If you have a high level of interaction with patients, students, clients or the general public in your chosen work, you might be putting yourself at significant risk of developing type 2 diabetes, according to a large new study. And, if you also have a poor support network among your peers, it could worsen your odds.
Researchers from Karolinska Institutet in Sweden used data from the Swedish Work, Illness, and labour-market Participation (SWIP) cohort, looking specifically at people aged 30-60 and the job they had in 2005. They only included those who had no history of any diabetes nor had ever used an antidiabetic drug before 2005.
In total, this left around three million Swedes.
Of these, the scientists looked at three aspects of jobs that involved contact with other people: general contact with other humans, the emotional demands caused by dealing with people that involved health or other problems, and confrontation in the workplace with other people. Then they also looked at the social support structure of those workplaces, based on Swedish Work Environment Surveys (1997-2013).
"Contact with other people" included interacting regularly with patients, customers, clients, passengers, students – everything from healthcare to customer service and teaching. In terms of contact with other people, the scientists included those who had responded to workplace surveys with the answer "roughly three-quarters of the time at work" and "almost all the time." To gauge personal demands and instances of confrontation, they calculated the proportion of respondents who said their job was emotionally taxing "a few days a week" or "every day."
Overall, 20 roles in sectors with the highest amount of contact with others – as well as being the most emotionally demanding and conflict-plagued – were singled out by the scientists. These included roles in healthcare, education, service industries, hospitality, social work, law, security and transport.
In 2019, Karolinska Institutet researchers conducted a similar study of diabetes prevalence, but instead looked at more than 200,000 Swedes with type 2 diabetes who were of working age during 2006-2015. They found that those at highest risk of developing diabetes were professional drivers, factory workers and cleaners – three times more likely to develop the condition than, for example, physiotherapists and teachers.
The new paper has some distinct differences in design – and now includes physiotherapists and teachers in the high-risk group. That earlier study has some clear flaws – particularly that lifestyle factors (smoking, obesity, diet) were not accounted for. The jobs the team identified with diabetes risk are typically overrepresented by people from low socio-economic backgrounds, who in turn already have a higher risk of chronic disease. So, while interesting, the link was a little tenuous.
The new study also sidesteps lifestyle factors, but it does cross broader economic lines and focuses instead on emotional demands and confrontation on the job. In 2006-2020, 216,640 people (60% men) developed type 2 diabetes – and once again there were certainly some lifestyle factors likely at play (they were most likely to have a lower level of education and low job security than those who did not develop the condition).
And in both men and women, participants working in high-people/highly taxing roles had a significant higher risk of going on to develop type 2 diabetes. It was 20% for men and 24% for women.
Adding on regular conflict and confrontation, that risk jumped another 15% for men and 20% for women. And then, looking at how these respondents fared in workplace support systems, the data showed that women in emotionally demanding jobs that required a high level of interaction with others, with low social support in the workplace, had a 47% higher risk of developing diabetes compared to women with low demands on the job and a robust support network among their team.
“With regards to having contact with people at work, there are expectations for emotional management where workers are required to express or hide emotions according to societal, occupational and organisational norms," the researchers noted. "It is especially stressful when the displayed emotion and the genuinely felt emotion are not aligned."
So what does this mean? While the study has its limitations, it does highlight that the workplace – and the support system that employees in people-facing jobs have – is linked to poor metabolic health outcomes. However, it must be said that the study is a generalized one that discounts the individual experience, and it's just a snapshot of someone's working life – where they were working in 2005.
"The biological mechanisms underlying the association between person-related work and type 2 diabetes may involve biological responses to repeated and chronic stress that affects the neuroendocrine system by activation of the central sympathetic nervous system and hypothalamus–pituitary–adrenal axis, leading to excessive cortisol production, increased insulin resistance, and decreased insulin secretion and sensitivity," wrote the researchers. "In addition, chronic stress can increase pro-inflammatory cytokines, which impair insulin signaling and functioning. With insufficient social support at work, stress in person-related work may worsen and exert a greater impact on these biological alterations."
Despite its limitations, the study is a fascinating insight into the often unseen and unappreciated stressors in roles like teaching, nursing and social work – which are associated with high burnout, high staff turnover and, in many regions, are chronically understaffed.
"Person-related work is associated with an increased risk of type 2 diabetes, and lacking social support at work may further amplify the association," the researchers concluded. "Our findings highlight the impact of demands and challenges in person-related work on workers’ metabolic health. Future studies are warranted to explore mechanisms (eg, biological or behavioural mechanisms) underlying the associations and develop preventive strategies aiming to lower health hazards in person-related work."
The study was published in the journal Occupational & Environmental Medicine.
Source: Karolinska Institutet via Scimex
