Diabetes at work. Fatigue in relation to job characteristics, diabetes symptoms and self-management

The focus of this thesis is on employees with diabetes. Fatigue, work characteristics and diabetes self-management are core aspects. Diabetes may have many consequences in the working situation and is expected to become an even bigger health problem, because the number of people with diabetes is growing considerably. Employees with a chronic disease might be at a higher risk of developing fatigue compared to healthy employees, because on top of the regular demands of their job, they have to deal with the demands of their disease. This could not be confirmed on the basis of data from a Maastricht Cohort Study on fatigue at work. Employees with diabetes but no co-morbidity (the presence of one or more additional chronic diseases), are not more likely to report fatigue-related complaints than ‘healthy’ employees, except for depressed mood. Co-morbidity, however, is associated with increased fatigue-related complaints. A further aim of this thesis was to contribute to a better understanding of the relationships between components of the Job Demands Control Support model and fatigue among employees with diabetes. Participants were employees with insulin-treated diabetes mellitus (types 1 and 2). Regression analyses revealed that work characteristics explain 19% of the variance in fatigue and diabetes related factors another 29%. Fatigue is especially more severe in the case of lack of social support at work, high job demands in combination with a lack of decision latitude, and more diabetic symptoms. Diabetic symptoms are especially relevant in combination with high job demands. Longitudinal data revealed that employees who experienced a lack of support at their workplace report higher levels of fatigue one year later. Interviews with employees with many diabetes symptoms showed major differences between low and high-fatigued employees with respect to coping and attribution strategies. Low-fatigued employees tend to use more active and problem-oriented coping strategies and seem to appreciate high levels of flexibility at work. High-fatigued employees appear to feel more helpless, use resigning strategies and judge high flexibility at work as a threat for a structured and regular life. Because diabetes is to a great extent a self-managed disease with implications during working hours, we also explored whether self-management activities are associated with the health status of employees with diabetes, and whether workplace characteristics are associated with diabetes self-management. It was concluded that the perceived burden of performing self-management activities is more strongly related to health than the frequency with which employees perform self-management activities. Furthermore, personal factors play a more prominent role in relationship to self-management than the way in which employees perceive their work situation. Employees with an avoidance coping style do monitor their blood glucose level less frequently and also perceive this self-management task as a burden. Individuals with a lower sense of self-efficacy feel more burdened by performing all self-management activities. It is recommended that performing self-management activities and the burden associated with it should be assessed and considered separately. In conclusion, we believe that people with diabetes can be valuable employees when necessary with some support from colleagues and superiors. Employees with co-morbidity, employees who experience many diabetes symptoms and those who feel burdened by performing self-management activities need special attention. Coping styles and self-efficacy should be taken into account. Also, keeping blood glucose levels balanced is one of the challenges in preventing fatigue