Diabetes and driving: 2015 Canadian Diabetes Association updated recommendations for private and commercial drivers

Exploring Knowledge and Safety Practices for Driving in Youth With Type 1 Diabetes

OBJECTIVES

The aim of this work was to survey how well adolescents with type 1 diabetes mellitus (T1D) of legal driving age understand the risks associated with driving with diabetes and report adherence to recommendations.

METHODS

This study was a cross-sectional survey of 191 adolescents, 14 to 18 years of age, with T1D.

RESULTS

The average (standard deviation [SD]) glycated hemoglobin of respondents with a learner's or a driver's license was 9.0% (SD, 1.9%) and 8.9% (SD, 1.9%), respectively (p=0.91). The proportions of adolescents with a learner's or a driver's license who almost always or always checked their blood glucose prior to driving was 69% and 41%, respectively (p=0.01). Eighteen percent of adolescents with a learner's license and 41% with a driver's license experienced hypoglycemia while driving. The average number of weekly hypoglycemic events in each group was 2.0 (SD, 1.4) and 2.3 (SD, 2.0), respectively. There was a higher reported frequency of weekly mild hypoglycemic events between drivers who reported pulling over at least once while driving due to symptoms of hypoglycemia (3.25±2.38) and those who reported never having pulled over for hypoglycemia (1.87±1.31) (p=0.012). Respondents with a learner's license reported higher adherence to guidelines than those with a full license.

CONCLUSIONS

Clinical education needs to reinforce adherence to recommendations, particularly checking blood glucose or wearing a continuous glucose monitor prior to driving, for all adolescents of driving age. The frequency of mild hypoglycemic events per week is associated with self-reported hypoglycemic events while driving.

Work stress and health problems of professional drivers: a hazardous formula for their safety outcomes

Background

Several empirical studies have shown that professional drivers are a vulnerable occupational group, usually exposed to environmental stressors and adverse work conditions. Furthermore, recent studies have associated work-related stress with negative job performances and adverse health outcomes within this occupational group, including cardiovascular diseases and unsafe vehicle operation.

Objective

The aim of this study was to describe the working conditions and the health status of this occupational group, and to evaluate the association between the Demand-Control model of job stress and their self-reported health and safety outcomes.

Methods

A pooled sample of 3,665 Colombian professional drivers was drawn from five different studies. The Job Content Questionnaire and the General Health Questionnaire were used to measure work stress and self-reported mental health, respectively. Additionally, professional drivers self-reported health problems (hypertension, dyslipidemia, diabetes and overweight) and health-related risky behaviors (smoking and sedentary behavior).

Results

Regarding the Job Demands-Control (JDC) model, it was found that approximately a third part of Colombian professional drivers suffer from high job strain (29.1%). Correlational and multivariate analyses suggest that de JDC model of stress is associated with the professional drivers' mental health, traffic accidents and fines, but not with other physical and behavioral health-related outcomes, which are highly prevalent among this occupational group, such as hypertension, dyslipidemia, diabetes, overweight, smoking and sedentary behavior.

Conclusion

The results of this study suggest that (a) stressful working conditions are associated with health and lifestyle-related outcomes among professional drivers, and (b) that evidence-based interventions are needed in order to reduce hazardous working conditions, job stress rates and their negative impact on the health of this occupational group.

Low normal fasting glucose and risk of accidental death in Korean adults: A prospective cohort study

AIM

This study aimed to prospectively examine whether low normal glucose levels and hypoglycaemia are associated with increased mortality due to external causes, especially unintentional accidents.

METHODS

A total of 345,318 normoglycaemic Korean adults who had undergone health examinations during 2002-2003 were followed-up to 2013. To avoid potential biases related to glucose-lowering medication use, those with known diabetes or hyperglycaemia were excluded.

RESULTS

During 3.6 million person-years of follow-up, 1293 participants died because of unintentional accidents. Hazard ratios (HRs) for these accidental deaths were 1.26 (95% CI: 1.11-1.42), 1.60 (1.21-2.11) and 3.07 (1.37-6.85) for fasting serum glucose (FSG) levels of 70-79, 55-69 and <55mg/dL (3.9-4.4, 3.05-3.83 and <3.05mmol/L), respectively, compared with 80-99mg/dL (4.44-5.5mmol/L). FSG levels<80mg/dL were associated with an approximately 30% higher mortality due to accidents: specifically, 40% were non-fall-related injury; 50% were automobile-related; and 80% were motorcycle-related. The associations were weak (approximately 10% higher mortality, with P>0.05 for each cause) for deaths due to traffic accidents (pedestrians, pedal cyclists), falls, intentional self-harm and physical assault. The population attributable risks for FSG levels <80mg/dL were 10% (95% CI: 2-18%) for non-fall-related injury, 11% (6-17%) for car accidents and 17% (6-27%) for motorcycle accidents.

CONCLUSION

FSG levels of 70-79mg/dL (3.9-4.4mmol/L) as well as <70mg/dL are risk factors for accidental death. Appropriate management of the impact of FSG levels <80mg/dL might reduce unintended deaths due to non-fall-related injury, and automobile and motorcycle accidents, by ≥10%.