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Maxwell H, Dubois S, Cottrell-Martin E, Regalado SM, Stinchcombe A, Migay M, Gibbons C, Weaver B, Bédard M. The association between diabetes and safe driving: A systematic search and review of the literature and cross-reference with the current guidelines. Diabet Med 2023; 40:e15175. [PMID: 37422905 DOI: 10.1111/dme.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
AIMS We conducted this review to characterize the quality of evidence about associations between diabetes and safe driving and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes. METHODS The first stage entailed a systematic search and review of the literature. Evidence surrounding harms associated with diabetes and driving was identified, screened, extracted and appraised for quality utilizing the Newcastle Ottawa Scales (NOS). Next, relevant guidelines regarding driving and diabetes were sourced and summarized. Finally, the identified guidelines were cross-referenced with the results of the systematic search and review. RESULTS The systematic search yielded 12,461 unique citations; 52 met the criteria for appraisal. Fourteen studies were rated as 'high', two as 'medium' and 36 as 'low'. Studies with ratings of 'high' or 'medium' were extracted, revealing a body of inconsistent methods and findings. These results, cross-referenced with the guidelines, suggest a lack of agreement and a limited evidence base to justify recommendations. CONCLUSIONS The results presented emphasize the need for a better understanding of the impacts of diabetes on safe driving to inform evidence-based guidelines.
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Affiliation(s)
- Hillary Maxwell
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Sacha Dubois
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
- NOSM University, Thunder Bay, Ontario, Canada
| | - Elyse Cottrell-Martin
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
| | - Sophie M Regalado
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- NOSM University, Thunder Bay, Ontario, Canada
| | - Arne Stinchcombe
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Marcia Migay
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
| | - Carrie Gibbons
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
| | - Bruce Weaver
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michel Bédard
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
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Fenalti Salla R, de David J, Schneider L, Tschiedel B, Teló GH, Schaan BD. Predictors of traffic events due to hypoglycemia in adults with type 1 diabetes: A Brazilian prospective cohort study. Diabetes Res Clin Pract 2021; 178:108954. [PMID: 34273455 DOI: 10.1016/j.diabres.2021.108954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals with type 1 diabetes (T1D) are exposed to an elevated risk of automobile accidents especially because of hypoglycemia that impairs physiological and defense responses. OBJECTIVES To assess local risk factors for traffic events in T1D adult Brazilian patients. METHODS This is a prospective study and 12-month follow-up to assess predictors for traffic events on a cohort of drivers with T1D (n = 168) in Brazil. The inclusion criteria for participants were Brazilian nationality, age ≥ 18 years-old, diagnosis of T1D for more than one year, driving license B, C or D categories (four-wheel vehicles), driving three-times per week or more, and checking blood glucose twice-daily or more. The primary outcome was hypoglycemia driving mishaps assessed by a seven-query questionnaire about the past 30 days. Secondary outcomes included driving mishaps not related to hypoglycemia. Statistical analysis was performed through Poisson regression models with robust variance estimarion, in which the measure of association is the relative risk. RESULTS A total of 109 participants completed the 12-month follow-up. Most of them were men (66%) and 37 ± 11 years-old, and had a mean HbA1c of 8.2% (66 mmol/mol). In the follow up, the incidence of traffic events was high (70.6%); however, only a minority was attributed to hypoglycemia as the cause of the reported event (19.3%). The best predictors for new traffic events due to hypoglycemia were those related to driving characteristics. The best of them was a history of episodes of hypoglycemia while driving [RR 3.40 (1.22-9.43); p < 0.05]. CONCLUSIONS We found that previous episodes of hypoglycemia while driving significantly increase the risk of new traffic events and are the best predictor for it. This highlights the need to assess the risks of traffic accidents especially in people who have had experienced episodes of hypoglycemia while driving.
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Affiliation(s)
- Rafaela Fenalti Salla
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Julia de David
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Larissa Schneider
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gabriela H Teló
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Population-Based Registry Analysis of Antidiabetics Dispensations: Trend Use in Spain between 2015 and 2018 with Reference to Driving. Pharmaceuticals (Basel) 2020; 13:ph13080165. [PMID: 32722515 PMCID: PMC7464462 DOI: 10.3390/ph13080165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
Insulins and some oral antidiabetics are considered to be driving-impairing medicines (DIM) and they belong to the Driving under the Influence of Drugs, alcohol, and medicines (DRUID) category I (minor influence on fitness to drive). The trend of antidiabetics use in Castilla y León from 2015 to 2018 is presented through a population-based registry study. Treatment duration with these medicines and the concomitant use of other DIMs were observed. An adjustment method was used with information from the drivers' license census. For all calculations, age and gender were taken into account. 3.98% of the general population used at least one antidiabetic, as well as 2.92% of drivers. The consumption of antidiabetics in men was higher than in women (4.35% vs. 3.61%, p = 0.001), and the use increases with age, especially from 35-39 years to 75-79 years in men and 85-89 years in women. Antidiabetics were consumed chronically, specifically 100% in the case of insulins and 95% in the case of oral antidiabetics. In addition to antidiabetics, 2.5 ± 1.86 DIMs were consumed, mainly anxiolytics (25.53%), opioids (23.03%), other analgesics and antipiretics (19.13%), and antidepressants (17.73%). Collaboration between pharmacists and physicians is a priority to clearly transmitting risks to patients. It is necessary that the health authorities include information on DIMs, such as the DRUID classification, in the prescription and dispensing software.
