ARTICLE
Published: October 30, 2024
Diabetes is one of the most common chronic diseases in the United States. Nearly 1 in 7 adults have the disease and 1.2 million are diagnosed with it every year.1,2 It’s costly as well. People diagnosed with diabetes account for $1 in every $4 spent on health care in the U.S. — and employers bear much of this financial burden.3 Now more than ever, helping employees successfully manage their diabetes is a workforce health imperative.
Diabetes is caused by the body’s inability to create or effectively use its own insulin — the hormone that regulates blood sugar. Without insulin, the body’s cells starve, dehydrate, and damage body tissue.
Traditionally, doctors advise people with diabetes to control their blood sugar by eating right, exercising, maintaining a healthy weight, and taking oral medicines or insulin. Doctors also advise doing A1c blood sugar testing at home. This involves placing a drop of blood on a test strip and inserting it into a blood glucose monitor. The person then keeps a record of their levels, and their care team uses this information to see if treatment needs to be adjusted.
Annual health care costs are $12,022 higher for employees with diabetes compared to their nondiabetic peers, and these costs are growing by close to 20% year over year.5, 6
Diabetes can often lead to more serious and costly health problems like kidney disease, heart failure, and stroke. For example, employers spend 252% more on health care for diabetic employees who develop kidney disease — to the tune of $68,325 per member per year.11 And when employees with type 2 diabetes develop heart disease, their health care costs increase by up to $9,705 per year.12
Traditional in-person medical care is essential in minimizing the impact of diabetes on both employee wellness and employer health care costs. But newer technologies like remote patient monitoring and virtual care have emerged as transformative diabetes care solutions with significant improvements in maintaining recommended blood sugar levels, or glycemic control, for type 2 diabetes.13 This is a key therapeutic goal because good glycemic control can prevent complications, which can reduce quality of life and life expectancy, and increase health care costs.14
Remote patient monitoring (RPM) connects employees to their care teams and transmits blood sugar level readings in real time. Using this data helps identify problems earlier, so doctors can adjust treatment faster — reducing both risk and cost.
Once on insulin, many employees transition from daily finger pricking to continuous blood glucose monitoring. This involves wearing a sensor where readings are more frequently recorded and uploaded to a reader or smartphone. With more regular glucose readings, the employee and their doctor can get better insight into how diet, exercise, or medications impact the employee’s glucose levels and if adjustments may be needed.
Dr. John P. Martin, who specializes in internal medicine and diabetes care at Kaiser Permanente, sees the benefits of remote patient monitoring, “Information that is quickly available is power, whether you're a patient trying to understand the impact of your own choices or a physician trying to make active changes to a patient’s care plan.”
Numerous studies show that employees who use remote patient monitoring for diabetes are better able to manage their blood sugar — reducing their average blood sugar levels, or A1c, by an average of 0.55.15 When you consider that healthy A1c goals for type 2 diabetics are between 7% and 8%, a 0.55 improvement is significant.16
In fact, one study found when employees with type 2 diabetes participated in remote patient monitoring:17
Successfully managing diabetes involves a collaborative effort between patients and their care teams. It’s important for employees to stay engaged with their treatment plans, including taking their medications, maintaining a healthy diet, exercising regularly, and monitoring their A1c levels. Frequent virtual care consultations can help bridge the gap between in-person visits and keep employees on track. “The bottom line is that patients need to be proactive,” Dr. Martin explains. “If their blood sugar is seriously out of range and they need help, virtual care is a resource they can use to get assistance 24/7.”
Virtual care enables employees to access care without needing to travel to a physical location. Studies show a 50% increase in continuity of care when employees with diabetes use virtual care.18 And virtual care visits were associated with lower odds of uncontrolled type 2 diabetes compared with in-person only visits.19
Employers are in a great position to support employees who have diabetes by encouraging healthy behaviors and providing access to remote patient monitoring and virtual diabetes care.
Share resources to help your employees prevent and manage their diabetes. Work with your health care partner to promote the availability of remote patient monitoring and virtual care to employees.
