Diabetes in the Workplace: A Win-Win Approach to on-the-Job Accommodations and Job Retention

Abstract

Background

Diabetes affects over 38 million U.S. adults and is linked to higher absenteeism, presenteeism, early retirement, and workplace discrimination. Despite ADA protections and evidence that reasonable accommodations dramatically improve outcomes, workers with diabetes underutilize them, primarily due to stigma, fear of retaliation, and a daunting accommodation request process.

Objectives and Methods

This article first presents a detailed occupational and demographic profile of diabetes, showing disproportionate impact on racial/ethnic minorities; individuals who are overweight or obese; those in shift-based or physically demanding jobs; and those with mobility limitations, neuropathy, and vision impairment.

Results

A composite worker, Brendan (a 48-year-old Hispanic warehouse associate), illustrates how these factors intersect to deter disclosure and accommodation requests. The manuscript then introduces the Win-Win Approach—a non-adversarial, seven-step framework—and provides a step-by-step case example contrasting effective versus ineffective communication when Brendan requests private space and refrigeration for insulin administration.

Implications and Conclusions

By offering replicable strategies, the article equips workers, employers, and rehabilitation professionals to increase accommodation utilization, reduce stigma, and achieve better health and employment outcomes.

Keywords

diabetes mellitus workplace supports vocational rehabilitation job accommodations

Introduction

Diabetes mellitus, hereafter referred to as diabetes, is a group of chronic metabolic health conditions characterized by elevated blood glucose levels due to LIMITATIONS in insulin production, insulin resistance, or both (Centers for Disease Control and Prevention [CDC], 2024a). The two most common forms are Type 1 and Type 2 diabetes, which affect the body's ability to produce and use insulin in different ways (Falvo & Holland, 2018). Type 1 diabetes can be considered as an autoimmune reaction, where the body mistakenly attacks the pancreatic cells that produce insulin, resulting in little or no insulin production and subsequent high blood glucose levels. On the other hand, type 2 diabetes is characterized primarily by insulin resistance, where the body does not use insulin effectively and is unable to maintain normal blood glucose levels. Type 2 accounts for 90–95% of diabetes cases, while type 1 comprises 5–10% (CDC, 2024a). Besides these two forms, there is also Gestational diabetes, which develops during pregnancy, as well as other specific but less common types of diabetes.

Diabetes has emerged as one of the most significant public health challenges in recent decades. Globally, 830 million adults, approximately 14% of the human population, were living with diabetes in 2022, nearly doubling from 7% in 1990. In the U.S., the CDC (2024b) reported that 38.1 million (14.7%) of the U.S. adult population had diabetes in 2021, with prevalence increasing steadily with age. These figures are projected to continue increasing significantly in the coming decades due to factors such as an aging population, rising obesity rates, growth in higher-risk racial/ethnic minority groups, and improved survival rates among people with diabetes (Lin et al., 2018; Rowley et al., 2017).

Different causes and risk factors lead to the development of Type 1 and Type 2 diabetes. Type 1 diabetes results primarily from an autoimmune process in which the body attacks the insulin-producing beta cells of the pancreas. Although the exact cause is not fully understood, a combination of genetic predisposition (e.g., human leukocyte antigen [HLA] gene variants) and environmental exposures (e.g., viral infections, pollutants) plays a significant role (Falvo & Holland, 2018). In contrast, Type 2 diabetes, the most common form, is strongly associated with lifestyle-related factors, including obesity, poor nutrition, and physical inactivity, alongside genetic susceptibility. Additional risk factors such as advancing age, family history, certain ethnic backgrounds, and conditions like hypertension further increase the likelihood of developing Type 2 diabetes (Bellou et al., 2018).

Several symptoms are common across both forms of diabetes, including excessive thirst, frequent urination, fatigue, blurred vision, slow wound healing, and increased susceptibility to infections (CDC, 2024a; Falvo & Holland, 2018). Type 1 diabetes often develops suddenly and may present with weight loss, nausea, or diabetic ketoacidosis, a serious condition caused by dangerously high levels of blood acids (i.e., ketones). Type 2 diabetes typically develops gradually and is often marked by persistent fatigue, vision problems, and peripheral neuropathy, which can cause tingling, numbness, or pain in the extremities (American Diabetes Association, 2025).

As a life-long, chronic condition with no known cure, diabetes significantly and negatively affects multiple domains of life including the physical, psychological, and social realms. Symptoms such as fatigue and neuropathy can limit physical functioning, including stamina and mobility, which in turn may prevent people from engaging in meaningful social interactions and activities. The ongoing need for insulin injections and other treatment routines adds further inconvenience and complexity to managing daily tasks (Zhang et al., 2019). Beyond the physical challenges, individuals with diabetes are often stigmatized, with others attributing the condition to poor lifestyle choices or risky behaviors. Such perceptions can lead to feelings of shame and guilt, ultimately decreasing willingness to participate in social activities (Smart, 2012).