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Ma S, Zhang J, Zeng X, Wu C, Zhao G, Lv C, Sun X. Type 2 diabetes can undermine driving performance of middle-aged male drivers through its deterioration of perceptual and cognitive functions. ACCIDENT; ANALYSIS AND PREVENTION 2020; 134:105334. [PMID: 31689573 DOI: 10.1016/j.aap.2019.105334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 05/12/2023]
Abstract
It has been widely agreed that it is risky for patients with diabetes to drive during hypoglycemia. However, driving during non-hypoglycemia may also bring certain safety hazards for some patients with diabetes. Based on previous studies on diabetes-related to early aging effect, as well as gender differences in health belief and driving behavior, we have hypothesized that middle-aged male drivers with type 2 diabetes, compared with the control healthy ones, may experience a decline in driving performance without awareness. And the decline is caused by impaired perceptual and cognitive driving-related functions. To verify these hypotheses, we recruited 56 non-professional male drivers aged between 40 and 60 (27 patients with type 2 diabetes and 29 healthy controls) to perform a simulated car-following task and finish behavioral tests of proprioception, visual search, and working memory abilities during non-hypoglycemia. They also reported their hypoglycemia experience and perceived driving skills. We found that the patients had equal confidence in their driving skills but worse driving performance as shown in larger centerline deviation (t = 2.83, p = .006), longer brake reaction time (t = 3.77, p = .001) and shorter minimum time-to-collision (t = -3.27, p = .002). Such between-group differences in driving performance could be fully mediated by proprioception, visual search ability, and working memory capacity but not by hypoglycemia experience. Regarding the effect sizes of the mediation, the visual search ability played the most important role, and then followed the working memory and the proprioception. This initial study provides original and first-hand evidence demonstrating that the middle-aged male drivers with type 2 diabetes have deteriorated driving performance, but they are unaware of it. We will also discuss the possible measures to identify people of the highest risk and improve their safety awareness by using the findings of the current study.
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Affiliation(s)
- Shu Ma
- Department of Psychology, Zhejiang Sci-Tech University, 928 2nd Street, Xiasha Higher Education Park, Hangzhou, 310016, China; CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Jingyu Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China.
| | - Xianzhong Zeng
- Department of Endocrinology, Ganzhou People's Hospital, China
| | - Changxu Wu
- Department of Systems and Industrial Engineering, University of Arizona, United States
| | - Guozhen Zhao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Chunhui Lv
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Xianghong Sun
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
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Schmied LS, Zulewski H. Glucose Variations During Driving in People With Type 1 Diabetes Using a Continuous Glucose Monitoring System. Diabetes Care 2019; 42:1340-1343. [PMID: 31221699 DOI: 10.2337/dc18-0822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 03/28/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hypoglycemic events during driving are life-threatening complications in people with type 1 diabetes (T1D). While preliminary studies showed increased glucose demand in driving simulations, we investigated interstitial fluid (ISF) glucose when driving under real-life circumstances. RESEARCH DESIGN AND METHODS We measured ISF glucose in 10 participants with stable T1D during a 2-h driving course using a continuous glucose monitoring system. RESULTS Our data show a driving-associated rise of ISF glucose. Initially increasing glucose was followed by decreasing values. Under control conditions at the same time of the day without driving, no specific glucose changes were observed. CONCLUSIONS Real-life driving may have caused an initial glucose increase followed by decreasing glucose values in this cohort with well-controlled T1D. These findings may be limited to the selected study population.
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Affiliation(s)
| | - Henryk Zulewski
- Department of Biosystems Science and Engineering (D-BSSE) ETH Zurich, Zurich, Switzerland .,Division of Endocrinology and Diabetes, University Hospital Basel, Basel, Switzerland
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Cameron FJ, Garvey K, Hood KK, Acerini CL, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence. Pediatr Diabetes 2018; 19 Suppl 27:250-261. [PMID: 29900653 DOI: 10.1111/pedi.12702] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/28/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fergus J Cameron
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de Medicina, University of Chile, Santiago, Chile
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McAuley SA, de Bock MI, Sundararajan V, Lee MH, Paldus B, Ambler GR, Bach LA, Burt MG, Cameron FJ, Clarke PM, Cohen ND, Colman PG, Davis EA, Fairchild JM, Hendrieckx C, Holmes-Walker DJ, Horsburgh JC, Jenkins AJ, Kaye J, Keech AC, King BR, Kumareswaran K, MacIsaac RJ, McCallum RW, Nicholas JA, Sims C, Speight J, Stranks SN, Trawley S, Ward GM, Vogrin S, Jones TW, O'Neal DN. Effect of 6 months of hybrid closed-loop insulin delivery in adults with type 1 diabetes: a randomised controlled trial protocol. BMJ Open 2018; 8:e020274. [PMID: 29886443 PMCID: PMC6009467 DOI: 10.1136/bmjopen-2017-020274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Manual determination of insulin dosing largely fails to optimise glucose control in type 1 diabetes. Automated insulin delivery via closed-loop systems has improved glucose control in short-term studies. The objective of the present study is to determine the effectiveness of 6 months' closed-loop compared with manually determined insulin dosing on time-in-target glucose range in adults with type 1 diabetes. METHODS AND ANALYSIS This open-label, seven-centre, randomised controlled parallel group clinical trial will compare home-based hybrid closed-loop versus standard diabetes therapy in Australia. Adults aged ≥25 years with type 1 diabetes using intensive insulin therapy (via multiple daily injections or insulin pump, total enrolment target n=120) will undertake a run-in period including diabetes and carbohydrate-counting education, clinical optimisation and baseline data collection. Participants will then be randomised 1:1 either to 26 weeks of MiniMed 670G hybrid closed-loop system therapy (Medtronic, Northridge, CA, USA) or continuation of their current diabetes therapy. The hybrid closed-loop system delivers insulin automatically to address basal requirements and correct to target glucose level, while bolus doses for meals require user initiation and carbohydrate estimation. Analysis will be intention to treat, with the primary outcome time in continuous glucose monitoring (CGM) target range (3.9-10.0 mmol/L) during the final 3 weeks of intervention. Secondary outcomes include: other CGM parameters, HbA1c, severe hypoglycaemia, psychosocial well-being, sleep, cognition, electrocardiography, costs, quality of life, biomarkers of vascular health and hybrid closed-loop system performance. Semistructured interviews will assess the expectations and experiences of a subgroup of hybrid closed-loop users. ETHICS AND DISSEMINATION The study has Human Research Ethics Committee approval. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Results will be disseminated at scientific conferences and via peer-reviewed publications. TRIAL REGISTRATION NUMBER ACTRN12617000520336; Pre-results.
