Diabetes and Employment

Uncomplicated diabetes does not require any adjustment regarding employment, but those with complications should undergo detailed assessment to determine safety and effectiveness to perform duties. Though there is no such guidance in India, the American Diabetes Association (ADA) adopted a position statement that any person with diabetes, whether insulin treated or non-insulin treated, should be eligible for any employment for which he/she is otherwise qualified. Patients suffering from diabetes should be assessed individually, and after reviewing medical and treatment history, medical fitness to the job should be assigned. Maintenance of proper medical documentation and use of screening guidelines are a must. For this to be implemented properly, one needs state and national laws. A health care professional (HCP) treating the employee though preferred should have expertise in treating diabetes. If there is a disagreement between the opinions of physicians, an independent opinion from a HCP with clinical expertise in diabetes should be taken. An employer should not enquire about an employee’s condition till a job has been offered and can only do so if it is not safe or poses a threat to his health and also if expert opinion and medical documentation suggest so. Screening guidelines, though not used in India but regularly used in Western countries, can be used in evaluation. Safety risks should be assessed individually—recurrent hypoglycemia, not a single episode, may pose a risk whereas hyperglycemia and chronic complications though may not pose immediate risk should be assessed separately. Periodic safety assessments should be done. Jobs requiring operating firearms or running dangerous machinery may have safety concerns with patients having severe hypoglycemia or those on insulin or secretagogues. Hypoglycemia usually can be effectively prevented or self-treated by ingestion of glucose. Severe hypoglycemia requiring assistance may pose a risk; even if it is a single incidence, one has to be followed up properly and investigated to find out its cause. In recurrent severe hypoglycemia, as episodes cannot be explained, it is a risk for the employee himself as well as the public. Hyperglycemia leading to chronic complications is only relevant when it interferes with the performance in actual jobs. Self-monitored blood glucose measurements over a period of time give actual information and should be evaluated by a HCP with expertise in diabetes. Multiple incidents of severe hypoglycemia may pose a problem in high-risk occupations, and the factors responsible should be properly evaluated. Hypoglycemia unawareness increases the risk of a sudden episode of severe hypoglycemia and should be treated with changes in diabetes management. Chronic complications may pose a risk in some jobs, but if not present, possible future development should not be taken into consideration. The tools that do not accurately reflect the current state of diabetes like urine glucose and HbA1C should not be used. The term uncontrolled diabetes should also not be used as it is not well defined. A few accommodations are required at a job for diabetes patients to be able to perform their work responsibilities effectively and safely: testing blood glucose at regular intervals, administering insulin as and when required with proper storage facilities, access to snacks, and a flexible work schedule to accommodate needs and modifications if required for chronic complications.