 to 0.78), respectively. Obese individuals were also less likely to be employed and more likely to be absent from work.

DISCUSSION

Obesity is associated with lower workforce participation. This association appears to be independent of associated comorbidity and sociodemographic factors. These results indicate that the economic impact of obesity alone on workforce productivity is larger than previous reports suggest.

Understanding the impact of painful diabetic neuropathy

Painful neuropathy is a common and often distressing complication of diabetes. It has considerable impact on the social and psychological well-being of affected individuals. There are two distinct forms of painful neuropathy: an acute and self-limiting form that resolves within a year or a chronic form that can go on for years. There are now a number of drugs available for the treatment of neuropathic pain. However, some may fail to respond to these drugs or may have unacceptable adverse side effects. When this is the case, the patient's quality of life can be severely affected. Health care professionals need to assess the full impact of painful neuropathy. In this article we review a number of instruments that are used to assess the severity of painful neuropathy and its impact on the quality of life.

The effect of renal insufficiency on workforce participation in the United States: an analysis using National Health and Nutrition Examination Survey III data

BACKGROUND

End-stage renal disease is associated with workforce nonparticipation, but no previous study has assessed the impact of renal insufficiency on employment status from a population standpoint.

METHODS

To determine whether renal insufficiency is independently associated with labor force participation, an analysis was performed using observational data from the Third National Health and Nutrition Examination Survey, which represents a cross-sectional sample of the US population. Five thousand five hundred fifty-eight subjects of the civilian noninstitutionalized US population aged 18 to 64 years provided complete information regarding key variables. A logistic regression equation with workforce participation as the dependent variable was created. Explanatory variables included age, sex, race, marital status, census region, and education, as well as the health-state indicators of general health status, presence or absence of diabetes, hypertension, stroke, congestive heart failure, myocardial infarction, and an indicator of renal function. Renal dysfunction was defined by serum creatinine values greater than 1.7 mg/dL (150 micromol/L) for women and greater than 2.0 mg/dL (180 micromol/L) for men.

RESULTS

Renal dysfunction was independently associated with labor force nonparticipation, with an odds ratio of 7.94 (95% confidence interval, 1.60 to 39.43). This relationship remained statistically significant after subjects with markedly elevated serum creatinine levels were excluded.

CONCLUSION

A previously unrecognized independent association between renal function and labor force participation was identified. This group of patients warrants further attention regarding identification of specific factors leading to nonemployment, potential for workforce rehabilitation, and assessment of the impact of renal insufficiency in other functional spheres.

Diabetic foot ulcers: a quality of life issue

Foot ulcers are a serious complication of diabetes mellitus that are associated with adverse sequelae and high costs. In addition, such foot ulcers have a significant impact on quality of life (QoL). For example, the loss of mobility associated with foot ulcers affects patients' ability to perform simple, everyday tasks and to participate in leisure activities. These and other consequences of foot ulcers often lead to depression and poor QoL. Notably, several studies have shown that patients with diabetes mellitus and foot ulcers were more depressed and had poorer QoL than those who had no diabetic complications. Given the detrimental effect foot ulcers have on patients, it is essential that these foot ulcers are prevented or treated more effectively than at present. Evidence suggests that many foot ulcers can be prevented by using intensive interventions and adopting a multidisciplinary approach to treatment. In addition, preventative strategies may become more effective if new research into how patients with diabetes experience and interpret their health threats (e.g. diagnosis "loss of sensation" or a foot ulcer episode) is taken into account. With regard to treatment, new options should enable ulcers to heal more quickly than with standard therapies. One area of interest is the use of growth factors. For example, recombinant platelet-derived growth factor, in addition to good ulcer care, has been shown to improve the number of ulcers that heal and healing times significantly compared with good ulcer care alone. Other potential new treatments include the use of skin substitutes. In summary, improved preventative measures and wound treatment should reduce the potential for patients with diabetes mellitus to experience impaired QoL caused by foot ulcers.

Sickness absence in diabetic employees

OBJECTIVES

To compare sickness absence among diabetic and non-diabetic employees.

