Consumption of home-prepared food at the workplace as a predictor of glycated hemoglobin among people with type 2 diabetes in Hong Kong: a mixed methods study
Diabetes is associated with a two-fold increased risk for a number of vascular diseases, and increases the risk of death from cancer and other non-vascular deaths by 1.25 and 1.73 times, respectively. The number of people with diabetes of working age (20-64) is expected to increase to 417 million in 2030, or around 18% in just 10 years.
The phenomenon of youth-onset type 2 diabetes further highlighted the need to better understand the issues of diabetes control among the working population, given their higher average HbA1c concentrations, earlier onset of complications, and lower adherence to lifestyle modifications. From an economic perspective, the workforce affected by diabetes could lead to lost productivity in addition to the cost of healthcare.
From a health perspective, certain working conditions could affect the disease control of workers with diabetes, including hours worked, shift work, and work-related psychosocial stress. However, studies from this perspective were limited and of varied quality.
Goals
Increasing attention is being paid to the association between dietary patterns and diabetes control following global changes in dietary patterns. There has been very limited research into the eating patterns of employed diabetic patients, although the working-age population has seen the largest increase in diabetes incidence.
This study aimed to identify workplace eating patterns in relation to glycemic control among employed type 2 diabetic patients.
Methods
This is a sequential mixed methods study. The exploratory qualitative study involved focus group interviews with 31 employed type 2 diabetic patients, which guided the design of a subsequent cross-sectional investigation involving 185 employed patients.
Thematic analysis of qualitative data was performed to identify workplace eating patterns most relevant to glycemic control. Hierarchical multiple linear regression was performed to examine the association between workplace eating pattern and glycemic control, represented by HbA1c.
Results
Focus group interviews identified frequency of consumption of home prepared meals (HPM) and meal times as the main workplace eating patterns affecting glycemic control.
The cross-sectional study confirmed that regular consumption of HPM in the workplace could explain the variation of HbA1c , independently of sociodemographic, lifestyle and disease factors, with R2 = 0.146, F (14, 170) = 2.075, p = 0.015; Adjusted R2 = 0.076.
Patients who were female, in an unskilled occupation, on shift, with a fixed workplace, and who had breaks during work were more likely to consume HPM.
Conclusions Consumption of home-prepared meals (HPM) brought to the workplace should be promoted to facilitate better glycemic control by working patients with type 2 diabetes, possibly through more practical dietary advice and workplace adaptations. work in terms of space and facilities. In the context of the COVID-19 pandemic, the consumption of HPM also meant additional protection for diabetic patients by reducing exposure through close contact in restaurants. |
Discussion
Our analysis provided evidence that regular consumption of home prepared meals (HPM) during work hours was associated with lower HbA1c level for patients with type 2 diabetes, after adjusting for sociodemographic factors, lifestyle factors, life and disease condition.
It was found that the consumption of HPM during working hours was not a common practice, being more likely to be done by unskilled workers and those with a fixed workplace, in shifts and with breaks during work. However, these working conditions were not associated with HbA1c.
The absence of a fixed workplace and impractical dietary advice were possible barriers to HPM consumption during work hours. Our study was the first to examine workplace eating patterns in relation to HbA1c, shedding light on how employed type 2 diabetic patients could improve their disease control.
Eating out has been trending upward around the world and has been associated with a less healthy diet , including higher energy intake, more fat and fewer micronutrients, increased risk of diabetes, and insulin resistance. On the other hand, it was found that frequent consumption of HPM was associated with a lower risk of developing type 2 diabetes . However, the impact of eating away from home on glycemic control in people with diabetes has received little attention; and with eating out being more common among the working population, the eating pattern of employed diabetic patients deserves special attention.
The findings of our study supported the promotion of HPM in the workplace for better glycemic control and provided some evidence that more practical dietary advice and accommodations in workplaces could encourage HPM consumption in the workplace. Provision should be made to provide dietary advice, taking into account the schedules and needs of working patients, for example, easy-to-follow cooking instructions and recipes, plus discussion of the energy needs of working patients with dietitians.
In terms of workplace accommodation, companies should be encouraged to make it easier for employees with diabetes to bring HPM, providing space and facilities for storage, processing and consumption. For patients who were unable to switch to HPM due to their work conditions, more healthy food options.
