Managing diabetes leads to 'predictable moments of risk'

Diabetes is now the number two driver of private drug spend in Canada, just behind inflammatory conditions, according to a recent drug trends report by Express Scripts Canada.

The mental load of managing a 24/7 condition notably makes it difficult for employees to act at the moments when action matters most, particularly as sick days tend to be treated as one-off events. Moreover, the sharpest growth of diabetes claims – a 6 per cent jump in claimant in 2025 – came from adults aged 18 to 44, the core of the workforce.

While speaking at the 2026 Canadian Pensions and Benefits Institute (CPBI) annual Forum in Quebec City, panelists converged on the premise that most diabetes-related workplace disruption is preventable, but only if employers, insurers and clinicians shift from reacting to crises to building early intervention into its foundation.

“When diabetes starts earlier, people live with it longer, it means more years for complications and workplace impact. The challenge with diabetes is that it often gets more complex over time. But if we have early intervention, we can help slow that progression. When diabetes is managed early, there's a better chance for fewer complications, slower progression, helping contribute to a more stable productive workforce. That's why it's important to act early.” said Gina Kawak, director of pharmacy benefits at Manulife. 

Without intervention, what begins as a single diagnosis can “become multi-system” she added, pointing to high blood pressure, high cholesterol, nerve pain and rising paramedical claims. Kawak argued these are often predictable inflection points.

Predictable moments of risk

Illness - whether minor or severe - can quickly destabilize diabetes. Reduced appetite, dehydration or infection can disrupt glucose levels and increase the risk of emergency room visit or hospitalization.

“A lot of people see these as isolated events, but they're actually predictable moments of risk,” she said, pointing to Manulife's wellness data that reveals a broader productivity challenge: absence accounts for just 3 per cent of lost time, but reduced productivity accounts for 19 per cent -- adding up to 46 lost working days per employee per year.

“We need to rethink sick day management as a preventive strategy because consequences of poor preparation go far beyond the person's control alone,” said Dr. Marie-Philippe Morin, a specialist in general internal medicine and bariatric medicine at the Quebec Heart and Lung Institute and researcher in obesity and cardiometabolic factors, pointing to diabetic ketoacidosis (DKA) as a case in point. DKA can develop rapidly during routine illnesses like gastro or influenza, as stress hormones spike insulin requirements, glucose climbs and ketones accumulate. But left untreated, it can be fatal.

“Early intervention in diabetes is really critical because we have strong evidence that good glycemic control will reduce the complications, care utilization and also workplace disruption,” Dr. Morin added, noting how the clinical evidence for early glycemic control is unambiguous, as every 1 per cent reduction in HbA1c translates to a 35–40 per cent drop in microvascular complications and a 15–20 per cent reduction in macrovascular risk, including heart attack, citing a Diabetes Care study from 2019.

Other than GLP-1 receptor agonists,  sensor-based glucose monitoring, such as Abbott’s FreeStyle Libre Flash Glucose Monitoring Systems, which can deliver HbA1c reductions comparable to adding a medication and drives behavioural change through real-time feedback. Dr. Morin also acknowledged automated insulin pumps, which can achieve tighter control for type 1 patients without increasing hypoglycemia.

Still, she cautioned that coverage for real-time glucose monitoring remains restricted to patients already on insulin - a gap that undermines early intervention.

Christine Than, a Drug Benefit Consultant and Canada Pharmacy Leader at Willis Towers Watson (WTW) emphasized that workplace disruption is often the clearest signal. Uncontrolled diabetes doesn’t just affect health - it impacts performance in real time. Employees with poorly managed diabetes are more likely to make errors, and those errors carry real consequences depending on their role. Than argued early disease control reduces not just complications but the downstream absenteeism that follows.

When should employers intervene?

Still, while early intervention is the best medicine, when does it make sense to intervene and how should employers know when to make that call?

Than emphasized it comes down to knowing who your employees are. After all, the people closest to employees — their managers and colleagues — are the ones most likely to notice when something is wrong, like fatigue, repeated errors or frequent lateness. But she also acknowledged how benefits teams and consultants never see those signals.

“Managers already face pressures and demands from the employees. They’re the ones who should be on the lookout for symptoms, patients, employees who come in late or who are fatigued. That’s why you need eyes on the ground,” she said.

Intervention is not straightforward

Diabetes management sits at the intersection of workplace oversight and personal privacy. Disclosure must remain voluntary, and organizations that fail to build trust risk reinforcing stigma around chronic conditions.

“While sharing personal experiences can be valuable, it’s important to respect boundaries so individuals aren’t put in situations that could reinforce stigma or bias," said Emilie Vigneault-Simard, specialized nurse practitioner in Adult Care at Infirmière praticienne spécialisée en soins aux adultes (IPSSA).

Effective benefits design

Kawak reinforced that effective sick day management needs to connect the supports, such as access to dietitians, health coaches, virtual healthcare, mental health support and EAP services into a measurable strategy. Pairing health coaching with sensor-based glucose monitoring data—and measuring outcomes against disability claims, absenteeism and productivity—can provide the evidence plan sponsors need to justify investment.

According to Manulife’s own data, early dietitian engagement cuts the likelihood of progressing to second-line therapy by 40 per cent and lowers cardiovascular risk, with a $400 per-employee reduction in combined drug and paramedical spend over two years.

Ultimately, the panel underscored a fundamental shift: effective diabetes management in the workplace must move from reaction to anticipation. This means equipping employees with education on managing illness, enabling earlier detection through sensor-based glucose monitoring and ensuring timely access to care before a short illness turns into a major health event.

“The most important role insurers and plan advisors can play is ensuring that patients have timely access to the right medication, the right technology and the right multidisciplinary supports to improve outcomes long-term for people living with diabetes,” said Dr. Morin.

The opportunity is clear: by treating predictable risks as preventable events, employers and insurers can reshape outcomes - not just for costs, but for the workforce itself.

This article was produced in partnership with Abbott