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Affiliation(s)
- Sybil A McAuley
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Martin I de Bock
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Vijaya Sundararajan
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa H Lee
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Barbora Paldus
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoff R Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia
| | - Morton G Burt
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Fergus J Cameron
- Department ofEndocrinology and Diabetes and Centre for Hormone Research, Royal Children'sHospital, Melbourne, Victoria, Australia
- Murdoch Children'sResearch Institute, Melbourne, Victoria, Australia
- Department ofPaediatrics, University ofMelbourne, Melbourne, Victoria, Australia
| | - Philip M Clarke
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jan M Fairchild
- Endocrinology and Diabetes Centre, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - D Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jodie C Horsburgh
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alicia J Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Joey Kaye
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Bruce R King
- Department of Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kavita Kumareswaran
- Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Roland W McCallum
- Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jennifer A Nicholas
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Catriona Sims
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Stephen N Stranks
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Steven Trawley
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Cairnmillar Institute, Melbourne, Victoria, Australia
| | - Glenn M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Pathology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - David N O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Cox DJ, Gonder-Frederick LA, Singh H, Ingersoll KS, Banton T, Grabman JH, Schmidt K, Clarke W. Predicting and Reducing Driving Mishaps Among Drivers With Type 1 Diabetes. Diabetes Care 2017; 40:742-750. [PMID: 28404657 PMCID: PMC5439415 DOI: 10.2337/dc16-0995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/18/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Two aims of this study were to develop and validate A) a metric to identify drivers with type 1 diabetes at high risk of future driving mishaps and B) an online intervention to reduce mishaps among high-risk drivers. RESEARCH DESIGN AND METHODS To achieve aim A, in study 1, 371 drivers with type 1 diabetes from three U.S. regions completed a series of established questionnaires about diabetes and driving. They recorded their driving mishaps over the next 12 months. Questionnaire items that uniquely discriminated drivers who did and did not have subsequent driving mishaps were assembled into the Risk Assessment of Diabetic Drivers (RADD) scale. In study 2, 1,737 drivers with type 1 diabetes from all 50 states completed the RADD online. Among these, 118 low-risk (LR) and 372 high-risk (HR) drivers qualified for and consented to participate in a 2-month treatment period followed by 12 monthly recordings of driving mishaps. To address aim B, HR participants were randomized to receive either routine care (RC) or the online intervention "DiabetesDriving.com" (DD.com). Half of the DD.com participants received a motivational interview (MI) at the beginning and end of the treatment period to boost participation and efficacy. All of the LR participants were assigned to RC. In both studies, the primary outcome variable was driving mishaps. RESULTS Related to aim A, in study 1, the RADD demonstrated 61% sensitivity and 75% specificity. Participants in the upper third of the RADD distribution (HR), compared with those in the lower third (LR), reported 3.03 vs. 0.87 mishaps/driver/year, respectively (P < 0.001). In study 2, HR and LR participants receiving RC reported 4.3 and 1.6 mishaps/driver/year, respectively (P < 0.001). Related to aim B, in study 2, MIs did not enhance participation or efficacy, so the DD.com and DD.com + MI groups were combined. DD.com participants reported fewer hypoglycemia-related driving mishaps than HR participants receiving RC (P = 0.01), but more than LR participants receiving RC, reducing the difference between the HR and LR participants receiving RC by 63%. HR drivers differed from LR drivers at baseline across a variety of hypoglycemia and driving parameters. CONCLUSIONS The RADD identified higher-risk drivers, and identification seemed relatively stable across time, samples, and procedures. This 11-item questionnaire could inform patients at higher risk, and their clinicians, that they should take preventive steps to reduce driving mishaps, which was accomplished in aim B using DD.com.
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Affiliation(s)
- Daniel J Cox
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Harsimran Singh
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Tom Banton
- University of Virginia School of Medicine, Charlottesville, VA
| | - Jesse H Grabman
- University of Virginia School of Medicine, Charlottesville, VA
| | - Karen Schmidt
- Department of Psychology, University of Virginia, Charlottesville, VA
| | - William Clarke
- University of Virginia School of Medicine, Charlottesville, VA
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El-Menyar A, Mekkodathil A, Al-Thani H. Traumatic injuries in patients with diabetes mellitus. J Emerg Trauma Shock 2016; 9:64-72. [PMID: 27162438 PMCID: PMC4843569 DOI: 10.4103/0974-2700.179461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) is associated with increased in-hospital morbidity and mortality in patients sustained traumatic injuries. Identification of risk factors of traumatic injuries that lead to hospital admissions and death in DM patients is crucial to set effective preventive strategies. We aimed to conduct a traditional narrative literature review to describe the role of hypoglycemia as a risk factor of driving and fall-related traumatic injuries. DM poses significant burden as a risk factor and predictor of worse outcomes in traumatic injuries. Although there is no consensus on the impact and clear hazards of hyperglycemia in comparison to the hypoglycemia, both extremes of DM need to be carefully addressed and taken into consideration for proper management. Moreover, physicians, patients, and concerned authorities should be aware of all these potential hazards to share and establish the right management plans.