Diabetes and Employment

Employment is a notable life domain significantly impacted by diabetes. Evidence consistently shows a negative association between diabetic symptoms and employment outcomes. Adults with diabetes are 2–10 percentage points less likely to be employed compared with those without the condition, and they face higher risks for early retirement and disability pensions (Pedron et al., 2019). In terms of work attendance, employees with diabetes miss 0.5 to 3.9 more workdays per year than non-disabled workers, depending on demographic groups (Parker et al., 2023). Workers with diabetes and neuropathic symptoms are 18% more likely than other workers to lose 2 or more hours of work per week (Lavaysse et al., 2022). At the national level, the economic impact is substantial. In the U.S., the indirect costs of diabetes to employers are staggering, with an estimated $5.4 billion due to absenteeism and $35.8 billion from reduced productivity at work. Diabetes also costs the national economy $28.3 billion related to people with diabetes not working, and nearly $32.4 billion from premature mortality attributed to diabetes (CDC, 2024c).

Symptoms of diabetes create unique challenges for individuals in performing work tasks and fully engaging in the workplace. For example, fatigue, foot ulcers, and other neuropathic symptoms significantly reduce stamina and limit the capacity to perform physically demanding tasks over long periods (Falvo & Holland, 2018; Palmer et al., 2023). Cognitive difficulties such as confusion and memory loss, often due to fluctuations in blood glucose levels, can interfere with concentration and alertness, reducing productivity (Lee et al., 2018). Vision impairment, even when mild, can hinder the ability to complete visually demanding tasks such as reading screens, operating machinery, or driving, which restricts access to certain occupations and may reduce opportunities for career advancement (Chai et al., 2023).

In addition to symptoms, lifelong treatment requirements also add layers of complexity. Individuals with diabetes often need private, temperature-controlled storage for insulin and other medical supplies, as well as adequate time and space to administer insulin (Ghosh et al., 2018). Further, diabetes-related stigma and discrimination, such as facing doubts about work capability or being overlooked for advancement opportunities, can lead to workplace exclusion and psychological distress at work (Olesen et al., 2020; Speight et al., 2024) Together, these internal and external challenges make it more difficult for individuals with diabetes to achieve sustained success in employment.

Workplace Accommodations for People with Diabetes

From a legislative perspective, efforts have been made to protect the employment experiences of people with diabetes. The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination and in particular requires employers to provide reasonable accommodations to qualified employees with disabilities. Under the original ADA (1990), individuals with diabetes often struggled to qualify for coverage and accommodation receipt because the definition of disability was interpreted narrowly, requiring proof that the condition “substantially limited” a major life activity (Widiss, 2015). This created barriers for many employees with diabetes, particularly those whose symptoms were controlled through treatment. The passage of the ADA Amendments Act of 2008 (ADAAA, 2008) expanded the definition of disability and clarified that mitigating measures such as insulin use should not be considered when determining coverage. As a result, diabetes is now more readily recognized as a disability under the law, ensuring that individuals with the condition are entitled to reasonable workplace accommodations and protection against discrimination.

An accommodation is a modification or adjustment to a job, the work environment, or the way things are usually done that enables a qualified individual with a disability to perform the essential functions of the position and enjoy equal employment opportunities. A variety of workplace accommodation solutions have been developed to support the unique needs of employees with diabetes, often organized according to specific symptoms and the job functions they affect. For employees experiencing fatigue and weakness, the Job Accommodation Network (2020) recommends frequent rest breaks and the elimination of strenuous activities to help maintain energy throughout the workday. Neuropathic symptoms may be addressed through modifications to dexterity-related tasks and the use of protective equipment, such as diabetic shoes or ergonomic hand tools. For those with vision-related complications, accommodations such as external magnification devices, high-contrast work environments, and screen readers can improve accuracy and productivity. In addition, flexible work hours, reminder systems, and reduced workplace distractions can support employees managing cognitive challenges associated with diabetes. Also, providing private areas for blood sugar monitoring, insulin administration, and secure storage of medications and supplies are considered important accommodations that allow effective diabetes management in the workplace (Rumrill et al., 2022).

Employees who do not receive necessary accommodations experience significantly greater productivity losses, with approximately 5.11 times higher odds of lost productivity compared to those who receive the accommodation they need (Gifford & Zong, 2017). In contrast, workers with diabetes whose accommodation needs are met or exceeded often report better job outcomes, even with just small, individualized, low-cost adjustments to existing workplace practices (Gignac et al., 2018; McCarthy et al., 2021). For example, accommodations, such as flexible scheduling and psychological support, can help alleviate presenteeism, the phenomenon in which employees are physically present at work but not functioning at full capacity due to chronic illness and disability (Mori et al., 2019). Moreover, the use of digital health programs implemented as workplace accommodations to manage diabetes-related distress have been shown to improve productivity outcomes, including reductions in both absenteeism and presenteeism (Lavaysse et al., 2022).

Despite the positive effects of accommodations on workplace performance and productivity, as well as the federal mandate requiring employers to provide reasonable accommodations, workers with diabetes still have not fully benefited from them. Issues between employees with diabetes and their employers regarding awareness of laws and accommodation options, communication regarding needs and rights, and implementation through formal policies and individualized practices often hinder the effective provision of accommodations (Dong et al., 2020). For example, workers with diabetes may hesitate to disclose their condition or request accommodations due to fear of reprisal or being perceived as less capable than other workers. On the other hand, employers may lack knowledge about diabetes and accommodation strategies or may rely on rigid workplace policies, resulting in accommodations being overlooked or inconsistently applied (Dong et al., 2020; Von Schrader et al., 2014).

