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DEFINITION

• When a person is unreasonably denied a job, terminated from employment, or kept from promotion on the basis of their medical condition.
• A person with diabetes may be discriminated against if he/she is not offered employment opportunities that he or she is able to perform.
• Legal definitions of employment discrimination vary from state to state and country to country, and can be complex.
• An experienced lawyer may be needed to evaluate the strength of a case involving discrimination.

EPIDEMIOLOGY

• No reliable statistics exist to describe the extent of job discrimination against people with diabetes.
• Discrimination may be subtle, as employers may not specify that diabetes is the reason a person is not hired, not promoted or terminated; or it may be overt, if the employer has a fixed policy against employing people with diabetes or people who take insulin.
• Employers in the U.S. may fear that hiring a person with diabetes will adversely affect the cost of employer-based health insurance.
• Discrimination may occur in individual, isolated circumstances or as a broad, blanket employer policy.
• Unfair and potentially illegal discrimination in employment practices may occur because employers misunderstand diabetes, including its management and treatment.

DIAGNOSIS

• In the U.S., the Americans with Disabilities Act (ADA) protects people with disabilities. Due to successful amendments effective starting in 2009, virtually all people with diabetes are considered to have a "disability" and therefore covered by the ADA.
• The ADA requires that an employer make "reasonable accommodations" to help people with disabilities.
• In the case of diabetes, reasonable accommodations may include, for example, allowing a person to carry a snack with them, or to measure their own blood glucose level while on the job.
• As above, an experienced lawyer may be needed to advise on what is truly employment discrimination.

SIGNS AND SYMPTOMS

• Any employer with a blanket policy of not hiring people with diabetes may be guilty of employment discrimination.
• A potential employer cannot ask about a person's health history, including whether or not the person has diabetes, before making a job offer but an offer may be contingent upon passing a medical history and examination.
• Failure to make reasonable accommodations in the workplace for a person with diabetes may be employment discrimination.

CLINICAL TREATMENT

• Health care professionals are frequently asked to evaluate a person with diabetes for employment.
• The medical evaluation for employment should consider: Does the person have long-term complications that would significantly impair job performance? Does he/she have a recent history of severe hypoglycemia? What are the job requirements? Is the individual able to perform the job despite having diabetes?
• Health care professionals may be in a position to advise employers about the benefits of treating people with diabetes fairly.
• When advising employers, some key points may be that: 1) people with diabetes can and have been successful in virtually all types of work; 2) people with diabetes are often more health/safety conscious and personally careful or reliable than the average employee; 3) the main risk-- severe hypoglycemia-- occurs only in some people who take certain medications and are prone to hypoglycemia.
• Sometimes, health care professionals will be in a position to advise people with diabetes about seeking employment.
• In advising people with diabetes, it is important not to be too pessimistic or restrictive. While there are some employers (such as the military) that categorically will not hire people with diabetes, most will and should.
• People with diabetes do not need to tell potential employers about their health history (including having diabetes) until they have been offered a job and are having a pre-employment physical examination.
• In unusual cases, health care professionals may need to help people with diabetes get further legal assistance if discrimination occurs. Diabetes organizations such as the American Diabetes Association can often be of assistance.

EXPERT COMMENTS

• The health care professional's first obligation is to the patient. This is compatible with simultaneously protecting public safety and the legitimate interests of an employer.
• The health care professional should promote safety in the workplace and a productive work force.
• Employers are often happy to be educated about diabetes and willing to hire and promote people with diabetes when they understand the facts.
• In protecting people with diabetes from employment discrimination, the first principle is that each person deserves individual consideration. Not every person is able to do every job (e.g. severe retinopathy may prohibit work requiring fine eyesight); but blanket policies against diabetes are potentially discriminatory and illegal.
• Helping employers make reasonable accommodations for the person with diabetes, and helping the person with diabetes have reasonable expectations, is the optimal role of the health care professional.
• Severe hypoglycemia (requiring another person's assistance) is the real potential danger in certain high-stress employment situations, not whether hyperglycemia is well controlled.
• On the whole, people with diabetes can be outstanding employees in the vast majority of employment positions.

Basis for Recommendations

• American Diabetes Association; Diabetes and Employment; Diabetes Care; 2009; Vol. 32, Suppl 1; pp.
  PUBMED: 10.2337/dc09-s080
  Rating: Basis for recommendation
  Comments:The American Diabetes Association's policy statement, with good advice for health care professionals on all aspects of evaluating individuals.