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Affiliation(s)
- Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar; Department of Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Ahammed Mekkodathil
- Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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10
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Graveling AJ, Frier BM. Driving and diabetes: problems, licensing restrictions and recommendations for safe driving. Clin Diabetes Endocrinol 2015; 1:8. [PMID: 28702227 PMCID: PMC5471925 DOI: 10.1186/s40842-015-0007-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/25/2015] [Indexed: 12/04/2022] Open
Abstract
Driving is a complex process that places considerable demands on cognitive and physical functions. Many complications of diabetes can potentially impair driving performance, including those affecting vision, cognition and peripheral neural function. Hypoglycemia is a common side-effect of insulin and sulfonylurea therapy, impairing many cognitive domains necessary for safe driving performance. Driving simulator studies have demonstrated how driving performance deteriorates during hypoglycemia. Driving behavior that may predispose to hypoglycemia while driving is examined. Studies examining the risk of road traffic accidents in people with insulin-treated diabetes have produced conflicting results, but the potential risk of hypoglycemia-related road traffic accidents has led to many countries imposing restrictions on the type and duration of driving licenses that can be issued to drivers with diabetes. Guidance that promotes safe driving practice has been provided for drivers with insulin-treated diabetes, which is the group principally addressed in this review.
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Affiliation(s)
- Alex J Graveling
- JJR Macleod Centre for Diabetes & Endocrinology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZP UK
| | - Brian M Frier
- The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, EH16 4TJ UK
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Abstract
PURPOSE Driving is a vision-based activity of daily living that impacts safety. Because visual disruption can compromise driving safety, contact lens wearers with astigmatism may pose a driving safety risk if they experience residual blur from spherical lenses that do not correct their astigmatism or if they experience blur from toric lenses that rotate excessively. Given that toric lens stabilization systems are continually improving, this preliminary study tested the hypothesis that astigmats wearing toric contact lenses, compared with spherical lenses, would exhibit better overall driving performance and driving-specific visual abilities. METHODS A within-subject, single-blind, crossover, randomized design was used to evaluate driving performance in 11 young adults with astigmatism (-0.75 to -1.75 diopters cylinder). Each participant drove a highly immersive, virtual reality driving simulator (210 degrees field of view) with (1) no correction, (2) spherical contact lens correction (ACUVUE MOIST), and (3) toric contact lens correction (ACUVUE MOIST for Astigmatism). Tactical driving skills such as steering, speed management, and braking, as well as operational driving abilities such as visual acuity, contrast sensitivity, and foot and arm reaction time, were quantified. RESULTS There was a main effect for type of correction on driving performance (p = 0.05). Correction with toric lenses resulted in significantly safer tactical driving performance than no correction (p < 0.05), whereas correction with spherical lenses did not differ in driving safety from no correction (p = 0.118). Operational tests differentiated corrected from uncorrected performance for both spherical (p = 0.008) and toric (p = 0.011) lenses, but they were not sensitive enough to differentiate toric from spherical lens conditions. CONCLUSIONS Given previous research showing that deficits in these tactical skills are predictive of future real-world collisions, these preliminary data suggest that correcting low to moderate astigmatism with toric lenses may be important to driving safety. Their merits relative to spherical lens correction require further investigation.
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Papaspurou M, Laschou VC, Partsiopoulou P, Fradelos EC, Kleisiaris CF, Kalota MA, Neroliatsiou A, Papathanasiou IV. Fears and Health Needs of Patients with Diabetes: A Qualitative Research in Rural Population. Med Arch 2015; 69:190-5. [PMID: 26261390 PMCID: PMC4500317 DOI: 10.5455/medarh.2015.69.190-195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/15/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction: Insulin-dependent patients are individuals with chronic disease who are well adapted to living and dealing with any health needs and fears arising. An important aspect in the process of adaptation to chronic illness is the provision of nursing care in the early stages of the disease, because this contributes to its acceptance and the early identification and management of potential complications. Purpose: To investigate the health needs and self-management problems faced by patients with diabetes daily, especially those who use insulin. Furthermore purpose of this study was to investigate the fears experienced by patients in the early stage of the disease, but also in its subsequent development and to study possible differences between sexes. Methodology: This is a qualitative study, using interpretative phenomenological approach. Fifteen (nine women and six men) insulin-dependent patients, recounted their personal fears and their needs, through semi-structured interviews, which took place in Central Greece. The method used for processing the results is the Mayering one. Results: The analysis of the narratives showed that patients have a variety of fears and needs associated with the diagnosis, treatment, expected consequences, prognosis and everyday life in the management of the disease. Most patients express the concept of need as desire. Care needs, psychological support and education to recognize and prevent hypoglycemia. Conclusions: Insulin-dependent patients express fears and needs in their daily lives. Nurses providing care aimed at enhancing the level of health, while putting self-care information and training them. Patients want the nurse next to them, so that information is continuous and permanent.
