Type 2 Diabetes
Dr. Alain Sotto, Hon. B.Sc., M.D., CCFP (E.M.), F.C.B.O.M.
bh in Brief
Dr. Alain Sotto, Hon. B.Sc., M.D., CCFP (E.M.), F.C.B.O.M. is Occupational Medical Consultant for the Toronto Transit Commission, Director of Medcan Wellness Clinic and Investigative Coroner for York Region. He is also Chief Health and Wellness Physician, RRJ Investments Inc. In addition to serving on the Advisory Council to AstraZeneca’s motivactionTM he is a member of the Advisory Board of the 2015 Edition of The Sanofi Canada Health Care Survey.
*Type 2 or adult onset diabetes differs from type 1 or childhood diabetes which is an inherited, lifelong condition that begins in childhood and is managed, but not cured, with insulin.
1 One Adult in Ten Will Have Diabetes by 2030. Press Release. International Diabetes Federation. 14 November 2011. Available:
2 ROI of One Life: Diabetes, p.6. Available:
3 Sanofi Canada Health Care Survey, 2015, p. 30. Available:
4 US Preventive Services Task Force. 2008. Diabetes Mellitus (Type 2) in Adults: Screening. Available:
5 See Figure 1 adapted from Ten Leading Causes of Death, Canada, 2011, Statistics Canada.
6 Baicker, Katherine, David Cutler & Zirui Song. 2010. Workplace wellness program can generate savings. Health Affairs 29(2): 304-311. Abstract:
7 See Figure 2, The Employer's 4 Es Response
Dr Alain Sotto is an occupational physician who focuses on the prevention and management of illness, injury or disability that is related to the workplace. He currently has a particular focus on type 2 diabetes* and is a member of the Advisory Council to AstraZeneca’s new workplace health management approach and research initiative, motivactionTM .
1. Why should employers be concerned about diabetes?
Employers should be concerned about diabetes because of its power to influence productivity in their workplace, not just today but far into the future. Globally, the World Health Organization reports that three new cases of diabetes are diagnosed every 10 seconds.1 In Canada, one in three Canadians will have diabetes, pre-diabetes or undiagnosed diabetes by 2020.2 The human and financial costs are staggering. The value of early detection and effective treatment is obvious: a study of the Alberta School Employee Benefit Plan found that over 20 years, a plan member with reasonably well-managed diabetes cost the plan about $30,000, while the cost for a member with poorly managed diabetes ballooned to more than $550,000.3The full costs, however, are higher and include, in addition to drug utilization, the toll taken by short- and long-term disability leaves, failure to pass fitness for duty assessments in safety control occupations, and presenteeism in a range of situations.
2. Are standard approaches, like focusing on diet and weight reduction, working?
Yes, standard approaches do work. The causes of type 2 diabetes are obesity (what I call “diabesity”) and physical inactivity. Well known studies in the United States and Finland have shown that 58% of participants resolved their type 2 diabetes by reducing their weight by at least 5-7% with diet and exercising at least 150 minutes per week.4 Type 2 diabetes is reversible and preventable. Further, when they know what can be done, employers – and employees – can take personal responsibility and start to change. They can set goals, take action and, most important, expect success.
3. What does the research tell us about other approaches?
In addition to assessing standard approaches to treatment, research is also helping us understand the complexity of diabetes. As the condition advances, complications arise that are often more costly and life-threatening than the diabetes itself. Potential complications include high blood pressure, heart attacks, strokes and other aspects of cardiovascular disease (CV), retinal disease, neuropathy, kidney disease and depression. For example, a new study at AstraZeneca has shown that a high percentage of the costs associated with diabetes actually reflect the presence of mental health issues. Also, 80% of people with diabetes die of CV. In 2011 diabetes contributed to 3% of all deaths in Canada according to the Public Health Agency of Canada.5
4. How will these research findings influence workplace strategies?
Research findings clearly point the way to strategies for ensuring that employees are healthy and productive, something they can’t be if they have diabetes or are pre-diabetic. The answer is to establish screening programs to identify disease early, before it develops, and certainly, before costly complications arise. The screening itself is relatively inexpensive. Studies show that preventive activity saves $3.27 for every $1 spent.6 That’s not a cost, but an investment in health and productivity that increases employee engagement and preserves the workforce. It builds human capital.
5. What steps can employers take now?
Employers can begin to address type 2 diabetes in the workplace by recognizing that it is both preventable and reversible. With those goals and the prospect of success in view, employers can start by following my 4Es:
Educate – to make employees aware.
Engage – to persuade employees to “own” their own health, especially “diabesity.”
Empower – to ensure employees change their trajectory and enjoy better health.
Enable – to provide employees with the right tools – diet, screening, treatment, health coaching.7 bh