Multi-Dimensional Barriers for Work Productivity and Possible Solutions to Overcome Presenteeism in Young-Onset Diabetes: A Mixed-Methods Study.

Authors

Kelly T C Wong, Jason D C Yin, Sunny C S Chan, Nga Sze Wong, Chun-Kwan O, Yiming Dai, Yuzheng Zhang, Marques S N Ng, Risa Ozaki, Ronald C W Ma, Alice P S Kong, Andrea O Y Luk, Elaine Y K Chow, Juliana C N Chan, Juliana N M Lui

Published in

Diabetes, obesity & metabolism. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

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.
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.
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 = -0.07, p = 0.049) and suboptimal HRQoL (β = 3.36, p = 0.037). 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.
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.

PMID:
42649103
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

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