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  • How comorbidity conditions of diabetes & obesity impact claims outcomes: Part five

    Nov 07, 2019
    • Clinical Connection team

    Common comorbid conditions that may be a contributing factor and/or a complication of an injury are diabetes and obesity. With over 30 million patients with diabetes (PWD) in the United States, diabetes presents a potential concern when it comes to injuries.1

    Diabetes complicates injuries
    An example of the impact of diabetes is an accident involving ankle or foot fractures. The potential for complications and negative outcomes is amplified in PWDs compared to non-diabetics.2

    Diabetes is associated with wounds that may have prolonged healing times. Delays in recovery are related to decreased blood flow and increased blood glucose, which may promote bacterial growth.

    Plus, elevated glucose levels negatively impact surgical wound healing and infection rates. Overall infection rate nearly doubles for individuals with glucose >200 mg/dl. (Normal fasting glucose for non-diabetic <100 mg/dl).

    Surgical wound complications related to increased blood glucose3

    Blood Glucose Levels Wound reopening (%) Return to OR (%) Infection Rate (%)
    Preoperative <200 mg/dl 19.3 12.9  6.5
    Preoperative >200 mg/dl 43.5 26.1 11.0
    Postoperative <200 mg/dl 18.2 15.1  6.1
    Postoperative >200 mg/dl 43.5 23.9 10.9
    Unstable glucose <200 mg/dl 26.1 11.6  6.5
    Unstable glucose >200 mg/dl 42.4 35.3 15.2

    Risks of obesity

    Quadruples risk of Type 2 diabetes4
    Obesity is the leading risk factor for developing Type 2 diabetes. More than 90% of Type 2 PWD are classified as overweight or obese, clearly increasing health risks associated with these concurrent diseases.5

    Raises the likelihood of injuries
    Potential injuries include heat stress, falls and excess sedation that can contribute to motor vehicle or machinery accidents.6 Individuals with higher body mass index (BMI) were found to have an elevated risk of experiencing multiple workplace injuries ― an estimated 38%-68% increased incidence of injuries.7,8

    Boosts claims costs
    Claims involving obese individuals are significantly more costly than non-obese individuals, according to a 2010 NCCI study.9

    Higher claims’ costs among obese individuals

    Claims’ time frame Cost
    36 months 4 times greater
    60 months 5 times greater

    Comorbid obesity and diabetes significantly increase complications and mortality risk
    Obesity and diabetes combined contribute to a seven-fold increase in overall mortality risk.10 Managing a complex injured case with comorbid diabetes and obesity takes extra effort from everyone on the healthcare team to safely return the individual to work.

    Mitigating the risk
    Once a complex comorbidity claimant is identified, steps can be taken to manage the heightened risk:11

    • Early interventions such as nurse case management may ensure that the individual receives evaluation, care and supplies needed to lessen the risk of complications.
    • Nurse case managers can coordinate care across multiple providers. Though diabetes care may not be covered under the claim, making sure the individual keeps appointments with all providers can improve disease management and injury healing. Case management helps confirm compliance with the treatment plan.12
    • Coordination of home health needs also can help ensure the individual follows the treatment plan. For example, staying off of an injured foot is critical for comorbid diabetes. Assuring access to wound care, crutches, canes or walkers, if needed, will promote proper healing.
    • Telehealth may improve outcomes and access to care for individuals who live in remote locations.13

    Reduce comorbidity risks with preventive measures
    Encouraging workplace health initiatives such as steps-per-day incentives can assist workers in maintaining a healthy lifestyle while helping to manage risk factors associated with comorbidity. Employer wellness programs can serve a dual purpose ― improve quality of life for employees and mitigate complications associated with comorbidity.

    A study published in 2017 reports that employees with diabetes miss an average of 5.5 days more each year compared with non-diabetic employees and annually cost employers $16 billion14

    Check out our entire series on comorbid conditions in workers’ comp and auto no-fault on our Comorbidity Conditions page here.  We cover comorbid conditions that can negatively impact workers’ compensation and auto no-fault cases: 1. Effect of comorbidities, 2. Mental Health, 3. Hypertension, 4. Respiratory Issues, 5. Diabetes/Obesity.


    1. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes. 2019. Accessed November 6, 2019.
    2. Official Disability Guidelines. 2019. Accessed via subscription on November 6, 2019
    3. Endara M, Masden D, Goldstein J, et al. The Role of Chronic and Perioperative Glucose Management in High-Risk Surgical Closures: A Case for Tighter Glycemic Control. Plast Reconstr Surg. 132(4):996-1004, October 2013.
    4. Witters D and Liu D. Obesity quadruples diabetes risk for most U.S. adults. Well Being. 2017.
    5. World Health Organization. Obesity and Overweight Fact Sheer. Accessed from Accessed November 6, 2019.
    6. Scace E. What does the obesity epidemic mean for workplace safety? Safety.BLR.Com. 2014. Accessed November 6, 2019.
    7. Froom P, Melamed S, Kristal-Boneh E et al. Industrial accidents are related relative body weight: the Israeli CORDIS study. BMJ Occup Environ Med. 1996;53:832-835.
    8. Gu JK, Charles LE, Andrew ME, et al. Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004-2012. J Safety Res.2016;58:21-30.
    9. Shuford, H. and Restrepo, T. How Obesity Increases the Risk of Disabling Workplace Injuries. NCCI Holdings, Inc. 2010, December.
    10. Leitner DR, Fruhbeck G, Yumuk V. et al. Obesity and Type 2 Diabetes: Two diseases with a need for combined treatment strategies-EASO can lead the way. 2017;10:483-492
    11. Busse JW. Effect of case management on time to return to work: A systematic review and meta-analysis. IWH Penary; March 2011.
    12. Watts SA, Sood A. Diabetes nurse case management: Improving glucose control: 10 years of quality improvement follow-up data. Appl Nurs Res. 2016; February:202-205.
    13. Verhoeven, Fenne et al. Asynchronous and Synchronous Teleconsultation for Diabetes Care: A Systematic Literature Review. Journal of Diabetes Science and Technology. 2010;4(3):666-681.
    14. Gallup-Sharecare Wellbeing Index. The cost of diabetes in the U.S.: Economic and well-being impact.2017. Accessed November 5, 2019