Workplace Interventions to Prevent Type 2 Diabetes Mellitus: a Narrative Review

Abstract

Purpose of review This study aims to summarize the recent peer-reviewed literature on workplace interventions for prevention of type 2 diabetes mellitus (T2DM), including studies that translate the Diabetes Prevention Program (DPP) curriculum to workplace settings (n = 10) and those that use different intervention approaches to achieve the specific objective of T2DM prevention among employees (n = 3). Recent findings Weight reduction was achieved through workplace interventions to prevent T2DM, though such interventions varied substantially in their effectiveness. The greatest weight loss was reported among intensive lifestyle interventions (i.e., at least 4 months in duration) that implemented the structured DPP curriculum (n = 3). Weight reduction was minimal among less intensive interventions, including those that substantially modified the DPP curriculum (n = 2) and those that used non-DPP intervention approaches to prevent T2DM (n = 3). Most studies (n = 12) reported increased levels of physical activity following the intervention. Summary Implementation of the DPP in workplaces may be an effective strategy to prevent T2DM among employees.

The effectiveness of workplace health promotion interventions on physical and mental health outcomes – a systematic review of reviews

“…Although CBT is particularly applied to patients, these techniques were included in workplace health promotion interventions to target behavioral changes to promote (mental) health (22). CBT intervention has shown to be effective in the prevention and reduction of anxiety problems (25). From this preventive perspective and the focus on behavioral change to promote health, we considered this type of intervention eligible in this review.…”

“…With respect to the metabolic risk factors for T2DM and CVD, most reviews (14, 18, 20, 21, 24-33) evaluated the effect of workplace health promotion interventions on weight-related outcomes, such as body weight, body mass index (BMI), percentage of body fat, waist circumference. The remaining metabolic risk factors, such as lipid measures, blood glucose, and blood pressure were also studied in 5 reviews (14,18,(25)(26)(27). Defined by depression, anxiety or stress, mental health as outcome was studied in 6 reviews (17-20, 22, 34).…”

“…Main outcomes under study included body weight, body mass index (BMI), and body fat percentage. Except for 2 (25,26), all reviews evaluated studies that targeted the promotion of physical activity and/or healthy diet. These lifestyle behavior interventions however used different strategies, including individually-based approaches and environmental adjustments.…”

“…These lifestyle behavior interventions however used different strategies, including individually-based approaches and environmental adjustments. A broader approach, such as total worker health interventions in which both health protection and wellness were addressed, was evaluated in 2 reviews (25,26). All 3 high quality reviews (21,24,32) The remaining 11 reviews, which were of low quality, overall showed some evidence for beneficial effects on weight-related outcomes although some reported mixed results for different weight-related outcomes.…”

What should governments be doing to prevent diabetes throughout the life course?

“…• Set minimum standards for break times and outdoor equipment to increase physical activity levels [52] • Include a health subject called 'health' in (pre-) schools and continuously qualify the teachers [38] • Provide drinking water and low-cost/ free-of-charge healthy food [53] • Cooperate with local sports clubs in designing break time activities, physical activity lessons and afternoon care [54] • Improve access to eHealth devices for diabetes self-management [55] • Restrict advertisement of unhealthy food choices across the media spectrum [41,56] • Publicity intervention to increase awareness to promote earlier diagnosis of type 1 diabetes [57] • Implement binding quality standards and healthy food procurement for the catering tenders in (pre-)schools [41] • Restrict the advertisement of unhealthy products [41,54,56] • Implement fat and/or sugar taxes [56] and/or set smaller prices for healthier beverages (especially at school) [41] Working-age population • Implement the structured, evidence-based curricula like the Diabetes Prevention Program (DPP) [58] and monitor their effectiveness in different settings and target groups [59] • Include community awareness campaigning in national chronic disease and/or diabetes plans [61] • Offer (tax) subvention for companies who actively support their employees' health and support companies to develop and implement measures of operational health management [58] • Improve access to eHealth devices for diabetes self-management [55] • Include workplace interventions for individuals at risk [61] • Offer subvention of healthy food procurement for companies [59] Elderly • Develop structured care programmes, and increase frequency of educational sessions [62,63] • Continuously monitor the enrolment rates in interventions and effectiveness for specific subgroups of the population [64] • Strengthen eHealth literacy to increase access to digital health information [65] • Reduce or eliminate out-of-pocket costs for diabetes medication and self-monitoring supplies [66] The Interventions should, according to the authors, include regular counselling on dietary behaviour, such as the composition of a healthy meal (not more than 75...…”