A. Diabetes Impact on Drug Plan Costs

Benefit plan diabetes drug spend is usually one of the first areas of concern for plan sponsors. This is just the tip of the iceberg in terms of costs, says Clarke. “Underneath the surface, there are a multitude of associated hard and soft costs to the organization, including increased absenteeism and presenteeism, and reduced productivity.”

According to TELUS Health, diabetes drugs were the second most costly therapeutic class for employee benefit plans, accounting for 11.4% of costs and 7.5% of claims in 2020.26 Claimants with diabetes take an average of seven medications for an annual cost of $3,020, and approximately half of the costs are attributable to drugs to treat diabetes.27 Over the past five years, the total eligible cost of drugs and supplies to treat diabetes grew 12.9%. This, in part, is attributable to the 7.5% growth in the number of claims and 5.1% increase in the number of claimants.²⁸

The significant impact of diabetes on drug costs may be attributable to the increasing prevalence of diabetes in Canada; however, it may also be due to poorly managed diabetes.

B. Workplace Impact of Hypoglycemic Events

Studies have shown that hypoglycemia costs employers $850 annually per person with type 1 diabetes, due to reduced work productivity. When a hypoglycemia event occurred at work, 18% of people left work early or missed a full day, or 9.9 hours of work per month. A nocturnal hypoglycemia event resulted in 23% of people arriving late or missing a full day of work, or 14.7 hours of missed work per month.²⁹

C. Mental-Health Impact of Diabetes

i. Depression³⁰

People with diabetes are twice as likely to experience depression, which can lead to worsened blood glucose levels and diabetes complications.

ii. Diabetes Distress^{31, 32, 33, 34}

Approximately 40% of people with type 1 diabetes experience diabetes distress, which is the mental burden and negative emotion of living with and managing diabetes. It is different from depression because people don’t have these feelings about other parts of their life; however, diabetes distress can turn into depression if these feelings last for an extended time.

“Stress plays a huge part in managing diabetes,” says Nicole Pelcz, who lives with type 1 diabetes. “Increased levels of stress for extended periods of time can lead to insulin resistance, which makes it more difficult for the body to keep blood glucose levels in range.”

iii. Diabetes Burnout^{35, 36}

Long-term diabetes distress can lead to diabetes burnout. At first, people with diabetes may feel frustrated and exhausted by the daily management of diabetes, and if they don’t resolve their negative feelings, they begin to change their behaviour. They may no longer be motivated to follow their diabetes management plan and may stop taking care of themselves and their diabetes.

iv. Diabetes Stigma^{37, 38, 39, 40}

“Perceived diabetes stigma can cause disempowerment, increased psychological distress and poor outcomes,” notes Krisel Quiambao, a Registered Nurse, Certified Diabetes Educator and the director of clinical services, Ellerca Health Corp., a digital health firm focused on supporting chronic disease management. “It’s important that communication related to diabetes is neutral, objective and non-judgmental and that employers fight stigma related to diabetes in the workplace.”

Most people with diabetes say they’ve been stigmatized, blamed or shamed for having the condition, which can lead to far-reaching consequences. The resulting guilt, shame and self-stigma can contribute to diabetes distress or compromising self-care and ultimately poorer health outcomes. Diabetes stigma is primarily due to a lack of understanding, negative stereotypes, and myths and misconceptions, which result in misplaced judgment, blame and disrespect toward people with diabetes. Education and awareness are the best ways to fight stigma. Those dealing with guilt and self-stigma may benefit from access to mental-health professionals who can help them perceive themselves and their diabetes in a more positive way.