Diabetes, obesity & metabolism · 2026
Multi-Dimensional Barriers for Work Productivity and Possible Solutions to Overcome Presenteeism in Young-Onset Diabetes: A Mixed-Methods Study.
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Wong Kelly T C, Yin Jason D C, Chan Sunny C S, Wong Nga Sze, O Chun-Kwan, Dai Yiming, Zhang Yuzheng, Ng Marques S N, Ozaki Risa, Ma Ronald C W, Kong Alice P S, Luk Andrea O Y, Chow Elaine Y K, Chan Juliana C N, Lui Juliana N M
Аннотация
AIMS: Young-onset non-type 1 diabetes (YOD, age-at-diagnosis ≤ 40) is associated with poor physical and mental health, presenteeism and productivity loss. We examined patient-perceived barriers to work productivity and key enablers to reduce presenteeism.
MATERIALS AND METHODS: In this mixed-methods study, we utilized validated questionnaires to measure presenteeism (World Health Organization Health and Performance Questionnaire); self-care activities (Summary of Diabetes Self-Care Activities; Compliance Questionnaire for Medication); health-related quality of life (HRQoL, EQ-5D-3L) and psychological distress (Depression Anxiety Stress Scale; Chinese Diabetes Distress Scale) among participants with YOD in the Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes-Randomised Controlled Trial (PRISM-RCT). We conducted four semi-structured focus group discussions (FGDs) for inductive thematic analysis.
RESULTS: Employees with YOD (n = 465, mean age: 43.4 ± 6.4 years, disease duration: 10.9 ± 6.0 years, 59.8% male) had better cardiometabolic, psychological and HRQoL profiles than non-employees (n = 103). Among the employees, 67.4% had at least one sickness presenteeism episode in the preceding year, with a mean presenteeism score of 7.1 ± 1.6 (out of 10). Increased presenteeism was independently associated with diabetes-related emotional burden (β = -0.08, p = 0.029) and suboptimal HRQoL (β = 3.30, p = 0.041). [Correction added on 11 September 2026, after first online publication: In the preceding sentence, the beta and p values have been corrected.] Participants of FGDs (n = 16) reported distress contributors related to inter-personal (psychological/physical status, family collectivism), work (schedules/types, absence justification, colleagues' attitudes) and societal factors (relationships with providers, out-of-pocket payment, stigmatisation). Enablers included public awareness, early diagnosis (genetic testing for offspring, regular health-check), peer support, treatment choices autonomy and insurance coverage.
CONCLUSION: In YOD, presenteeism is associated with interpersonal, work and societal factors accompanied by psychological distress, suboptimal diabetes care, self-management challenges, calling for holistic assessment and person-centred management.
MATERIALS AND METHODS: In this mixed-methods study, we utilized validated questionnaires to measure presenteeism (World Health Organization Health and Performance Questionnaire); self-care activities (Summary of Diabetes Self-Care Activities; Compliance Questionnaire for Medication); health-related quality of life (HRQoL, EQ-5D-3L) and psychological distress (Depression Anxiety Stress Scale; Chinese Diabetes Distress Scale) among participants with YOD in the Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes-Randomised Controlled Trial (PRISM-RCT). We conducted four semi-structured focus group discussions (FGDs) for inductive thematic analysis.
RESULTS: Employees with YOD (n = 465, mean age: 43.4 ± 6.4 years, disease duration: 10.9 ± 6.0 years, 59.8% male) had better cardiometabolic, psychological and HRQoL profiles than non-employees (n = 103). Among the employees, 67.4% had at least one sickness presenteeism episode in the preceding year, with a mean presenteeism score of 7.1 ± 1.6 (out of 10). Increased presenteeism was independently associated with diabetes-related emotional burden (β = -0.08, p = 0.029) and suboptimal HRQoL (β = 3.30, p = 0.041). [Correction added on 11 September 2026, after first online publication: In the preceding sentence, the beta and p values have been corrected.] Participants of FGDs (n = 16) reported distress contributors related to inter-personal (psychological/physical status, family collectivism), work (schedules/types, absence justification, colleagues' attitudes) and societal factors (relationships with providers, out-of-pocket payment, stigmatisation). Enablers included public awareness, early diagnosis (genetic testing for offspring, regular health-check), peer support, treatment choices autonomy and insurance coverage.
CONCLUSION: In YOD, presenteeism is associated with interpersonal, work and societal factors accompanied by psychological distress, suboptimal diabetes care, self-management challenges, calling for holistic assessment and person-centred management.