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Affiliation(s)
| | - Vasiliki C Laschou
- Department of Biochemistry and Biotechnology, University of Thessaly, Greece
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Dømgaard M, Bagger M, Rhee NA, Burton CM, Thorsteinsson B. Individual and societal consequences of hypoglycemia: A cross-sectional survey. Postgrad Med 2015; 127:438-45. [PMID: 25971530 DOI: 10.1080/00325481.2015.1045815] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypoglycemia and fear of hypoglycemia threaten individuals' ability to work and drive. We studied the effect of hypoglycemia on the individual and society, with a focus on possible implications of new European union legislation on patients' continued ability to drive. METHODS A cross-sectional survey of Danish Diabetes Association members was conducted to investigate individual and societal consequences of hypoglycemia. RESULTS A total of 3117/9951 individuals with type 1 diabetes (T1DM) (32.2%) or type 2 diabetes (T2DM) (67.8%) completed the survey. The calculated incidence rates of self-reported severe and mild hypoglycemia were 2.9, 0.6 and 0.1 events per patient year (ppy) in patients with T1DM, insulin using T2DM and non-insulin using T2DM, respectively; and incidence rates of self-reported mild hypoglycemia were 99.0, 23.2 and 10.9 events ppy, respectively. Self-care strategies to avoid hypoglycemia include maintaining higher blood glucose levels (45.7%) and reducing physical activity (15.7%). Few people take sick leave as a result of hypoglycemia, but prolonged mental recovery ≥4 h following an episode of mild or severe hypoglycemia was reported by 8.7 and 31.0%, respectively. 26.5% of patients holding a valid driving license reported having ever had at least one episode of severe hypoglycemia. Patients considering underreporting of hypoglycemia to maintain their driving license were more likely to have experienced severe hypoglycemia (odds ratio [OR]: 3.03; 95% CI: 2.42-3.79; p < 0.0001). CONCLUSION A high proportion of insulin-treated patients experience hypoglycemia resulting in fear of hypoglycemia and changes in self-care behavior that may compromise glycemic control. Many patients with a history of severe hypoglycemia consider underreporting hypoglycemic events through concern over retaining their driving license.
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Kerr JL, Frichtl KD, Behnen EM. Diabetes management in Commercial Driver License holders. DIABETES EDUCATOR 2015; 41:231-40. [PMID: 25673426 DOI: 10.1177/0145721715569606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to evaluate diabetes management in Commercial Driver License (CDL) holders, how prescribing habits change when treating this patient population, and health care providers' knowledge of regulations concerning insulin use in CDL holders. METHODS A survey was posted on the American Association of Diabetes Educators (AADE) Communities of Interest websites and was open for 2 weeks. The anonymous survey collected demographic data and evaluated the perspectives of health care providers on diabetes management in CDL holders. Descriptive statistics were used to analyze the survey results. RESULTS A total of 139 AADE members responded to the survey, and 22.2% were prescribing providers. Findings from the survey indicated an overall lack of knowledge by health care professionals regarding the current laws affecting diabetes management in CDL holders. Most participants emphasized the need for making decisions on CDL suspension on a case-by-case basis, and some expressed concern that current laws may not be appropriate. CONCLUSION Additional diabetes education for health care providers who treat CDL holders is warranted as many health care providers were not familiar with current regulations and management strategies.
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Affiliation(s)
- Jessica L Kerr
- Southern Illinois University Edwardsville School of Pharmacy, Department of Pharmacy Practice, Edwardsville, Illinois (Dr Kerr, Dr Frichtl, Dr Behnen)
| | - Kelsey D Frichtl
- Southern Illinois University Edwardsville School of Pharmacy, Department of Pharmacy Practice, Edwardsville, Illinois (Dr Kerr, Dr Frichtl, Dr Behnen),Veterans Affairs Medical Center, Lincoln, Nebraska (Dr Frichtl)
| | - Erin M Behnen
- Southern Illinois University Edwardsville School of Pharmacy, Department of Pharmacy Practice, Edwardsville, Illinois (Dr Kerr, Dr Frichtl, Dr Behnen)
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Unger J, Parkin C. Hypoglycemia in Insulin-Treated Diabetes: A Case for Increased Vigilance. Postgrad Med 2015; 123:81-91. [DOI: 10.3810/pgm.2011.07.2307] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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17
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Pedersen-Bjergaard U, Færch L, Allingbjerg ML, Agesen R, Thorsteinsson B. The influence of new European Union driver's license legislation on reporting of severe hypoglycemia by patients with type 1 diabetes. Diabetes Care 2015; 38:29-33. [PMID: 25288675 DOI: 10.2337/dc14-1417] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We test the hypotheses that the implementation in Denmark of new, stricter European Union (EU) legislation on driver's licensing, with the purpose to improve traffic safety in January 2012, has reduced the self-reported rate of severe hypoglycemia in a routine clinical setting and that anonymous reporting results in higher event rates. RESEARCH DESIGN AND METHODS A cohort of 309 patients with type 1 diabetes was recruited in the outpatient clinic at Nordsjællands University Hospital Hillerød, Denmark. Yearly numbers of severe hypoglycemic events defined by need for treatment assistance from another person were retrieved from medical records in the years 2010 to 2012 and retrospectively reported in an anonymous questionnaire. Data from medical records in 2012 were compared with those from 2010 and 2011 and with data from the questionnaire. RESULTS Reported rates of severe hypoglycemia in the medical records were reduced by 55% in 2012 compared with the prior years (P = 0.034). The proportion of subjects reporting recurrent episodes was grossly reduced from 5.6 to 1.5% (P = 0.014). Compared with anonymous reporting in the questionnaire, the rate of severe hypoglycemia in 2012 was 70% lower (P < 0.001). CONCLUSIONS Reporting of severe hypoglycemia by patients with type 1 diabetes is significantly reduced following implementation of EU driver's licensing legislation that implies withdrawal of driver's licensing in case of recurrent episodes within 1 year. The resulting burden of concealed severe hypoglycemia may impair the safety of affected patients and unintentionally paradoxically reduce the general traffic safety.
