The Plan Sponsor's Guide to Diabetes

Why this guide exists. In the United States, 37.3 million people, about 11.3% of the population, live with diabetes. Managing a complex chronic condition while juggling work, family, and finances is hard, and the workplace plays an outsized role in whether people succeed. This guide translates the clinical picture of diabetes into terms that insurers, plan sponsors, and employers can act on.

Diabetes basics

Diabetes is a group of metabolic conditions in which genetic and environmental factors drive the progressive loss of pancreatic β-cells or rising insulin resistance, clinically producing hyperglycemia. Left untreated, high blood glucose can cause nerve damage, kidney damage, heart attack, stroke, peripheral vascular disease, cataracts, and vision loss. Ongoing lifestyle modification and disease-management education are vital to preventing acute and long-term complications.

The main types:

• Type 1: autoimmune destruction of β-cells leading to absolute insulin deficiency.
• Type 2: progressive loss of β-cell insulin secretion driven by insulin resistance; accounts for 90% to 95% of all diabetes.
• Gestational: diagnosed in the second or third trimester; affects roughly 2% to 10% of U.S. pregnancies annually.
• Prediabetes: glucose higher than normal but below the diabetes threshold; an estimated 96 million U.S. adults had prediabetes in 2019.

The workplace impact

Diabetes carries a considerable financial burden. The global cost in 2017 was $760 billion, projected to reach $845 billion by 2045. In the U.S., diabetes medications represent 43% of the total medical burden, including roughly $15 billion for insulin, $15.9 billion for other antidiabetic medications, and $71.2 billion for treating complications.

For employers, type 2 diabetes costs an estimated $7,000 per employee per year in reduced productivity and missed work. Medical costs roughly double ($11,354 versus $5,101) and drug-plan spending runs about three times that of other claims ($4,182 versus $1,189).

For employees, rising out-of-pocket costs outpace wage growth, leaving less for necessities and making it harder to follow a treatment plan. As United Healthcare’s Dr. Ana Stankovic put it, “A tremendous burden is placed on employees to manage their diabetes in the face of comorbidities and high costs.”

The mental-health dimension

A largely overlooked obstacle to glycemic control is mental health.

• Depression: lifetime rates in type 2 diabetes run 24% to 29%, and depression is linked to poorer diabetes control and worse outcomes.
• Diabetes distress: 38% to 45% of adults with diabetes report moderate distress, often tied to balancing work and disease management.
• Diabetes stigma: blame, judgment, and feeling treated differently can feed distress and undermine self-care.

Managing diabetes, and supporting it at work

A diagnosis begins a lifelong relationship with the health-care system and a demanding set of daily management tasks, what many patients describe as “more than a full-time job.” Innovations in monitoring (such as continuous glucose monitoring) and structured diabetes education can ease that load, and plan sponsors can amplify their effect through benefit design, coverage decisions, and a supportive workplace culture.

The plan sponsor’s role

Insurers, plan sponsors, and employers sit at a leverage point: thoughtful formulary and benefit decisions, access to education and monitoring tools, and a stigma-free environment can measurably improve outcomes while controlling cost. The guide closes with a practical checklist for sponsors looking to act.

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Written by Heba Azzam as a medical writer at HMP Global for an Abbott-sponsored market-access program. This is a readable adaptation; the fully designed guide is available as a PDF above. Product and safety information and full references appear in the original publication.