Given the positive role of workplace accommodations and the persistent challenges workers with diabetes face in receiving them, this article examines the accommodation request process and provides practical examples of strategies for making this process smoother and more effective for employers and workers with diabetes alike.

Profile of Workers with Diabetes

Before examining the job accommodation request process and specific navigation strategies, it is helpful to consider the characteristics and experiences of workers with diabetes. Who comprises this population? In which occupations and work environments are they most commonly employed? What barriers do they most frequently encounter?

This profile is not intended to stereotype individuals with diabetes or reduce their experiences to a single archetype. Given the vast diversity of diabetes presentations (type 1, type 2, gestational, and secondary forms), symptom severity, complication profiles, occupational demands, and workplace cultures, no universal accommodation solution exists. Nevertheless, understanding common demographic, occupational, and functional patterns among workers with diabetes provides essential context. Such a foundation helps demystify the accommodation process, highlights why many eligible individuals hesitate to request support, and serves as a practical reference point for individualized strategies.

Occupational Distribution

Workers with diabetes are employed across all sectors of the economy, but prevalence varies significantly by job type and is influenced by lifestyle risks (e.g., shift work, physical demands, sedentary behavior). Overall, about 6% of employed U.S. adults are diagnosed with diabetes, with higher rates in manual or service-oriented roles (Shockey et al., 2021).

Workers with diabetes have elevated representation in several occupation groups. Key examples include protective services (e.g., law enforcement officers, security guards): 9–10.5% prevalence in U.S. workers, compared with a national workforce average of approximately 6.4% (Shockey et al., 2021); transportation and material moving (e.g., truck drivers, delivery drivers): up to 8.8% prevalence among men, driven in part by prolonged sedentary periods and irregular meal schedules (Shockey et al., 2021); manufacturing and blue-collar manual occupations (e.g., assembly-line workers, machine operators): 6–9% prevalence in population-based cohorts from Sweden and Hong Kong (Carlsson et al., 2019; Hung et al., 2021); healthcare support and personal care roles (e.g., nursing assistants, home health aides): 8–9% prevalence, linked to high rates of shift work and physical demands (Shockey et al., 2021); and non-skilled manual and service occupations (e.g., cleaners, food-service workers): 5–7% prevalence among women, with some subgroups showing even higher age-adjusted rates (Carlsson et al., 2019; Hung et al., 2021).

These patterns of overrepresentation are consistently associated with occupational characteristics that either exacerbate diabetes risk or complicate disease management: non-standard shift schedules, chronic work-related stress, limited access to healthy meals, prolonged sedentary time, and—in manual roles—physically demanding tasks that may conflict with glycemic control or increase injury risk when hypoglycemia occurs (Shockey et al., 2021). Thus, workers with diabetes do not necessarily select these occupations; rather, the working conditions inherent to these jobs appear to contribute—both directly and indirectly—to the development of diabetes and to its subsequent management challenges (Shockey et al., 2021). This bidirectional relationship between hazardous occupational environments and diabetes underscores the critical importance of reasonable accommodations in enabling affected workers to maintain both health and employment.

Demographic Profile

Workers with diabetes are disproportionately drawn from certain demographic groups, a pattern that reflects both higher incidence and greater functional burden. Prevalence is higher among racial and ethnic minorities than among non-Hispanic White adults: age-adjusted rates reach 19% for non-Hispanic Asians, 17–20% for non-Hispanic Black adults, 15–22% for Hispanic adults, and 13.6% for American Indians and Alaskan Natives, compared with 12–14% for non-Hispanic Whites (Cheng et al., 2019; CDC, 2024b). These minority populations also experience higher complication rates and poorer glycemic control, translating into greater work-related disability (Spanakis & Golden, 2013). Overweightness and obesity are nearly ubiquitous among adults with diabetes; nearly 90% have a body mass index of 25 kg/m² or higher, and nearly 50% meet criteria for obesity (BMI ≥ 30 kg/m²; CDC, 2024b). Obesity prevalence contributes directly to mobility limitations, chronic pain, and elevated absenteeism. Socioeconomic gradients are equally pronounced. Diabetes prevalence is as high as 16% among adults below the federal poverty level or with less than a high school education, but falls to 6–7% among college graduates and those with household incomes at or above 500% of the poverty threshold (CDC, 2024b). Lower socioeconomic status is associated with delayed diagnosis, inadequate disease management, and markedly higher rates of work disability. Co-occurring disabilities are common. People with diabetes have a 50%-90% increased risk of disability compared to those without diabetes. 25–40% of working-age adults with diabetes report major mobility limitations, 20–40% experience vision impairment or peripheral neuropathy, and cardiovascular disease further restricts functional capacity (Gregg et al., 2017; Kassaw et al., 2025; Pfannkuche et al., 2020). Diabetes is currently the leading cause of new cases of blindness among adults, and approximately 10% of people with diabetes report severe vision issues or blindness (CDC, 2024b). Finally, although diagnosed diabetes is slightly more prevalent among working-age men (15.4%) than women (14.1%), women bear a disproportionate functional burden, with 27–35% higher rates of disability (Bardenheier et al., 2018; CDC, 2024b).