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Affiliation(s)
- Ulrik Pedersen-Bjergaard
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Louise Færch
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Marie-Louise Allingbjerg
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Rikke Agesen
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birger Thorsteinsson
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Sundberg F, Forsander G. Detection and treatment efficacy of hypoglycemic events in the everyday life of children younger than 7 yr. Pediatr Diabetes 2014; 15:34-40. [PMID: 23809540 DOI: 10.1111/pedi.12057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/24/2013] [Accepted: 05/14/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mild hypoglycemia is commonly observed in children treated for type 1 diabetes mellitus (T1DM). Hypoglycemia disturbs cognition and learning. OBJECTIVE To describe how and to what extent hypoglycemia in young children with T1DM is detected in everyday life. To learn how parents and caregivers treat hypoglycemia and to evaluate how efficient this treatment is. METHODS Twenty-three children [12 girls, mean age: 4.5 yr, mean HbA1c: 59 mmol/mol (7.5%)], 17 of whom were treated with an insulin pump, underwent blinded continuous glucose monitoring (CGM). Data on symptoms and treatment of hypoglycemia were collected in a logbook. Plasma glucose values were collected through self-monitoring of blood glucose and entered in the logbook, and glucometer memories were uploaded. Data were collected during 1 wk in autumn and 1 wk in spring. RESULTS Only 32% of all hypoglycemic events were detected despite plasma glucose being checked 10 times per day. Most hypoglycemic events were asymptomatic (90% overall and 98% of those occurring at night). Untreated hypoglycemic events were associated with a relapse into hypoglycemia within 3 h in the majority of events. Compared to treatment of hypoglycemia events with a defined dose of simple carbohydrates, treatment with a mixed meal resulted in a significantly higher glucose value 1 and 2 h after the hypoglycemia. CONCLUSION For optimum treatment, children younger than 7 yr with T1DM need better strategies and support for detecting hypoglycemia with real-time CGM. Hypoglycemia should be treated with a defined dose of carbohydrates rather than a mixed meal.
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Affiliation(s)
- Frida Sundberg
- Diabetes Unit, Department of Pediatrics, Sahlgrenska Academy, The Queen Silvia Children's Hospital/Sahlgrenska University Hospital, SE 41685, Gothenburg, Sweden
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Lorber D, Anderson J, Arent S, Cox DJ, Frier BM, Greene MA, Griffin J, Gross G, Hathaway K, Hirsch I, Kohrman DB, Marrero DG, Songer TJ, Yatvin AL. Diabetes and driving. Diabetes Care 2014; 37 Suppl 1:S97-103. [PMID: 24357217 DOI: 10.2337/dc14-s097] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Inkster B, Frier BM. Diabetes and driving. Diabetes Obes Metab 2013; 15:775-83. [PMID: 23350766 DOI: 10.1111/dom.12071] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
The principal safety concern for driving for people treated with insulin or insulin secretagogues is hypoglycaemia, which impairs driving performance. Other complications, such as those causing visual impairment and peripheral neuropathy, are also relevant to medical fitness to drive. Case control studies have suggested that drivers with diabetes pose a modestly increased but acceptable and measurable risk of motor vehicle accidents compared to non-diabetic drivers, but many studies are limited and of poor quality. Factors which have been shown to increase driving risk include previous episodes of severe hypoglycaemia, previous hypoglycaemia while driving, strict glycaemic control (lower HbA1c) and absence of blood glucose monitoring before driving. Impaired awareness of hypoglycaemia may be counteracted by frequent blood glucose testing. The European Union Third directive on driving (2006) has necessitated changes in statutory regulations for driving licences for people with diabetes in all European States, including the UK. Stricter criteria have been introduced for Group 1 vehicle licences while those for Group 2 licences have been relaxed. Insulin-treated drivers can now apply to drive Group 2 vehicles, but in the UK must meet very strict criteria and be assessed by an independent specialist to be issued with a 1-year licence.
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Affiliation(s)
- B Inkster
- Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Kalra S, Mukherjee JJ, Venkataraman S, Bantwal G, Shaikh S, Saboo B, Das AK, Ramachandran A. Hypoglycemia: The neglected complication. Indian J Endocrinol Metab 2013; 17:819-34. [PMID: 24083163 PMCID: PMC3784865 DOI: 10.4103/2230-8210.117219] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycemic control invariably increases the risk of hypoglycemia. A six-fold increase in deaths due to diabetes has been attributed to patients experiencing severe hypoglycemia in comparison to those not experiencing severe hypoglycemia Repeated episodes of hypoglycemia can lead to impairment of the counter-regulatory system with the potential for development of hypoglycemia unawareness. The short- and long-term complications of diabetes related hypoglycemia include precipitation of acute cerebrovascular disease, myocardial infarction, neurocognitive dysfunction, retinal cell death and loss of vision in addition to health-related quality of life issues pertaining to sleep, driving, employment, recreational activities involving exercise and travel. There is an urgent need to examine the clinical spectrum and burden of hypoglycemia so that adequate control measures can be implemented against this neglected life-threatening complication. Early recognition of hypoglycemia risk factors, self-monitoring of blood glucose, selection of appropriate treatment regimens with minimal or no risk of hypoglycemia and appropriate educational programs for healthcare professionals and patients with diabetes are the major ways forward to maintain good glycemic control, minimize the risk of hypoglycemia and thereby prevent long-term complications.
