**5. Conclusions**

The minimum requirements for a health issue to become an occupational medicine subject are a proven relation with the working conditions, and a benefit from a working place interven‐ tion. This chapter had provided arguments that insulin resistance has both characteristics. It has, however, a specificity, that in some countries had brought benefits for including it in the occupational services and in others have been an obstacle: insulin resistance shares both ele‐ ments of the classical health protection and of the health promotion activities.

In terms of health protection, insulin resistance is related to medium or even low exposure to air pollution (particles, solvents) or heavy metals. The biological monitoring reference for insulin resistance is not yet defined, making difficulties in interpreting field data. Using the general population assessments might be a solution, but there is clearly a need for well‐ designed research in this area to reach a valid conclusion. Insulin resistance is also related to other work hazards: work schedules, sedentary behaviour and stress. Concerning the work schedules, we benefit of many data, experience and general recommendations about working on shifts; flexible working time is a new challenge and probably needs more individual solu‐ tions. Occupational stress is recognized as one of the most important risk factor of the modern society and, even if it is more in the occupational psychology field, it has to be integrated in the occupational medicine service, as many other medical conditions, except insulin resistance, are aggravated by stress.

In terms of health promotion, prevention of insulin resistance and its major consequences (the cardio‐vascular disease and type‐2 diabetes) are perceived as part of the healthy life‐ style and well‐being programmes. Healthy nutrition, smoking cessation, physical activity and sleep hygiene are the pillars of these programmes. The appropriate and culturally adapted design increases the adherence to these programmes; their real success is the integration of the healthy behaviours and the reduction of obesity and insulin resistance‐related mortality. Management support is needed in the preliminary phases (approving and promoting the programme) but also during the implementation phase, as many of these activities request working condition adaptations. Better employee engagement is obtained by involving them from the early steps of the programme.

Therefore, assessment of the risk, screening and workplace intervention programmes to reduce insulin resistance incidence are part of the occupational medicine activity and should be included in the occupational health service provision. Further research to develop tools for on appropri‐ ate individual and organizational assessment and strategies for interventions is needed.