Workplace Stigma and Discrimination

Workers with diabetes frequently encounter stigma-driven barriers in the workplace, manifesting as stereotypes about unreliability, safety risks, or perceived laziness due to symptoms like fatigue or the need for medical breaks. These biases not only deter disclosure of the condition but also lead to discriminatory employer actions, including denial of accommodations, harassment, and termination—issues prominently documented in Equal Employment Opportunity Commission (EEOC) complaints under the ADA. Analysis of over 328,000 EEOC allegations from 1992–2003 revealed that diabetes accounted for 3.5% (n = 11,437) of discrimination charges, with affected individuals facing higher rates of job-retention discrimination (e.g., demotions or firings) compared to other impairments, often rooted in unfounded fears of hypoglycemic episodes impairing performance (McMahon et al., 2005).

What follows are examples of common and specific stigma-related barriers for people with diabetes, as evidenced by EEOC enforcement actions. First, perceptions of unreliability or incompetence, where employers label diabetic workers as “liabilities” for needing breaks to monitor blood glucose or eat snacks, leading to exclusion from customer-facing roles or promotions. In EEOC v. United States Parcel Service (2019), a diabetic employee was terminated after requesting short breaks, with supervisors citing safety concerns despite stable control; the court ruled this direct evidence of discriminatory intent, awarding $150,000 in relief (EEOC, 2019). Second, harassment and privacy violations, such as co-workers or managers mocking symptoms (e.g., shakiness as “drunkenness”) or demanding disclosure beyond ADA limits, fostering a hostile environment. EEOC guidance highlights that such conduct violates ADA anti-retaliation provisions, yet complaints reveal underreporting due to fear of further stigma (EEOC, 2011a). Third, refusal of reasonable accommodations due to stereotypes about the person's job fitness, particularly in safety-sensitive positions. For instance, in EEOC v. Walgreens (2011), a diabetic cashier was fired for needing snack access rather than accommodated, reflecting biases against visible self-management; the suit emphasized ADA protections for non-disruptive adjustments like modified schedules (EEOC, 2011b).

In summary, the typical U.S. worker with diabetes is disproportionately a racial/ethnic minority group member; overweight or obese; employed in physically demanding or shift-based manual/service occupations; burdened by higher rates of mobility limitations, neuropathy, and vision problems; and acutely aware of workplace stigma that portrays symptom management as weakness or unreliability. With this statistical and occupational profile in mind, consider Brendan—a composite but highly representative worker with diabetes. Brendan is a 48-year-old Hispanic man with type 2 diabetes, overweight (BMI ≈ 34), and employed as a warehouse associate in material-moving and transportation. He experiences persistent fatigue, early peripheral neuropathy that makes prolonged standing painful, occasional blurred vision, and unpredictable hypoglycemic episodes that require quick access to food or glucose tabs—needs that clash with rigid break schedules and a workplace culture that views any “special treatment” as favoritism. Like many workers in similar demographic and occupational circumstances, Brendan has never formally requested accommodations, fearing he will be labeled unreliable, mocked for his symptoms, or pushed toward early retirement (fears repeatedly documented in EEOC charges and stigma research). Brendan's story illustrates why, despite clear legal protections and proven low-cost solutions, the accommodation request process remains underutilized and daunting for the very population that needs it most.

The Accommodation Request Process: The Win-Win Approach

Brendan — like millions of other workers – is a qualified individual with a disability (diabetes) and is therefore entitled to reasonable accommodations under the ADA. For many employees, however, the process of identifying, requesting, implementing, and maintaining those accommodations feels intimidating and adversarial. To make the experience simpler, faster, and more successful, we strongly recommend the Win-Win Approach: a non-confrontational, collaborative framework that guides the employee and employer through planning, requesting a meeting, explaining the need, addressing resistance, negotiating solutions, agreeing on implementation, and following up—treating the entire process as joint problem-solving rather than a legal showdown (Rumrill et al., 2023). When an individual with diabetes is properly accommodated, everyone wins—the employee gains greater job satisfaction, health stability, and productivity, while the employer retains a skilled worker, boosts morale, and avoids the significant legal and financial risks associated with denial (including potential six-figure settlements).

A complete explanation of the Win-Win Approach, along with legal definitions, examples of disability-related functional limitations and corresponding accommodations, and additional resources, is available in the Win-Win brochure (https://hdi.uky.edu/setp/wp-content/uploads/sites/6/2025/08/The-Win-Win-Approach-to-Reasonable-Accommodations.pdf). Consistent with the goals of this manuscript—to demystify the accommodation request process and offer practical, evidence-based strategies for workers with diabetes and their employers—the following case example follows Brendan step-by-step through a real-world request for private space and refrigeration for insulin administration. At each stage we contrast effective, collaborative communication with common ineffective approaches, illustrating exactly how the Win-Win framework transforms a potentially tense interaction into a true mutual success.

