[Diabetes screening and prevention in a large chemical company]

INTRODUCTION

Diabetes is with 6 million cases in Germany one of the most common and most expensive chronic diseases. Studies presume a high number of unreported cases. Early detection of diabetes with a specific screening method is very important. In Germany family physicians offer a preventive check-up starting at the age of 35 years but only 19% males participate. From this background the BASF department for Occupational Medicine and Health Protection introduced for all 35.000 employees at the headquarter, in Ludwigshafen a general health check focused on the early detection of lifestyle diseases.

METHODS

From April 2011 to June 2013 12.114 employees participated in the general health check offered by the medical department (2.530 women, 9.584 men). All participants filled out a questionnaire named "Findrisk" a scientifically validated questionnaire which focuses on risk factors for diabetes. Furthermore, the blood glucose and the HbA1c of the participants have also been checked in a laboratory test

RESULTS

Following the Findrisk criteria the results are: 1.368 employees had an elevated risk of 17%, 854 employees a risk factor of 33% and 131 employees a risk factor of 33%. In 1.533 employees (13,2% of all participants) we diagnosed a prediabetes with an elevated HbA1c-parameter between 5.7 to 6,4%. In 243 employees a manifest diabetes disease with HbA1c of > than 6,5% was diagnosed.

DISCUSSION

We found out that diabetes prevention within the workplace setting is helpful to detect prediabetes and diabetes earlier than family doctors outside the company are able to do.Occupational physicians have the opportunity to inform the employees on risks for lifestyle diseases at an early stage when they are still healthy (primary prevention).For secondary prevention surveillance and clearance examination can be easily combined with screening tests for diabetes. For further diagnostics and therapy the family doctors will be addressed. This system helps individuals to prevent negative health effects, it helps the employer to reduce incapacity time and it also helps the state health system to safe money for therapy and rehabilitation.

[Early detection of bowel cancer in occupational surveillance examinations: switching from a guaiak-based to an immunochemical fecal occult blood test]

BACKGROUND

If the diagnosis is made early the cure rate of bowel cancer is more than 90 %. Occupational preventative medical care required by law and carried out by company physicians can be supplemented by a medical consultation and by simple screenings to interest employees in cancer prevention and refer them to registered general practitioners and specialist doctors for further diagnosis and treatment.

SUBJECTS AND METHODS

Since 2001, BASF SE in Ludwigshafen, Germany offers its employees aged 45 and more a program to detect intestinal cancer early. The employees receive personal invitations for this program once a year. The participants answer a standard questionnaire about risk factors for bowel cancer and an endoscopic diagnosis, if this has already been carried out, and receive a FOBT. Since 2010 an immunological test system was used. We compare the results from two consecutive years with a Guajacum test system (g-FOBT) and an immunological test (i-FOBT). The German Association of Digestive and Metabolic Diseases, DGVS, recommends a colonoscopy if test results are positive or a family member has suffered from bowel cancer.

RESULTS

Between 2008 and 2011, a total of 52,797 invitations were sent to employees aged 45 and over. Overall, 16,730 men (37.7 % of 46,245) and 1,585 women (24.4 % of 6,552) took part (in some cases more than once). The return rate of the FOBT increased from 66.7 % in 2008 to 79.5 % in 2011. Due to positive results and/or suspicious information in the questionnaire, 2,441 colonoscopies were recommended, 849 of them because of a positive FOBT. The medical department was informed of 224 endoscopy diagnoses. In 8 cases, manifested cancer (6 × colon, 2 × rectum) and in 57 cases adenomatous polyps were diagnosed as preliminary stages of cancer. Most of these diagnoses were made using the i-FOBT, the simultaneous increase in positive test results and therefore more frequent recommendations for a colonoscopy.

CONCLUSION

The additional offer of a program for early detection of bowel cancer as part of an occupational surveillance examination helps detecting bowel cancer early in employees who show no symptoms. Since men on average fall ill earlier, it makes sense to offer these tests at the age of 45.  Personal invitations lead to consistently high participant rates and the simplicity of the i-FOBT leads to high return rates of tests. The rate of positive test results is higher compared to g-FOBT. In our follow-up, significantly more intestinal cancer and possible preliminary stages were detected through screening with the immunological test.

Darmkrebs-Vorsorge im Betrieb

BACKGROUND AND OBJECTIVE

The annual incidence of colorectal cancer in Germany is estimated at 27000 in men and 30000 in women. If the diagnosis is made early the cure rate is over 90%. Against this background the department of occupational medicine and health protection of the BASF Aktiengesellschaft initiated a study on the potential prevention of colorectal cancer among the staff at its Ludwigshafen site.

SUBJECTS AND METHODS

The target group included all 13265 actively working employees aged 45 years or above. Those expressing interest were given a standardized questionnaire concerning risk factors for colorectal cancer and a test for occult fecal blood (FOBT). If the test was positive and/or a positive answer was given to the question on blood in the stool or on a positive family history, coloscopy - to be arranged via the general practitioner - was advised, in line with the recommendations of the German Society of Digestive and Metabolic diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselerkrankungen).

RESULTS

At the end of the study 3732 employees (337 women, 3395 men, mean age 52 years) had completed the questionnaire and the FOBT results were available. Coloscopy was recommended to 688 employees, 323 of whom (47%) underwent the investigation. Nine of the subjects already had manifest cancer, six of them in the early stage T1 or T2. Adenomatous polyps were found in an additional 61 and subsequently excised. Cost-benefit considerations at the company level or in the area of the health system, respectively, gave favourable ratios of 1:10 and 1:14.

CONCLUSION

It requires considerable expenditure to increase the number of participants in the cancer prevention programme and obtain a consequent clarification of suspicious findings. Health care within a company is a valuable complementation in Germany of medical care provided by general practitioners or specialist, if close cooperation between practitioners in the given region is assured. Initiatives like the one presented here protect people personally affected against pain and distress and are also of economic value.