The aim of this study was to investigate how factors in the workplace and personal factors are related to the frequency with which people with diabetes perform self-management activities and the degree to which they do or do not experience the performing of self-management activities as a burden. Two hundred and ninety-two employees with insulin-treated diabetes completed questionnaires on socio-demographic and illness-related background variables, work experience, diabetes self-efficacy, social support outside of work, coping styles and self-management activities. The results indicate that employees who reported a high workload were more likely to perceive injecting insulin as a burden. The level of social support was positively related to the frequency of dietary self-management in type 2 diabetes and negatively related to the sense of being burdened by dietary self-management in type 1 diabetes. With respect to personal factors, we found that a diabetes avoidance coping style was associated particularly with infrequent blood glucose monitoring and a high sense of being burdened by blood glucose monitoring. Individuals with a low level of self-efficacy were more likely to perceive all types of self-management activities as a burden. These results may guide health professionals when counseling individuals with diabetes.

Occup Environ Med 2003;60(Suppl I):i93-i98Aims: To examine the relations between work characteristics as defined by the Job Demand-ControlSupport model (JDCS) (that is, job demands, decision latitude, and social support), diabetes related burden (symptoms, seriousness of disease, self care activities, and disease duration), and fatigue in employees with diabetes mellitus. Methods: Employees (n = 292) aged 30-60 years, with insulin treated diabetes, filled in self administered questionnaires that assess the above mentioned components of the JDCS model and diabetes related burdens. Results: Both work and diabetes related factors are related to fatigue in employees with diabetes. Regression analyses revealed that work characteristics explain 19.1% of the variance in fatigue; lack of support, and the interaction of job demands and job control contribute significantly. Diabetes related factors explain another 29.0% of the variance, with the focus on diabetes related symptoms and the burden of adjusting insulin dosage to circumstances. Fatigue is more severe in case of lack of social support at work, high job demands in combination with a lack of decision latitude, more burden of adjusting insulin dosage to circumstances, and more diabetic symptoms. Furthermore, regression analysis revealed that diabetic symptoms and the burden of adjusting the insulin dosage to circumstances are especially relevant in combination with high job demands. Conclusions: Both diabetes and work should be taken into consideration-by (occupational) physicians as well as supervisors-in the communication with people with diabetes.

The work situation and fatigue-related complaints of employees with diabetes (N = 141) were compared with "healthy" employees (N = 8946) and employees with other chronic diseases (N = 1883). Baseline data from a Dutch Cohort Study on Fatigue at Work were used to test differences in background variables, work characteristics, lifestyle factors, and fatigue-related complaints. Odds ratios were calculated for prolonged fatigue, the need for recovery, burnout, and psychological distress. Results showed that employees with diabetes work more daytime hours and work less overtime than the other groups. If they have no comorbidity, they are no more likely to report fatigue-related complaints than "healthy" employees, except for a depressed mood. Comorbidity (the presence of one or more additional chronic diseases) is associated with increased fatigue-related complaints. Therefore, this group will need special attention from professionals.

We explored the relationship between frequency and perceived burden of different self-management activities and HbA 1c %, symptoms of diabetes, fatigue, depression, and quality of life in 292 employees between 30 and 60 years of age with insulin-treated diabetes. Participants completed questionnaires that assess self-management and health-related variables. t-Tests were performed for type 1 (DM1) and type 2 diabetes (DM2) separately to compare the mean health scores of individuals who frequently or infrequently perform self-management activities and who do or do not perceive this as a burden. Participants frequently perform their self-management activities, particularly injection of insulin (96.1%), following dietary guidelines (70.8%) and eating regularly (65.6%). Dietary self-management is most often seen as a burden (70.4%), while injecting insulin is seen as least burdensome (12.8%). The perceived burden of self-management is more strongly related to health than the frequency of self-management. Frequency of self-management especially relates to HbA 1c % in DM1. People with DM2 who frequently follow the dietary guidelines have more positive health outcomes. Participants who perceive dietary self-management and injecting insulin as a burden have more negative health outcomes. Because different relationships were found between frequency and perceived burden of self-management and health