Case Example: Brendan Successfully Requests Private Space and Refrigeration Using the Win-Win Approach

The Win-Win approach comprises seven key steps: planning and preparation, requesting the initial meeting, requesting accommodations and disability disclosure, responding to employer resistance, negotiation, agreeing on an implementation plan, and follow-up and evaluation. See Appendix A (Win-Win Visual) for a chart with more details on each step. This scenario illustrates the application of the Win-Win problem-solving process for requesting a reasonable job accommodation under the ADA. In this scenario, Brendan, a warehouse associate with type 2 diabetes, needs a private and clean space to test his blood sugar and administer insulin injections two to three times during the workday. He also needs access to a refrigerator to store his insulin. Each step outlined below includes both an example of effective communication and a contrasting example of poor communication, followed by a brief explanation of why the effective approach is superior.

Step 1: Planning and Preparation.

Effective Example

Brendan, a 48-year-old warehouse associate, notices that managing his blood sugar at work is becoming increasingly difficult amid long shifts on his feet and rigid break schedules. He compiles a prioritized list of needs: (1) a small private room where insulin injections can be administered safely and hygienically, and (2) access to a mini-refrigerator to store his insulin at the appropriate temperature. Before approaching his employer, Brendan researches accommodation options through JAN and the ADA National Network. He also consults his VR counselor to explore examples of workplace accommodations appropriate for his needs. Brendan practices the conversation with a trusted friend, focusing on safety, stamina, and the benefits to the employer of retaining an experienced worker such as himself. A letter from Brendan's physician is prepared, describing the need for a private sanitary space and refrigeration for medication without disclosing unnecessary medical details.

Ineffective Example

Brendan plans on just telling his supervisor, Janice, about his needs without preparing a list or gathering supporting information. No research is conducted, no alternative solutions are considered, and no documentation is prepared.

Why the Effective Approach Works

The prepared approach ensures that Brendan enters the conversation with credible information, a clear rationale, and practical solutions, setting a constructive and collaborative tone. The unprepared approach increases the likelihood of misunderstandings, incomplete communication, and dismissal of the request.

Step 2: Requesting the Meeting.

Effective Example

Brendan sends a brief email to Janice: “Hi Janice, I’d like to set up a short meeting this week to discuss a small adjustment to my workspace that would help me stay safe and productive on the warehouse floor. Would you have 15 min on Wednesday or Thursday?” Janice replies with a scheduled time in a private setting, ensuring both parties can prepare.

Ineffective Example

Brendan approaches Janice during a busy shift change and says, “I need to talk to you about something medical. Do you have five minutes right now?” Janice, caught off guard and pressed for time, gives a distracted answer.

Why the Effective Approach Works

Scheduling a dedicated meeting respects the supervisor's time and ensures a focused, private conversation. Abruptly raising the matter in a busy setting risks partial attention and reduced willingness to engage.

Step 3: Explaining the Need.

Effective Example

At the meeting, Brendan begins by thanking Janice for her time. “I appreciate you meeting with me. I wanted to talk to you about accommodation options for a health condition I have that requires me to monitor my blood sugar and administer insulin during the workday. To do this safely—especially with the physical demands and variable temperatures in the warehouse—I would need a small, private space. This will allow me to handle my medical needs quickly and get right back to my workstation. I would also need a small refrigerator nearby to store my medication safely.”

Ineffective Example

Brendan opens with, “I have diabetes, so I need a private room. Honestly I can’t believe we don’t already have something like this.”

Why the Effective Approach Works

The effective example frames the request in terms of safety and productivity, while keeping the tone professional and solution-focused. The ineffective approach uses accusatory language, which can trigger defensiveness.

Step 4: Responding to Employer Resistance

Janice responds, “Bathrooms are private, couldn’t you just use one of those?”

Effective Example

Brendan responds calmly: “I understand why that might seem like a reasonable option. However, bathrooms are not sanitary for handling needles or medication. Additionally, I need a refrigerated space for insulin storage, which would not be possible in a restroom. The ADA encourages employers and employees to work together to find reasonable solutions, and I believe we can identify a space that works well for both of us.”

Ineffective Example

Brendan reacts sharply: “That's not acceptable. The law says you have to give me what I want. Bathrooms are disgusting, and frankly, it's irresponsible to even suggest that.”

Why the Effective Approach Works

The effective example acknowledges the employer's perspective, provides a rational explanation, and introduces the ADA as a collaborative framework rather than a threat. The ineffective example escalates conflict and may shut down constructive dialogue.

Step 5: Negotiating the Accommodation

Effective Example

Brendan says, “I have a couple of ideas that might work. My top choice would be the unused storage room on the second floor; it's quiet, lockable, and close to my workstation. It could easily accommodate a mini-fridge. If that is not possible, I could reserve one of the small break rooms for short periods during the day. I’m happy to coordinate scheduling to minimize disruption.” Janice responds that the storage room could be made available with minor adjustments, and Brendan offers to help with the reorganization.

Ineffective Example

Brendan insists, “It's the storage room or nothing. That's my first choice, and I’m not going to settle for less.”

