Type 2 diabetes significantly increases the risk of vascular diseases, cancer death, and other mortality. The working-age population (20-64) is experiencing a substantial rise in diabetes incidence, projected to reach 417 million by 2030. Young-onset type 2 diabetes further highlights the need for understanding diabetes control among working individuals due to higher average HbA1c, earlier complications, and poorer adherence to lifestyle modifications. The economic burden of diabetes among working populations includes productivity loss and increased healthcare costs. Working conditions such as hours worked, shift work, and psychosocial stress can also influence diabetes control. In Hong Kong, employed individuals spend a significant amount of time at work (44 hours/week), influencing their daily routines, including eating patterns. Global shifts in eating habits, such as increased eating out and irregular meal times, have been linked to diabetes risk and control. Previous studies have examined the association between various eating patterns (e.g., breakfast skipping, meal frequency, late-night dinners) and glycemic control, but few focused on employed diabetic patients and workplace-influenced eating patterns. This study aimed to identify major workplace eating patterns affecting glycemic control among employed type 2 diabetic patients.

The literature review highlighted the increased risk of vascular diseases and mortality associated with diabetes, particularly within the working-age population. Studies showed that younger-onset type 2 diabetes is linked to more severe complications and poorer adherence to lifestyle changes. The economic impact on productivity and healthcare costs was also emphasized. The review examined the limited research on the influence of working conditions (hours, shift work, stress) on diabetes control. It noted the global trend of changing eating patterns, with increased eating out and irregular meal times potentially affecting diabetes risk and management. Existing research showed correlations between specific eating patterns (breakfast skipping, meal frequency, etc.) and glycemic control, but lacked a specific focus on employed diabetic patients and workplace eating habits.

This study employed a sequential mixed-methods design. The qualitative phase involved semi-structured focus group interviews with 31 employed type 2 diabetic patients recruited from a large public hospital in Hong Kong. Participants were purposively sampled to ensure diversity in occupations, diabetes regimens, and age/gender. Thematic analysis was used to identify workplace eating patterns relevant to glycemic control. The quantitative phase was a cross-sectional study involving 185 employed type 2 diabetic patients randomly sampled from a large public clinic. Data were collected using a self-administered questionnaire, which was developed based on findings from the qualitative study and piloted with experts and patients. The questionnaire included demographic information, socioeconomic status, employment details, disease characteristics, and workplace eating patterns. HbA1c levels were retrieved from the clinic's electronic records. Hierarchical multiple linear regression was performed to assess the association between workplace eating patterns (home-prepared meal consumption and meal timing) and HbA1c, adjusting for socio-demographic, lifestyle, and disease factors. Appropriate statistical tests were used to analyze the data.

Focus group interviews revealed that the frequency of home-prepared meal (HPM) consumption at the workplace and meal timing were the most important workplace eating patterns influencing glycemic control. The cross-sectional study confirmed that regular consumption of HPM at work was significantly associated with lower HbA1c levels, independent of other factors (R² = 0.146, F(14, 170) = 2.075, p = 0.015; adjusted R² = 0.076). Patients who were female, in non-skilled occupations, working shifts, with fixed work locations, and having work breaks were more likely to consume HPM regularly. There was a statistically significant difference in HbA1c levels between patients regularly consuming HPM and those eating only restaurant meals (H(2) = 9.579, p = 0.008). Diabetes duration showed a low, positive correlation with HbA1c (r = 0.299, p < 0.001). Other factors like age, sex, education, income, smoking, exercise, and presence of comorbidities were not significantly associated with HbA1c levels after adjusting for HPM consumption.

The findings demonstrate a significant association between regular consumption of HPM at the workplace and improved glycemic control among employed type 2 diabetic patients. This association remained significant even after adjusting for various potential confounders. The study highlights the importance of considering workplace eating patterns when developing diabetes management strategies. The lower prevalence of regular HPM consumption, particularly among males and skilled workers, suggests the need for targeted interventions. Barriers to HPM consumption included impractical dietary advice and the nature of some work locations. The results support the promotion of HPM consumption at work through practical dietary guidance, tailored to the work schedules and needs of patients (e.g., easy-to-follow recipes, energy needs considered), and by providing workplace accommodations (storage, processing, and consumption facilities). For those unable to consume HPM, restaurant-based interventions could be considered (e.g., menu labeling, healthy food choices).

This study provides evidence that regular consumption of home-prepared meals at the workplace is associated with better glycemic control in employed type 2 diabetic patients. This suggests the need for interventions promoting HPM consumption through practical dietary advice and workplace accommodations. Future research should explore the nutritional content of HPM and conduct larger-scale studies to establish causality and generalize findings.

The study has some limitations. The nutritional content of HPM was not assessed. Unmeasured confounders could exist. Self-reported data might introduce measurement error. The relatively small sample size, especially for those regularly consuming HPM, limits generalizability. The higher percentage of individuals on diabetic medication within the non-HPM consuming group needs further investigation. The observational nature of the study prevents establishing a causal relationship between HPM consumption and HbA1c.