People suffering from diabetes can be found at workplaces. These individuals do not want their disease to interfere with their everyday lives or careers, and with proper disease management, they can and will continue to be productive members of the workforce. Employees with diabetes can have an impact on your company. It can cause increased health care costs and hamper productivity if the disease is not properly managed. However, it is important for employers to avoid discriminating against employees with diabetes. By providing diabetes management education and support for your employees, you can help them manage their conditions and remain productive workers.

Types of Diabetes

Type 1 diabetes:

• Usually diagnosed before age 30.
• Pancreas produces little or no insulin, so the body cannot control the amount of sugar (glucose) in the blood.
• Type 1 diabetes sufferers take insulin and monitor their blood sugar, eat healthy foods and engage in regular physical fitness to control blood sugar levels.

Type 2 diabetes:

• Usually diagnosed after age 40.
• Pancreas produces insufficient amounts of insulin and/or the body cannot use the insulin to control blood sugar levels.
• Managed by eating healthy foods, engaging in regular physical fitness, taking medication and monitoring blood sugar levels.

Gestational diabetes:

• Pregnant women can develop gestational diabetes when blood sugar becomes elevated because their bodies cannot produce enough insulin or cannot use insulin properly.
• Managed similar to Type 2 diabetes.

The Employer’s Role

Since diabetic employees need education to manage their disease, you can take an active role to help in their efforts. Here are some easy yet effective ways to assist your diabetic employees:

• Create a supportive work environment so that employees feel comfortable performing behaviors to manage their condition (taking insulin shots or monitoring blood sugar).
• Provide opportunities for all employees to live healthier lifestyles to reduce the risk of developing chronic conditions such as diabetes.
• Provide healthy food options at employee functions.
• Educate employees on prevention and early detection methods.
• Increase awareness of blood sugar management.
• Offer high quality medical care and educate your employees on the care that they have at their disposal by outlining their covered benefits, services and supplies provided to control their disease.
• Promote blood sugar management techniques for diabetic employees to control blood glucose levels. This will improve their quality of life and will reduce health care costs.

ADA Implications The Americans with Disabilities Act (ADA) is a federal law that prohibits discrimination against individuals with disabilities. Since an employee with diabetes may be considered disabled under the ADA, employers need to understand their rights and obligations under the ADA. Under Title I of the ADA, qualified individuals with disabilities are protected from discrimination in the job application process; in hiring, firing, advancement, compensation and job training; and in other terms, conditions and privileges of employment. Employers are also required to provide reasonable accommodations to qualified individuals with disabilities, provided that the accommodations do not impose an “undue hardship” on the employer’s business.

By providing diabetes management education and support for your employees, you can help them manage their conditions and remain productive workers.

When is diabetes considered a disability?

The determination of whether a person has a disability under the ADA is made on a case-by-case basis. Diabetes is a disability when it substantially limits one or more of a person’s major life activities, or if the diabetes was substantially limiting in the past. Major life activities are activities that an average person can perform with little or no difficulty, such as working, caring for oneself and walking. Diabetes could also be a disability when it causes side effects or complications that substantially limit a major life activity. Finally, a person could be considered disabled if an employer simply treats a person as though diabetes substantially limits his or her major life activities.

When may an employer ask an applicant questions about his or her diabetes?

During the application stage, an employer may not ask questions about an applicant’s medical condition or require a medical examination. In the event an applicant voluntarily tells an employer about his or her diabetes, an employer may only ask whether the applicant needs a reasonable accommodation and what type of accommodation is necessary. Once a job offer is made, an employer may ask questions about an applicant’s health and may require a medical exam. However, the employer must treat all applicants the same. The fact that an applicant has diabetes may not be used to withdraw a job offer if the applicant is able to perform the essential functions of the job, with or without reasonable accommodation, and without posing a direct threat to safety.

When may an employer ask an employee questions about his or her diabetes?

An employer may ask an employee questions or require a medical exam only if the employer has a legitimate reason based on objective medical evidence to believe that diabetes or another medical condition may be affecting an employee’s ability to do his or her job, or that the employee is a direct threat to safety. An employer may also ask about diabetes when an employee requests a reasonable accommodation because of his or her diabetes, or if the employee participates in a voluntary wellness program that focuses on early detection, screening and management of diseases such as diabetes. In general, an employer may only use the information provided by the employee to make reasonable accommodations or to determine whether the employee is a direct threat to safety.

What is a reasonable accommodation for an employee with diabetes?

Accommodations will vary depending on the person. The ADA requires employers to provide modifications requested by employees unless doing so would be a significant difficulty or expense. The employer should ask the employee what they need to help do their job. Accommodations for diabetic employees may include:

• A private area to test blood sugar levels or take insulin
• A place to rest until blood sugar levels become normal
• Breaks to eat or drink, take medication or test blood sugar levels
• Leave for treatment
• Modified work schedules or shift changes

An employer does not have to provide the most difficult or the most costly accommodation if there is an easier or less costly way to meet an employee’s needs. The website for the Job Accommodation Network (http://janweb.icdi.wvu.edu/media/diabetes.html) provides accommodation ideas for employees with diabetes.

Can an employer disclose that an employee has diabetes?

An employer must keep any medical information that it learns about an applicant or an employee confidential. However, there are limited exceptions:

• Disclosure to supervisors that an employee has diabetes, to provide a reasonable accommodation or to meet an employee’s work restrictions
• Disclosure to first aid and safety personnel if an employee needs emergency treatment or some other assistance
• Disclosure to individuals investigating compliance with the ADA and similar state and local laws
• Disclosure when needed for workers’ compensation insurance purposes, such as for processing claims

Real-life Example

According to the Wisconsin Diabetes Prevention & Control Program, a division of the Department of Health Services, diabetes management programs are effective in the workplace. A 12-week study of 569 male employees who had Type 2 diabetes revealed these results:

• Employees who had assistance managing their diabetes were more productive on the job and able to remain employed longer than those who did not manage their blood sugar levels.
• The lost earnings from absenteeism were estimated at $24 per employee per month for those who had assistance managing their blood sugar levels versus $115 per employee per month for those who had uncontrolled blood sugar levels.
• Employees with assistance had fewer instances of needing bed rest and restricted activities than those who did not have diabetes management assistance.