Type 2 diabetes is associated with a number of comorbidities, particularly cardiovascular diseases (such as heart attack, heart failure and stroke), eye disease, nerve disorders and other forms of organ damage. Treatment for type 2 diabetes and its comorbidities is lengthy and costly and places a heavy burden on the healthcare system.

Education and prevention are good ways to combat type 2 diabetes. As most working people spend a large proportion of their time at work, the workplace is an important setting for education and prevention activities. Measures need to consider which working conditions promote or hinder the development of type 2 diabetes. They should also identify individuals and occupational groups at higher risk of the disease.

Incapacity to work and diabetes

The incidence of type 2 diabetes among employees varies from one sector to another. According to the statutory insurance fund AOK, a particularly high incidence of diabetes has been observed in the metalworking industry, in public administration, transport and energy industries, and water and waste industries. In contrast, studies from other countries show a particularly high incidence of type 2 diabetes among employees in the health and construction sectors and among professional drivers.

The number of days of sickness absence due to  to diabetes rises sharply with age and is twice as high for men than for women.

Development and progression

A number of different factors can promote the development of type 2 diabetes:

• obesity
• physical inactivity
• smoking
• alcohol consumption
• a diet low in fibre and high in fat and sugar
• certain medications that have a negative effect on sugar metabolism
• genetic predisposition

Type 2 diabetes is also closely associated with metabolic syndrome, a combination of factors that significantly increases the risk of cardiovascular disease and type 2 diabetes. The combination of abdominal obesity, high blood pressure, lipid metabolism disorder and insulin resistance or impaired glucose tolerance is known as the “deadly quartet”. As type 2 diabetes and cardiovascular disease share common risk factors, they are closely related and can influence each other.

Working conditions as a risk factor

Besides the largely lifestyle-related risk factors mentioned above, there are indications that certain working conditions can also contribute to metabolic disorders. They include:

• shift work, especially night work
• long working hours
• high physical workload
• psychosocial stress
• physical inactivity as a result of largely sedentary activities

Occupational and personal risk factors can act individually or in combination. Type 2 diabetes often develops gradually over several years (prediabetes) and goes unnoticed at first.

Work-related risk factors are associated with type 2 diabetes in a number of different ways. For example, a disturbance of the circadian rhythm as a result of working night shifts can lead to a lack of sleep, reduced sleep quality, reduced relaxation time, social isolation and stress. Adverse lifestyle changes are also observed (dietary changes and alcohol and tobacco consumption) among night shift workers. Workers who work long hours have less time for physical and social activities and for relaxation and sleep. Other detrimental factors include psychosocial factors, such as stress caused by high mental and physical demands or chemical, physical and other risk factors in the workplace, including noise, chemicals and a lack of natural light.

The pattern of breaks and recovery times during working hours can also play a role. Spending longperiods either sitting or standing, especially uninterrupted, can lead to a reduction of metabolic activity and thus contribute indirectly to higher blood sugar levels.

The risk factors mentioned above lead to changes in various physiological processes in the body that have an impact on hormone production, the immune system and the autonomic nervous system. This can lead to an imbalance in sugar and lipid metabolism and/or obesity, which can contribute to the development of type 2 diabetes.