METHODS

A cross sectional case-control study was conducted in a random sample of 400 diabetic employees 21--50 years old from Ljubljana that compared their sickness absence in the year 1996 with sickness absence of non-diabetic employees matched by sex, age, and occupation. Sickness absence was compared in total and also in subgroups formed by sex, age, occupation, and disability. Non-parametric statistics were used (chi(2) test, Wilcoxon matched pairs test).

RESULTS

The randomised sample consisted of 61.2% of men (245) and 38.8% of women (155) with a mean age of 42.5 years. Unskilled workers made up 30.2% of employees, and less than 16.4% were highly educated. Among diabetic employees there were 7.0% disabled and among non-diabetic employees 2.0%. The mean frequency of sickness absences of diabetic employees was 0.89 times in the year 1996 (95% confidence interval (95% CI) 0.70 to 1.08), and of non-diabetic employees 0.56 times (95% CI 0.47 to 0.65), p=0.01. The mean total duration of sickness absence of diabetic employees was 31.71 days (95% CI 24.86 to 38.57), of non-diabetic employees 16.57 days (95% CI 11.72 to 21.42), p<0.01. Differences were also found in subgroups but the size of subgroups was not sufficient to detect significant differences.

CONCLUSIONS

The study confirmed that diabetes affects the ability to work. Appropriate work and good control of the disease are important to prevent long term complications.

Impact of diabetes on employment and income in Manitoba, Canada

OBJECTIVE

To compare employment and income of working-age (18-64 years) people with and without diabetes.

RESEARCH DESIGN AND METHODS

We conducted a prospective population-based cohort study based in Manitoba, Canada, consisting of 25,554 individuals without diabetes and 608 with diabetes, of whom 242 had a complication of the disease. Adjusted odds ratios (ORs) of employment and income variables were determined.

RESULTS

Diabetic individuals with complications were twice as likely not to be in the labor force (OR 2.07 [95% CI 1.49-2.87]) than nondiabetic individuals. This difference was not evident for diabetic individuals without complications (OR 1.20 [0.93-1.56]). Diabetic individuals without complications had incomes similar to those of nondiabetic individuals. The total income of diabetic individuals with complications was 72% of the income of nondiabetic individuals. When the analysis was limited to only those in the labor force, diabetic workers with complications still had only 85% the employment income of nondiabetic people. Diabetic individuals with complications received 58% more social support income. In a separate analysis of aboriginal individuals, complicated diabetes was not associated with an increased likelihood of not working or a decrease in employment income.

CONCLUSIONS

In general, complications of diabetes and the absence of the disease affect the ability to earn income in Manitoba, Canada. This effect was not identified in the aboriginal population of the province.

Coping with employment discrimination against diabetics: trends in social medicine and social psychology

In many European countries, social-medical aspects in the management of diabetes mellitus are not satisfactorily respected. Our contribution reports a study addressing the impact of diabetes on the patient's career and daily work, in order to determine the extent to which diabetics are being discriminated against at work. Type I diabetics were questioned about their experience, and not on the objective burden. A questionnaire was developed to evaluate patients' social and employment problems. Few elements of an education program for Type I diabetes optimizing social skills (social competence) are demonstrated. In a group of 6-8 patients, assertive behavior in the work place is modelled (e.g., for hypoglycaemia, social phobia) by applying psychological methods (behavior modification role-playing). These methods can help diabetic patients to master their discrimination. They learn assertive behavior in social situations with superiors and colleagues and develop self-confidence (self-efficacy). This special education program supports Type I diabetics in coping with employment discrimination.

Sickness absence in diabetic employees at a large engineering factory

It is not known whether employees who have diabetes mellitus lose more time from work due to sickness than non-diabetic employees. A study was undertaken to compare sickness absence in 91 diabetic with 91 non-diabetic employees matched for sex, age, and occupation. Although sickness absence was greater in the diabetic group this was not significant. Mean sickness absence for the diabetic employees and controls was 32 v 20 days/year (95% confidence interval -5 to 29 days). Because of the large variability in sickness absence in both diabetic and non-diabetic employees, a study of this size is probably not sufficiently powerful to detect a difference.

