Miriam E Tucker

September 16, 2015

STOCKHOLM — Hyperglycemia after eating is interfering with work productivity for some people with diabetes, new research suggests.

The findings — believed to be the first to address this issue — were presented September 15 here at the European Association for the Study of Diabetes (EASD) 2015 Meeting by Annie Nikolajsen, a health economist at Novo Nordisk, Copenhagen, Denmark, and colleagues.

"What we have seen in our study is that it is something the patients feel, both in how it impacts their body and how they concentrate. It gives them issues while they're at work. If they feel bad or feel sick, then they might leave work," Ms Nikolajsen told Medscape Medical News.

The topic arose as a result of responses from a broader 85-question Novo Nordisk survey of 906 adults with type 1 (39%) and insulin-treated type 2 diabetes (61%), eliciting information about their use of premeal (bolus) insulin.

Nearly two-thirds reported problems with postmeal hyperglycemia, with a quarter having missed work because of it and three-quarters reporting that the high blood sugar had affected their work productivity.

The findings were unexpected, Ms Nikolajsen told Medscape Medical News. "The survey investigated issues around taking bolus insulin. We were not expecting to see associations of this kind," she said.

Asked to comment, session comoderator Juha Saltevo, MD, PhD, of Central Hospital, Jyväskylä, Finland, told Medscape Medical News that while much attention has been paid to the negative impact of hypoglycemia in many areas of life, including work productivity, "this postprandial hyperglycemia is a totally new area.…It is very interesting."

The results suggest that patients should measure their glucose levels both before and 2 hours after meals in order to assess the degree to which meals are appropriately covered by the bolus insulin dose.

European guidelines advise that postmeal glucose levels not exceed 10 mmol/L (180 mg/dL). "If it's more than 10, it's not very good, and you have to do something next time," Dr Saltevo commented.

Missed Work, Lost Productivity

The original 906 focus-group participants were all adults who used premeal insulin and did not use premixed insulin or other injectable glucose-lowering drugs. They came from the United States (40%), Germany (34%), and the United Kingdom (26%). Sixty-one percent had type 2 diabetes and 39% had type 1.

More than half used prefilled pens, 33% used syringes, and 13% used insulin pumps. More than half (55%) said that their diabetes was "well" or "very well" controlled.

A total of 519 respondents (57%) reported working for pay, for an average of 35 hours per week. Among that group, when asked whether they had experienced problems in stabilizing their blood glucose levels after eating, 68% said yes, and 64% of those reported that the problem was hyperglycemia, with 27% experiencing three or more episodes of postprandial hyperglycemia in the past week. (The investigators only measured self-report and did not confirm the blood glucose levels.)

The current analysis was restricted to 263 (56% type 2, 44% type 1) patients who reported that their most recent out-of-range postprandial blood glucose value was hyperglycemia.

The group as a whole experienced an average 1.7 postprandial hyperglycemia episodes over the course of the week, with no significant differences by the respondents' work status or diabetes type.

Asked how the high blood sugar affected their work life, 27% said they had missed any work, with 19% leaving work early, 14% going in late, and 10% missing an entire day of work.

When they stayed at work despite the hyperglycemia, 71% reported having had had some kind of work productivity problem, with 54% reporting difficulty in focusing, 45% feeling less productive, 44% needing to take breaks, 28% making more mistakes, 11% canceling/rescheduling meetings or appointments, and 10% missing meetings/appointments.

Type 2 Patients More Likely to Miss Work for Hyperglycemia

Patients with type 2 diabetes were significantly more likely to report work productivity problems, 77% compared with 63% with type 1 diabetes. Specifically, the type 2 patients had more difficulty in focusing (62% vs 44%) and felt they were less productive at work (50% vs 37%).

German respondents were significantly more likely than those in United Kingdom or United States to report any work productivity issue due to postprandial hyperglycemia, 84% in Germany vs 65% in the United States and 62% in the United Kingdom (P < .01). The German group was significantly more likely to report making more mistakes at work and to have difficulty focusing due to postprandial hyperglycemia (both P < .05).

"Since we saw that so many patients actually experienced these postprandial hyperglycemic episodes and because they indicated that it had some impact on their work productivity, we believe it would be relevant if patients and physicians discuss this on an individual basis to figure out if this is a problem and how we can prevent it to make their lives easier," Ms Nikolajsen said from the podium.

Since her paper was presented during a session entitled, "The Price of Diabetes Care," she noted that the study didn't capture other outcomes of postprandial hyperglycemia — such as healthcare utilization — that could also affect costs. "This could be investigated further," she said.

Also not captured, Dr Saltevo pointed out, was the impact of postprandial hyperglycemia on type 2 patients who don't use insulin but may also experience drowsiness or other adverse effects. "It would also be very important to have this kind of analysis done for them," he said.

For now, though, he told Medscape Medical News that this study brings up an aspect of diabetes care that may receive less focus during clinical diabetes encounters. "You have to concentrate on this issue also, not just hypoglycemia. I think this is important."

The study was supported by Novo Nordisk. Ms Nikolajsen is an employee of Novo Nordisk. Dr Saltevo has given lectures for Novo Nordisk, Merck, and Sanofi and has received travel expenses from AstraZeneca.

European Association for the Study of Diabetes 2015 Meeting; Stockholm, Sweden. Abstract 51, presented September 15, 2015.

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