Case 12: The identification and rehabilitation of a (type 2) diabetic
Major multi-site bakery company
The provision of occupational health services aims to ensure the effect of work does not interfere with health and that people are fit for work. The strategy for employee health within this company supports this concept through the work of occupational health practitioners. Their role includes statutory health surveillance, the rehabilitation of those with health problems and health promotion.
This case study illustrates the care of an employee who was seen for statutory health surveillance. It detected a ‘physical’ health problem that required medical investigation. The employees subsequent return to full duties required physical and psychological rehabilitation and ongoing health surveillance.
Statutory health surveillance includes a health check for night workers. Within the company this was undertaken through a ‘Passport for Health’ – an initiative that combines employee health checks with general health promotion and gender specific health advice. For night workers, fitness is assessed by checking for the presence of sleep disorders, bowel problems, cardiovascular disease or medical treatments that may affect ability to work nights (e.g. the effect of sleep inducing medications or the need to stabilise people on medications during the initial treatment of conditions such as epilepsy or diabetes). ‘Passport for health’ also includes physical measurements that including weight, blood pressure, cholesterol, vision and functional mobility.
A 55 year old employee had worked for the company at its Liverpool bakery for 20 years. His job as a production operative involved rotational night shifts. His job required strength and stamina to work 8 – 10 hour shifts undertaking manual handling for the packing, stacking and moving of bakery baskets.
The employee attended for his ‘Passport for Health’ in June 2006 and indicated he was ‘feeling-old’. He had given up smoking, gained weight and reported several episodes of sickness absence with infections, resulting in lost time from work that had reduced his income.
A check of his height/weight ratio revealed a body mass index score of 23, a desirable BMI figure indicating a healthy weight. The employee queried whether the scales were accurate, saying his weight was at least 5kg heavier than that which this measurement revealed. His blood pressure was raised and a test of blood sugar showed an abnormally high level, despite it being several hours since his last meal.
The outcome of his ‘Passport for Health’ was a three-part occupational health rehabilitation plan. The plan involved the employee, his GP and the employee’s line manager:
- The employee was given lifestyle advice and a personal health action plan for his diet and exercise regime to maintain his weight and improve his blood pressure by reducing dietary salt
- The employee gave his written consent for the GP to be contacted. An occupational health letter asked the GP to review his general health, investigate his blood sugar level and supply a medical report detailing the outcome of medical investigations
- The line manager was informed that the employee required medical investigations before being fit to resume night work. Arrangements were made to roster the worker for day shift work only.
A review of his health occurred some 4 weeks later. The employee had been following the diet and exercise plan. At the time of reviewing his progress, the GP had not supplied a medical report. The employee said he had received a further blood test and was waiting for an appointment at a diabetes clinic. He was fearful the outcome may result in him needing insulin injections. He had not disclosed his anxieties to others and appreciated the time given in his occupational health review to say how he felt and ask questions.
Monthly reviews continued and, 8 weeks after writing to the GP, the employee told the occupational health manager that he had been seen at the diabetic clinic and was told he had type 2 diabetes.
[Type 2 diabetes usually develops in men or women over 40 years of age. Symptoms include an increased production of urine, unusual thirst, tiredness, loss of weight, increased appetite, feeling sick , blurred vision, increased infections and symptoms of feeling generally unwell.]
The effect of work on health: In view of the diagnosis, his occupational health rehabilitation plan was updated -
- The line manager was informed that the employee needed to avoid rotational day and night shifts for a further 3 months, to allow his blood sugar levels to be better controlled.
- Arrangements were made for the employee to take regular breaks, increasing in regularity during spells of hot weather
- First aiders were informed of his condition
- The employee was included in the bakery flu vaccination programme (diabetics are at greater risk of contracting infections including flu, with greater severity/duration).
The effect of health on work: After 3 months the GP supplied a medical report to confirm type 2 diabetes. The employee was now stabilised by diet and oral medication. The GP stated he would be able to enjoy a normal life, including a normal working life that involved physical work with rotational day and night shifts.
The occupational health practitioner discussed the medical report with the employee. His response was that he was feeling better now than he had done for years, but was fearful about returning to night shift work in case changes in his sleeping, eating, medication and physical routine endangered his health. His view was firmly held, presenting a psychological barrier to his rehabilitation and return to full duties. His occupational health rehabilitation plan was updated once more. Contact was made with the diabetic centre and arrangements were made for a diabetic specialist nurse to visit the work environment. The aim was to conduct a joint review involving the employee and the occupational health practitioner, with the objective of ensuring his health and safety for rotational day and night shifts. The outcome resulted in the following:
- The employee being told how his oral medication worked, resulting in him be reassured that changes in sleep patterns would not destabilise his blood sugar levels and not result in him needing insulin injections
- Advice on what to eat at work - getting the correct balance of carbohydrate, energy content, quantity, frequency of food intake
- Practical advice on what to do if feeling unwell
- Encouragement to attend support group meetings held at the diabetic centre
- An appointment with the diabetic physician to review his ability to undertake the shift and physical demands of work in a hot environment.
The immediate effect of this review gave the employee the reassurance needed to be more confident that medication and diet would match the demands of working life. The degree of reassurance was not sufficient to achieve his immediate return to rotational night shifts. This occurred after a subsequent appointment with the diabetic physician. The physician confirmed that the treatment prescribed would enable him to work nights and attendance at support group meetings allowed the employee to speak with other diabetics, many of whom worked rotational night shifts and coped without difficulty.
Return to normal duties: The employee has now returned to rotational day and night shift work. He feels very well and says he is coping with the demands of work. He is now in charge of his illness and free of concerns that interfered with his quality of life and ability to work night shifts.
This case study reflects the value of occupational health care. A medical condition was detected that would have gone untreated for many years, resulting in short term sickness absence, reduced productivity and the development of serious medical complications. His return to physical health occurred within a matter of weeks. His return to psychological health would not have occurred without occupational health instigating an active rehabilitation plan.