Education and employment for young people with diabetes

Educational achievements and employment experiences were examined using a postal questionnaire in a random sample of diabetic clinic attenders and non-diabetic control subjects aged 16-21 years, selected from 13 different centres in Great Britain. A response rate of 63% and 42% for diabetic and control subjects, respectively, was obtained. The diabetic group experienced a significantly greater number of health difficulties and problems at school (compared with their control group (21% vs 11%, p = 0.01) and there was a significant difference in perceived useful careers advice obtained at school for the two groups (5% vs 59%, p < 0.0001, diabetic and control groups, respectively). There was no difference in the number of General Certificates of Secondary Education (GCSEs) and Advanced (A) level qualifications obtained between the two groups. Of the young people who had left school, diabetic adolescents were significantly more likely to report having lost their jobs than their non-diabetic counterparts (19% vs 6%, p = 0.002). The diabetic group were also more likely to report that they were unable to do the job they wanted compared with the non-diabetic group (28% vs 16%, p = 0.005) and were more likely to report shift work problems (41% vs 12%, p = 0.04). With the increasing rate of unemployment it is important that youngsters with diabetes obtain specific diabetes-orientated vocational guidance in order to plan their careers and provision should be made for this in educational establishments.

Diabetes mellitus and employment: is there discrimination in the workplace?

The employment record of 102 diabetic workers (73 men, 29 women), identified in a cross-sectional survey of 5670 middle-aged people in a New Zealand workforce, was studied for evidence of discrimination in the workplace. Compared with 403 matched controls (292 men, 111 women), diabetic workers showed no significant differences in socioeconomic status, educational attainment, or distribution between occupational groups. Similarly, mean duration of current employment (12.3 vs 12.4 years), mean number of jobs in the past 5 years (1.25 vs 1.34 jobs), frequency of sickness absence, and mean number of hours worked each week (43.5 vs 43.3h) did not differ significantly between diabetic and non-diabetic groups. We found no significant differences in work stress, even among those diabetic individuals with poor blood glucose control. There was no convincing evidence across a broad spectrum of industry that diabetic workers did suffer discrimination in the workplace.

Diabetes mellitus and employment: survey of a New Zealand workforce

A cross-sectional survey of a 5670 multiracial New Zealand workforce aged > 40 years was used to determine the health status of people with diabetes mellitus in employment. One hundred and two workers (73 men, 29 women) had known diabetes mellitus (prevalence of 1.8%) of whom 91 individuals (89.2%) had Type 2 diabetes. Mean age of diabetic workers was 51.1 +/- 5.6 (SD) years and median duration of disease was 5.0 (range 0-51) years. Most subjects were asymptomatic, although only 31.4% of diabetic workers had fasting glucose concentrations and 35.5% had fructosamine concentrations within the mean +/- 2SD range of a matched control group. Moreover, 22.5% of diabetic participants had fasting hypertriglyceridaemia and 21.6% had microalbuminuria. Ethnicity (non-European vs European) and lack of insulin therapy were the most important predictors of poor glycaemic control. We advocate more aggressive therapy with insulin and with culturally sensitive education programmes to avert long-term macrovascular complications.

Diabetes in the workplace. Employment experiences of young people with diabetes mellitus

OBJECTIVE

To assess some of the employment experiences of people with diabetes mellitus and to compare their experiences with those of a non-diabetic sibling control group.

DESIGN

A questionnaire about employment experiences was administered to diabetic subjects aged 16-39 years, and an abbreviated questionnaire was administered to their eligible siblings.

SETTING

The Illawarra area of New South Wales.

PARTICIPANTS

The names of diabetic subjects were obtained from the Illawarra diabetes register.

RESULTS

Interviews were conducted with 184 of 226 (81.4%) eligible diabetic subjects and with 70 eligible siblings. There were no significant differences between the diabetic subjects and their siblings with respect to educational achievements and rates of employment. Siblings reported a mean of 2.6 days sickness absenteeism in the year prior to the survey. Diabetics were absent from work for a mean of 4.5 days for reasons not related to their diabetes and for a mean of 2.6 days for diabetic causes. Within the diabetic group, 50% felt that having diabetes would make it more difficult to find another job, 33.7% felt that diabetes would influence their search for alternative employment and 19.6% felt that at some stage they had been refused employment because of their diabetes. Fifteen per cent of diabetics were aware of an example of discrimination and 24.2% of diabetics in employment had at some stage tried to hide their diagnosis from their employer.