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Affiliation(s)
- Sanjay Kalra
- Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - Jagat Jyoti Mukherjee
- Department of Endocrinology and Diabetes, Apollo Gleneagles Hospital, Kolkata, India
| | | | - Ganapathi Bantwal
- Department of Endocrinology, St. John's Medical College, Bangalore, India
| | - Shehla Shaikh
- Department of Endocrinology, Prince Aly Khan Hospital and Saifee Hospital, Mumbai, India
| | - Banshi Saboo
- Department of Diabetology, Dia Care Diabetes Care Centre, Ahmedabad, India
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Abstract
Diabetes affects over 25 million people in the United States, most of whom are over the age of 16 and many of whom are licensed to drive a motor vehicle. Safe operation of a motor vehicle requires complex interactions of cognitive and motor functions and medical conditions that affect these functions often will increase the risk of motor vehicle accidents (MVA). In the case of diabetes, hypoglycemia is the most common factor that has been shown to increase MVA rates. When people with diabetes are compared with nondiabetic controls, systematic analyses show that the relative risk of MVA is increased by between 12% and 19% (Relative Risk Ratio 1.12-1.19). In comparison, the RRR for attention deficit hyperactivity disorder is 4.4 and for sleep apnea is 2.4. Epidemiologic research suggests that patients at risk for hypoglycemia-related MVAs may have some characteristics in common, including a history of severe hypoglycemia or of hypoglycemia-related driving mishaps. Experimental studies also have shown that people with a history of hypoglycemia-related driving mishaps have abnormal counter-regulatory responses to hypoglycemia and greater cognitive impairments during moderate hypoglycemia.
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Lorber D, Anderson J, Arent S, Cox DJ, Frier BM, Greene MA, Griffin JW, Gross G, Hathaway K, Kohrman DB, Marrero DG, Songer TJ, Yatvin AL. Diabetes and driving. Diabetes Care 2013; 36 Suppl 1:S80-5. [PMID: 23264427 PMCID: PMC3537281 DOI: 10.2337/dc13-s080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Cox DJ, Gonder-Frederick L, Shepard JA, Campbell L, Vajda KA. Driving safety: concerns and experiences of parents of adolescent drivers with type 1 diabetes. Pediatr Diabetes 2012; 13:506-9. [PMID: 22642583 PMCID: PMC3431447 DOI: 10.1111/j.1399-5448.2012.00862.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/16/2012] [Accepted: 02/15/2012] [Indexed: 12/31/2022] Open
Abstract
Driving is a dangerous activity for adolescents, perhaps being even more precarious for adolescents with type 1 diabetes due to the possibility of extreme blood glucose (BG). There is no available data on adolescent driving safety concerns and type 1 diabetes. To begin addressing this issue, we surveyed parents regarding their observations and concerns. Seventy-two parents (87.5% mothers) of adolescent drivers aged 16-19 with type 1 diabetes provided analyzable data. Females comprised 36% of their adolescents, with 74% using pump therapy. In the past year, 13 and 84% of parents reported that their adolescent had experienced severe or moderate disruptive hypoglycemia, respectively. Over half (56%) of the parents reported moderate to extreme worry about how diabetes impacted their adolescent's driving, while only 21% of parents thought their adolescents had similar concerns (p = 0.037). Almost one third (31%) of parents thought their adolescent need not treat low BG until it fell below 70 mg/dL, 13% thought their adolescent could safely drive with BG below 65 mg/dL. And, 31 and 14% of parents, respectively, reported their adolescent had been in a collision or stopped by the police in the past year, which they attributed to both hypo- and hyperglycemia. Adolescents reportedly took steps to prevent hypo- and hyperglycemia while driving, but more aggressively avoided hypoglycemia (p < 0.001). While this data is limited, lacking a non-diabetic control group and randomized sample, it does suggest that driving and adolescent type 1 diabetes deserve further attention and investigation.
