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

Aims 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. Materials and Methods 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. Results 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. Conclusion 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.