CONCLUSIONS

Diabetics do not appear disadvantaged compared with their siblings with respect to employment participation but are more likely to be absent from work due to sickness. However, many diabetic subjects had experienced a job refusal, had tried to hide their diagnosis from employers, were aware of examples of discrimination and were very negative about future employment prospects.

Is diabetes always diabetes?

Diabetes is always taken to be a life-long diagnosis. In order to re-examine this question, 75 g glucose tolerance tests (OGTT) were performed twice on 37 previously confirmed diabetic patients (mean duration of diabetes of 4.6 years; range 1-15 years) with normal glycosylated haemoglobin levels on regular review. Weight loss since institution of a healthy diet was 7.6 +/- 4.8 kg (+/- SE). Normal glucose tolerance was found in 27% of patients and impaired glucose tolerance in 21% with no significant change on rechallenge. HbA1 was 6.3 +/- 1.5% (+/- SD) (normal < 7.5%) in patients with normal glucose tolerance compared to 7.0 +/- 0.9% (+/- SD) in those with impaired glucose tolerance, P < 0.05. The response of the OGTT in these patients varied with dietary intake and weight. Such individuals could be regarded as having perfectly controlled diabetes or alternatively to have been cured. The definition of diabetes should be reviewed to allow people to escape the diagnosis where permanent change in dietary habits is established.

The attitude of employers to people with inflammatory bowel disease

Many patients with inflammatory bowel disease are anxious about their future prospects of employment. Personnel managers at 61 major national and 136 principal local employers in Leicester and Cardiff were asked to provide details about their attitude to people with inflammatory bowel disease and the type of health care they offer to employees. Over one million people were employed by these companies. A poor response rate of 27% suggested at best disinterest in the subject on the part of employers. In those who did reply the attitude to people with inflammatory bowel disease was often positive, although up to a quarter (25%) would not continue to employ people if they developed these conditions and many (30%) would not provide time off work to attend hospital clinics. Only 60% of respondents would consider providing lighter duties to affected employees. In general there is a surprisingly negative attitude to promotion of people with chronic diseases such as epilepsy, multiple sclerosis or liver disease. This seems less so in inflammatory bowel disease.

Who joins the BDA?

A comparison of demographic and clinical characteristics was made between a random sample of members and non-members of the British Diabetic Association (BDA) of working age (17-65 years) who responded to a questionnaire concerning their employment. There were large regional variations in BDA membership, but overall 27% of responders were BDA members. Of the responders, BDA members were more likely to be women than men (30 vs 25%, p = 0.04) and under rather than over the age of 36 years (38 vs 21%, p less than 0.001). A greater proportion of insulin-treated patients with diabetes were BDA members compared with patients who were not treated with insulin (37 vs 13%, p less than 0.001). Unemployment was significantly less amongst BDA members compared with non-members (12 vs 20%, p less than 0.001). Membership decreased with decreasing social status, with significantly more house-owners being BDA members compared with those living in rented accommodation (31 vs 23%, p less than 0.001).

Disability and diabetes

Little work has been carried out on diabetes and disability. A questionnaire survey on the employment of people with diabetes aged 17-65 years was carried out in the UK. Data were also collected from a questionnaire sent to a random sample of employers. A comparison between those diabetic patients registered as disabled and those not so registered showed that men were more likely to be registered than women. The disabled group were also older, lower down the social scale, more likely to rent their house, to have left school before the age of 17 years, and to live in the north of the country. Significantly fewer disabled patients were currently working compared with those not registered as disabled (30% versus 65%, p less than 0.0001). Registered disabled patients who were working were no more likely to report having more than 20 days off sick in the last year compared with those patients not registered as disabled (7% versus 9%). Employers did not report adverse sickness absence rates for their registered disabled diabetic patients. People with diabetes who are registered as disabled can make good employees in a range of different occupations. Registering as disabled may improve employment opportunities for people with diabetes who are finding difficulty in obtaining suitable employment.