Why the Effective Approach Works

Offering more than one solution while clearly identifying preferences allows room for compromise, building trust. Refusal to consider alternatives increases the risk of impasse.

Step 6: Agreeing on an Implementation Plan

Effective Example

Brendan confirms, “Great, we’ll start using the storage room on Monday. I’ll request a purchase with HR for a small fridge today, and I’ll check in after two weeks to let you know how it's working. If any issues come up, we can adjust as needed.”

Ineffective Example

Brendan says, “Okay, I’ll just start using it tomorrow, and you can figure out the fridge whenever.”

Why the Effective Approach Works

A clear implementation plan with timelines and responsibilities ensures accountability and reduces the risk of misunderstandings. The ineffective example leaves details unresolved.

Step 7: Following Up and Evaluating

Effective Example

Two weeks later, Brendan emails Janice: “Thanks again for making the storage room available. It's been working well, and I can quickly return to work after taking care of my medical needs. HR was prompt to get me the fridge, and it has been reliable. I’ll keep you updated if my needs change.”

Ineffective Example

Brendan says nothing further, leading Janice to assume that “no news is good news.”

Why the Effective Approach Works

Proactive follow-up signals appreciation, confirms the accommodation's effectiveness, and keeps the communication line open.

This case example demonstrates that effective use of the Win-Win approach involves preparation, respectful communication, willingness to consider alternatives, and ongoing collaboration. Even in situations where an employer initially proposes an inadequate accommodation, a calm, rational, and cooperative response increases the likelihood of a mutually acceptable outcome. In contrast, an unprepared or confrontational approach can erode goodwill and make resolution more difficult. By focusing on mutual benefit, employees like Brendan can maintain productivity while securing accommodations that protect their health and dignity!

Conclusion

Workers with diabetes represent one of the largest yet most underserved disability groups in the U.S. labor force. Despite robust protection under the ADA and ADAAA, and despite abundant evidence that low-cost accommodations dramatically improve health, productivity, and job retention, request rates remain strikingly low, driven by (legitimate) fears of discrimination and retaliation documented repeatedly in EEOC charges. The Win-Win approach offers a proven, non-adversarial approach that transforms accommodation discussions from perceived threats into collaborative problem-solving. As Brendan's case illustrates, when employees prepare thoughtfully and communicate collaboratively- and when employers respond in good faith- even longstanding barriers dissolve into mutual benefit. Widespread adoption of this framework by vocational rehabilitation professionals, diabetes educators, HR departments, and employee resource groups has the potential to reduce diabetes-related stigma, narrow employment disparities, and yield substantial economic returns for both workers and employers.

Footnotes

ORCID iD

Sara Park

Ethics Statement

This article does not involve human subjects.

Informed Consent

N/A.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The contents of this presentation were developed with support from a grant for the Career Innovations Project, in cooperation with the University of Illinois Urbana-Champaign and Michigan State University. The project is funded by a grant from the United States Department of Education, Rehabilitation Services Administration (award number H263G250011). The ideas, opinions, and conclusions expressed are those of the authors and do not necessarily represent recommendations, endorsements, or policies of the U.S. Department of Education.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Appendix A

Win-Win Visual

References

ADA Amendments Act of 2008. (2008). Pub. L. No. Pub. L. No. 110-325, 122 Stat. 3553 (2008).

American Diabetes Association. (2025). Diabetes Symptoms & Early Warning Signs: Know When to Take Action. https://diabetes.org/about-diabetes/warning-signs-symptoms.

Americans with Disabilities Act of 1990. (1990). Pub. L. No. Pub. L. No. 101-336, 42 U.S.C. § 12101 et seq. 104 Stat. 327 (1990).

Bardenheier

B. H.

Lin

Zhuo

Ali

M. K.

Thompson

T. J.

Cheng

Y. J.

Gregg

E. W.

(2018). Disability-free life-years lost among adults aged >50 years, with and without diabetes mellitus. Diabetes Care, 39(7), 1222–1229. https://doi.org/10.2337/dc15-1095

Bellou

Belbasis

Tzoulaki

Evangelou

(2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PloS One, 13(3), e0194127. https://doi.org/10.1371/journal.pone.0194127

Carlsson

Andersson

Talback

Feychting

(2019). Incidence and prevalence of type 2 diabetes by occupation: Results from all Swedish employees. Diabetologia, 63(1), 95–103. https://doi.org/10.1007/s00125-019-04997-5

CDC. (2024a, July 19). Diabetes Basics. Diabetes. https://www.cdc.gov/diabetes/about/index.html.

CDC. (2024b, July 23). National Diabetes Statistics Report. Diabetes. https://www.cdc.gov/diabetes/php/data-research/index.html.

CDC. (2024c, August 6). Employers and Insurers. Diabetes. https://www.cdc.gov/diabetes/hcp/employers/index.html.

10.

Chai

Y. X.

Gan

A. T. L.

Fenwick

E. K.

Sui

A. Y.

Tan

B. K. J.

Quek

D. Q. Y.

Qian

Wong

T. Y.

Cheng

C.-Y.