Employees who struggle with affording internet access are unable to use remote patient monitoring and virtual care. Research shows 1 out of 5 households don’t have home internet service because they say they can’t afford it.20 To overcome these financial barriers to internet connectivity, businesses should consider offering a stipend or subsidy toward the cost of a monthly broadband subscription. In addition, consider subsidizing copays to make devices more accessible for all employees.
In the workplace, consider designating a private space with secure internet so employees can engage in virtual care visits or upload clinical information for remote monitoring during their workday. In Dr. Martin’s view, “Employers can support employees’ needs for regular follow up with their care teams by providing time, and a space for employees to get care virtually.”
The ideal health care partner will offer integrated remote patient monitoring and virtual care tools embedded in their diabetes care program that captures employee health data in an electronic medical record. This integrated care approach helps employers avoid expensive point solutions and enables care teams to actively support employees, leading to greater adherence to their care plans.
It’s critical that employers make integrated telehealth capabilities for diabetes management a part of their workforce health and wellness strategy. As Dr. Martin sees it, remote patient monitoring and virtual care “allows patients to stay healthier in the immediate sense and enables their physicians to minimize the risk of diabetes complications, which could have prolonged impact on the patients’ ability to work and be productive.”
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John P. Martin is the co-lead for Diabetes Complete Care for the Southern California Permanente Medical Group, as well as serves as the subject matter expert for the Kaiser Permanente Diabetes National Clinical Practice Guidelines. In addition, he is the physician leader for Health Equity and Care Quality for the Kaiser Permanente Los Angeles Medical Center, where he serves as a primary care internist for a panel of primarily Spanish speaking patients in the East Hollywood area.
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Footnotes:
1cdc.gov
2diabetes.org
3Parker et al., “Economic Costs of Diabetes in the U.S. in 2022,” Diabetes Care, January 2024.
42024 Large Employer Health Care Strategy Survey, Business Group on Health, 2023.
5See note 3.
6Paige Minemyer, “Here's How Much Diabetes Costs Employers Each Year,” fiercehealthcare.com, accessed September 6, 2024.
7See note 6.
8See note 6.
9Park et al., “Productivity Loss and Medical Costs Associated With Type 2 Diabetes Among Employees Aged 18 – 64 Years With Large Employer-Sponsored Insurance,” Diabetes Care, 2022.
10See note 9.
11See note 6.
12Thomas R. Einarson et al, “Economic Burden of Cardiovascular Disease in Type 2 Diabetes: A Systematic Review,” Value in Health, July 2018.
13Stephanie S. Crossen, “Challenges and Opportunities in Using Telehealth for Diabetes Care,” Diabetes Spectrum, February 15, 2022.
14Saud A Bin Rakhis, Sr. et al., “Glycemic Control for Type 2 Diabetes Mellitus Patients: A Systematic Review,” Cureus, June 21, 2022.
15Puikwan A. Lee et al., “The Impact of Telehealth Remote Patient Monitoring On Glycemic Control In Type 2 Diabetes: A Systematic Review and Meta-analysis of Systematic Reviews of Randomised Controlled Trials,” BMC Health Services Research, June 26, 2018.
16Monique Tello, MD, MPH, “Rethinking A1c goals for type 2 diabetes,” Harvard Health Blog, October 27, 2020.
17Tzeyu L. Michaud et al., “Remote Patient Monitoring and Clinical Outcomes for Postdischarge Patients with Type 2 Diabetes,” Population Health Management, September 26, 2018.
18Wesley Peng, “Using Novel Telemedicine Interventions to Tackle the Diabetes Epidemic Crippling the Navajo Nation in the Southwestern United States,” Brown Undergraduate Journal of Public Health, May 2, 2023.
19Julianne N. Kubes, “Differences in diabetes control in telemedicine vs. in-person only visits in ambulatory care setting,” Preventive Medicine Reports, December 2022.
20Michelle Cao et al., “Switched Off: Why Are One in Five U.S. Households Not Online,” ntia.gov, October 5, 2022.