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Affiliation(s)
- Daniel J Cox
- Department of Psychiatry and Neurobehavioral Sciences; University of Virginia Health System; Charlottesville; VA; 22908; USA
| | - Linda A Gonder-Frederick
- Department of Psychiatry and Neurobehavioral Sciences; University of Virginia Health System; Charlottesville; VA; 22908; USA
| | - Jaclyn A Shepard
- Department of Psychiatry and Neurobehavioral Sciences; University of Virginia Health System; Charlottesville; VA; 22908; USA
| | - Laura K Campbell
- Department of Psychiatry and Neurobehavioral Sciences; University of Virginia Health System; Charlottesville; VA; 22908; USA
| | - Karen A Vajda
- Department of Psychiatry and Neurobehavioral Sciences; University of Virginia Health System; Charlottesville; VA; 22908; USA
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Lorber D, Anderson J, Arent S, J D, Frier BM, Greene MA, Griffin JW, Gross G, Hathaway K, Hirsch I, Kohrman DB, Marrero DG, Songer TJ, Yatvin AL. Diabetes and driving. Diabetes Care 2012; 35 Suppl 1:S81-6. [PMID: 22187475 PMCID: PMC3632177 DOI: 10.2337/dc12-s081] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Shaw K. Driving and diabetes: new licensing standards by European Union directive. PRACTICAL DIABETES 2011. [DOI: 10.1002/pdi.1638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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27
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Abstract
Strict glycaemic control is a major concern in many people with diabetes, hypoglycaemia being the most limiting factor in the daily management of patients with diabetes. Acute consequences of hypoglycaemic attacks are not precisely evaluated. Acute cardiovascular (CV) complications as myocardial ischaemia or stroke seem to be rare, but possibly ignored mainly in older frail patients. Recent large trials in type 2 diabetic patients have not shown the anticipated mortality benefits of strict glycaemic control, and reported a higher frequency of severe hypoglycaemia in the intensive treatment arms with an excess of CV deaths. The authors of these trials persist to deny a direct link between CV deaths and hypoglycaemia. In young type 1 diabetics "dead in bed" syndrome represents a rare but devastating consequence probably due to arrhythmia and prolonged QTc interval. Driving mishaps represent another complication but with a controversial frequency. Neurologic syndromes are frequent during severe hypoglycaemia but usually reversible. Major brain damages are scarce, but cognitive defects or dementia should be underestimated in older and frail type 2 diabetics. Thus, iatrogenic hypoglycaemia due to insulin or sulphonylureas may cause recurrent morbidity in type 1 and type 2 diabetic subjects, and should be prevented by a reevaluation of glycaemic targets in some patients, patient education and the use of new antidiabetic drugs without hypoglycaemic risk.
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Affiliation(s)
- S Halimi
- Clinique d'Endocrinologie Diabétologie Nutrition, Pôle DigiDUNE, CHU Grenoble, BP217X, Grenoble, France.
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Neurocognitive Differences Between Drivers with Type 1 Diabetes with and without a Recent History of Recurrent Driving Mishaps. ACTA ACUST UNITED AC 2010; 2:73-77. [PMID: 21127720 DOI: 10.1016/j.ijdm.2010.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE: A subset of drivers with type 1 diabetes mellitus (T1DM) may be at significant risk of hypoglycemia-related driving collisions and moving vehicle violations due to acute and chronic neurocognitive impairment. The present study compared drivers with T1DM with and without a recent history of multiple driving mishaps on a neurocognitive battery during euglycemia, progressive mild hypoglycemia, and recovery from hypoglycemia, to determine whether neurocognitive measures differentiate the two risk groups. We hypothesized that drivers with a history of multiple recent hypoglycemia-related driving mishaps would demonstrate greater psychomotor slowing, both during hypoglycemia and euglycemia. STUDY DESIGN: Partcipants were 42 adults with T1DM and were assigned to one of two groups: those reporting no driving mishaps in the last year (-History) and those reporting two or more (+History).Neurocognitive testing was conducted before and repeated during a hyper-insulinemic clamping procedure. RESULTS: Not surprisingly, all drivers demonstrated a decrease in functioning across all neurocognitive tasks during hypoglycemia. However, in contrast to the common belief that neurocognitive functions return slowly and gradually following hypoglycemia, baseline neurocognitive functioning immediately recovered upon return of BG to euglycemia for all subjects. Between-group analyses revealed that subjects with a recent history of driving mishaps consistently demonstrated poorer performance on tasks measuring working memory. CONCLUSION: Working memory is a potential neurocognitive indicator that may help differentiate adults with T1DM with and without a history of driving mishaps, predict future risk for driving mishaps, and provide targeted intervention programs to address this critical public health issue.
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Cox DJ, Singh H, Clarke WL, Anderson SM, Kovatchev BP, Gonder-Frederick LA. Metabolic Demand of Driving Among Adults with Type 1 Diabetes Mellitus (T1DM). ANNALS OF ADVANCES IN AUTOMOTIVE MEDICINE. ASSOCIATION FOR THE ADVANCEMENT OF AUTOMOTIVE MEDICINE. ANNUAL SCIENTIFIC CONFERENCE 2010; 54:367-72. [PMID: 21050619 PMCID: PMC3242559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Recent research suggests that the frequency of driving mishaps is increased in people with Type 1 diabetes (T1DM) as compared to those with Type 2 diabetes or their non-diabetic spouses. This study involved a sample of T1DM drivers and was designed to investigate the metabolic and physiologic demands of driving compared to sitting passively. Participants (N=38) were divided into two groups: the -History group included those reporting no driving mishaps in the past two years, and the +History group included participants reporting at least two such mishaps in the past two years. Glucose utilization rates were determined in participants while: (a) they were driving a virtual reality driving simulator for 30 minutes, and (b) watching a 30-minute video. Blood glucose (BG) levels were maintained at similar levels during both procedures. Other biological variables including heart rate (HR) were monitored. Participants rated their hypoglycemia (low BG) symptoms before and after each of the two procedures. . Participants could self-treat if they perceived they were experiencing hypoglycemia. There were no differences between the two groups. However, glucose utilization rates were significantly higher during the driving scenario (3.83mg/kg/min + 1.7 vs. 3.37 mg/kg/min + 1.6, p=0.047). HR was significantly higher during the driving scenario. Drivers reported more autonomic symptoms during driving and 32% treated perceived hypoglycemia during driving. Driving a virtual reality simulator is associated with increased glucose utilization rates suggesting that driving per se has a metabolic cost and that BG should be measured prior to driving and periodically during long drives.
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Affiliation(s)
- Daniel J Cox
- University of Virginia Health System, Charlottesville, Virginia, USA
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