Lamoureux

E. L.

Man

R. E. K.

(2023). Relationship between vision impairment and employment. British Journal of Ophthalmology, 107(3), 361–366. https://doi.org/10.1136/bjophthalmol-2021-319655

11.

Cheng

Y. J.

Kanaya

A. K.

Araneta

M. R. G.

Saydah

S. H.

Kahn

H. A.

Gregg

E. W.

Fujimoto

W. Y.

Imperatore

(2019). Prevalence of diabetes by race and ethnicity in the United States, 2011-2016. JAMA, 322(24), 2389–2398. https://doi.org/10.1001/jama.2019.19365

12.

Dong

Geyer

Hinton

Chin

(2020). Accommodation request strategies among employees with disabilities: Impacts and associated factors. Rehabilitation Counseling Bulletin, 63(3), 168–178. https://doi.org/10.1177/0034355219834630

13.

Equal Employment Opportunity Commission. (2011a). Diabetes in the workplace and the ADA. https://www.eeoc.gov/laws/guidance/diabetes-workplace-and-ada.

14.

Equal Employment Opportunity Commission. (2011b). Walgreens sued by EEOC for disability discrimination. https://www.eeoc.gov/newsroom/walgreens-sued-eeoc-disability-discrimination.

15.

Equal Employment Opportunity Commission. (2019). United Parcel Service to pay $150,000 to settle EEOC disability discrimination lawsuit. https://www.eeoc.gov/newsroom/united-parcel-service-pay-150000-settle-eeoc-disability-discrimination-lawsuit .

16.

Falvo

Holland

B. E.

(2018). Medical and Psychosocial Aspects of Chronic Illness and Disability. Jones & Bartlett Learning.

17.

Ghosh

Bajaj

Mukhopadhyay

Agarwal

Aravind

S. R.

Gupta

Chawla

Jana

Kalra

Kumar

Maheshwari

Makkar

B. M.

Moses

Panda

Panikar

Rao

P. V.

Saboo

Sahay

Viswanathan

(2018). Diabetes and employment. International Journal of Diabetes in Developing Countries, 38(2), 133–137. https://doi.org/10.1007/s13410-018-0643-0

18.

Gifford

Zong

(2017). On-the-Job productivity losses among employees with health problems: The role of work accommodations. Journal of Occupational and Environmental Medicine, 59(9), 885–893. https://doi.org/10.1097/JOM.0000000000001094

19.

Gignac

M. A. M.

Kristman

Smith

P. M.

Beaton

D. E.

Badley

E. M.

Ibrahim

Mustard

C. A.

(2018). Are there differences in workplace accommodation needs, use and unmet needs among older workers with arthritis, diabetes and No chronic conditions? Examining the role of health and work context. Work, Aging and Retirement, 4(4), 381–398. https://doi.org/10.1093/workar/way004

20.

Gregg

E. W.

Hora

Benoit

S. R.

& Albright

(2017). Disability and diabetes. In Cowie

C. C.

Saydah

Williams

, et al. (Eds.), Diabetes in America (3rd ed., Chap. 32, pp. 34-1–34-15). National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

21.

Hung

H. H. Y.

Chan

E. Y. Y.

Chow

E. Y. K.

Chung

G. K. K.

Lai

F. T. T.

Yeoh

(2021). Non-skilled occupation as a risk factor of diabetes among working population: A population-based study of community-dwelling adults in Hong Kong. Health and Social Care in the Community, 30(1), e86–e94. https://doi.org/10.1111/hsc.13415

22.

Kassaw

A. B.

Hadigu

A. A.

Abebe

M. S.

Tareke

A. A.

Debebe

Mankelkl

Kebede

Gedefie

(2025). Prevalence of vision impairment among patients with diabetes mellitus in Sub-Saharan Africa: A systematic review and meta-analysis. PLOS One, 20(6), e0326176. https://doi.org/10.1371/journal.pone.0326176

23.

Lavaysse

L. M.

Imrisek

S. D.

Lee

Osborn

C. Y.

Hirsch

Hoy-Rosas

Nagra

Goldner

Dachis

Sears

L. E.

(2022). One drop improves productivity for workers with Type 2 Diabetes. Journal of Occupational and Environmental Medicine, 64(8), e452–e458. https://doi.org/10.1097/JOM.0000000000002577

24.

Lee

Smofsky

Nykoliation

Allain

S. J.

Lewis-Daly

Schwartz

Pollack

J. H.

Tarride

J.-E.

McIntyre

R. S.

(2018). Cognitive impairment mediates workplace impairment in adults with Type 2 Diabetes Mellitus: Results from the Motivaction study. Canadian Journal of Diabetes, 42(3), 289–295. https://doi.org/10.1016/j.jcjd.2017.06.013

25.

Lin

Thompson

T. J.

Cheng

Y. J.

Zhuo

Zhang

Gregg

Rolka

D. B.

(2018). Projection of the future diabetes burden in the United States through 2060. Population Health Metrics, 16(1), 9. https://doi.org/10.1186/s12963-018-0166-4

26.

McCarthy

Vorderstrasse

Yan

Portillo

Dickson

V. V.

(2021). Managing diabetes in the workplace. Workplace Health & Safety, 69(5), 216–223. https://doi.org/10.1177/2165079920965538

27.

