Prevalence and characteristics of prediabetes in workers in industry

Type 2 diabetes is a chronic, progressive disease with serious health consequences. It affects an estimated 79 million (35%) adults in the United States aged 20 years and older. Progression to Type 2 diabetes occurs slowly, with steady progression from normal glucose metabolism to impairment severe enough to indicate illness. Prediabetes is the interim period between normal glucose metabolism and impaired glucose metabolism, where glucose metabolism is abnormal but not yet serious enough to meet the diagnostic criteria for Type 2 diabetes. Without treatment or intervention, a person with prediabetes will develop Type 2 diabetes in 10 years. Risk for prediabetes and subsequent Type 2 diabetes is multifactorial. Empirical evidence has shown that risk factors include demographic, sociocultural, and health behavior variables. Therefore, the purposes of this dissertation study were to: (1) describe the prevalence of work stress (job strain and job imbalance) and prediabetes in full-time employees at the central Texas headquarters of a large, computer technology company (2) describe the relationship among stress, work stress, and prediabetes, (3) explore the potential interactive effects of socio-cultural factors, stress, work stress, health behaviors, and coping on prediabetes, and (4) explore the potential mediating effects of health behaviors and coping on the relationship between work stress and prediabetes. This study used a descriptive, cross-sectional design. It was conducted in a single, computer technology company in central Texas. A conceptual framework, The Conceptual Model for Metabolic Risk, was developed for this study. The concepts in this model included known risk factors for prediabetes and additional risk factors that were theorized. Well established instruments were used to measure: job roles, smoking, alcohol, diet, exercise, sleep, stress, work stress (job strain, job imbalance), and coping. Physiologic data were extracted from the participants’ electronic medical record. The results indicated that prevalence of prediabetes was lower and the prevalence of work stress was higher in the participant sample than what is reported in the US population. Work stress and global stress were significantly correlated. Three variables predicted prediabetes: alcohol, job imbalance, and sleep. Job imbalance was inversely related to prediabetes (ρ = -0.192, p = 0.022). The study findings suggested that job imbalance lowers risk of prediabetes (OR = 0.05, 95% CI, 0.003 – 0.72, p = 0.028). The inverse relationship between job imbalance and prediabetes contradicts previous empirical data. A mediation model was unsuccessful at finding a mediating relationship of health behaviors on the relationship between job imbalance and prediabetes. Future prediabetes research should continue to explore the relationship between work stress and prediabetes and sleep and prediabetes. It would be especially important to include individual work-related characteristics, such as motivation, commitment, complacency, or passivity, to explore potential, underlying factors that may contribute to work stress. Individual work-related characteristics may explain the inverse relationship between job imbalance and prediabetes found in this study. Patient assessment and education are the hallmarks of nursing practice. During prediabetes screening exams, nurses should include assessments of new risk factors (sleep, stress, and work stress) with assessments of traditional risk factors (age, BMI). Patient education aimed at reducing the risk of prediabetes should include information about coping with stress and maintaining healthy sleep habits. Work-site education programs should include programs on work-life balance, coping with stress, and the significance of sleep.