McMahon

B. T.

West

S. L.

Mansouri

Belongia

(2005). Workplace discrimination and diabetes: The EEOC Americans with Disabilities Act research project. Work, 25(1), 9–18.

28.

Mori

Nagata

Iwasaki

Sakai

Kimura

Shinzato

(2019). Factors of occurrence and improvement methods of presenteeism attributed to diabetes: A systematic review. Journal of Occupational Health, 61(1), 36–53. https://doi.org/10.1002/1348-9585.12034

29.

Olesen

Cleal

Willaing

(2020). Discrimination and stigma among people with type 2 diabetes in the workplace: Prejudice against illness or obesity? Public Health, 180(2020), 100–101. https://doi.org/10.1016/j.puhe.2019.11.009

30.

Palmer

K. N. B.

Crocker

R. M.

Marrero

D. G.

Tan

T.-W.

(2023). A vicious cycle: Employment challenges associated with diabetes foot ulcers in an economically marginalized Southwest US sample. Frontiers in Clinical Diabetes and Healthcare, 4, 1027578. https://doi.org/10.3389/fcdhc.2023.1027578

31.

Parker

E. D.

Lin

Mahoney

Ume

Yang

Gabbay

R. A.

ElSayed

N. A.

Bannuru

R. R.

(2023). Economic costs of diabetes in the U.S. In 2022. Diabetes Care, 47(1), 26–43. https://doi.org/10.2337/dci23-0085

32.

Pedron

Emmert-Fees

Laxy

Schwettmann

(2019). The impact of diabetes on labour market participation: A systematic review of results and methods. BMC Public Health, 19, 25. https://doi.org/10.1186/s12889-018-6324-6

33.

Pfannkuche

Alhajjar

Ming

Walter

Piehler

Mertens

P. R.

(2020). Prevalence and risk factors of diabetic peripheral neuropathy in a diabetics cohort: Register initiative “Diabetes and Nerves.”. Endocrine and Metabolic Science, 1(1–2), 100053. https://doi.org/10.1016/j.endmts.2020.100053

34.

Rowley

W. R.

Bezold

Arikan

Byrne

Krohe

(2017). Diabetes 2030: Insights from yesterday, today, and future trends. Population Health Management, 20(1), 6–12. https://doi.org/10.1089/pop.2015.0181

35.

Rumrill

P. D.

Lee

Minton

Bishop

M. L.

Koch

L. C.

Pittman

(2022). Emerging vocational rehabilitation strategies for people with diabetes mellitus. WORK, 73(3), 753–759. https://doi.org/10.3233/WOR-223648

36.

Rumrill

P. D.

Rumrill

S. P.

Wickert

Sheppard-Jones

Baumunk

Roessler

R. T.

(2023). A “win-win” perspective on workplace accommodations: RETAIN Kentucky's self-advocacy guide to promote successful return to work and stay at work outcomes for workers with disabilities. Work, 74(1), 3–10. https://doi.org/10.3233/WOR-223651

37.

Shockey

T. M.

Tsai

R. J.

Cho

(2021). Prevalence of diagnosed diabetes among employed U.S. Adults by demographic characteristics and occupation, 36 states, 2014-2018. Journal of Occupational and Environmental Medicine, 63(4), 302–310. https://doi.org/10.1097/JOM.0000000000002117

38.

Smart

(2012). Disability across the developmental life span: For the rehabilitation counselor (pp. xv, 518). Springer Publishing Company.

39.

Spanakis

E. K.

Golden

S. H.

(2013). Race/ethnic differences in diabetes and diabetic complications. Current Diabetes Reports, 13(6), 814–823. https://doi.org/10.1007/s11892-013-0421-9

40.

Speight

Holmes-Truscott

Garza

Scibilia

Wagner

Kato

Pedrero

Deschênes

Guzman

S. J.

Joiner

K. L.

Liu

Willaing

Babbott

K. M.

Cleal

Dickinson

J. K.

Halliday

J. A.

Morrissey

E. C.

Nefs

O'Donnell

Skinner

T. C.

(2024). Bringing an end to diabetes stigma and discrimination: An international consensus statement on evidence and recommendations. The Lancet Diabetes & Endocrinology, 12(1), 61–82. https://doi.org/10.1016/S2213-8587(23)00347-9

41.

Von Schrader

Bruyère

S. M.

(2014). Accommodation requests: Who is asking for what? Rehabilitation Research, Policy, and Education, 28(4), 329–344. https://doi.org/10.1891/2168-6653.28.4.329

42.

Widiss

(2015). Still Kickin’ After All These Years: Sutton and Toyota as Shadow Precedents. 63 Drake Law Review, 919(2015), https://www.repository.law.indiana.edu/facpub/1671.

43.

Zhang

Goldberg

S. I.

Hosomura

Shubina

Simonson

D. C.

Testa

M. A.

Turchin

(2019). Lifestyle counseling and long-term clinical outcomes in patients with diabetes. Diabetes Care, 42(9), 1833–1836. https://doi.org/10.2337/dc19-0629