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Liu D, Chihuri S, Andrews HF, Betz ME, DiGuiseppi C, Eby DW, Hill LL, Jones V, Mielenz TJ, Molnar LJ, Strogatz D, Lang BH, Li G. Diabetes mellitus and hard braking events in older adult drivers. Inj Epidemiol 2024; 11:22. [PMID: 38840227 DOI: 10.1186/s40621-024-00508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) can impair driving safety due to hypoglycemia, hyperglycemia, diabetic peripheral neuropathy, and diabetic eye diseases. However, few studies have examined the association between DM and driving safety in older adults based on naturalistic driving data. METHODS Data for this study came from a multisite naturalistic driving study of drivers aged 65-79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs) of hard braking events (HBEs, defined as maneuvers with deceleration rates ≥ 0.4 g) associated with DM. RESULTS Of the 2856 study participants eligible for this analysis, 482 (16.9%) reported having DM at baseline, including 354 (12.4%) insulin non-users and 128 (4.5%) insulin users. The incidence rates of HBEs per 1000 miles were 1.13 for drivers without DM, 1.15 for drivers with DM not using insulin, and 1.77 for drivers with DM using insulin. Compared to drivers without DM, the risk of HBEs was 48% higher for drivers with DM using insulin (aIRR 1.48; 95% CI: 1.43, 1.53). CONCLUSION Older adult drivers with DM using insulin appear to be at increased proneness to vehicular crashes. Driving safety should be taken into consideration in DM care and management.
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Affiliation(s)
- Difei Liu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY, PH5-534, 10032, USA
| | - Howard F Andrews
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, 80045, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - David W Eby
- College of Engineering, University of Michigan Transportation Research Institute, Ann Arbor, MI, 48109, USA
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Vanya Jones
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- Columbia Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Lisa J Molnar
- College of Engineering, University of Michigan Transportation Research Institute, Ann Arbor, MI, 48109, USA
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, Cooperstown, NY, 13326, USA
| | - Barbara H Lang
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY, PH5-534, 10032, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY, PH5-534, 10032, USA.
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Chang YH, Hou WH, Wu KF, Li CY, Hsu IL. Risk of motorcycle collisions among patients with type 2 diabetes: a population-based cohort study with age and sex stratifications in Taiwan. Acta Diabetol 2022; 59:1625-1634. [PMID: 36103089 DOI: 10.1007/s00592-022-01967-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/29/2022] [Indexed: 11/01/2022]
Abstract
AIMS To investigate the overall and sex-age-specific absolute and relative risks of motorcycle collisions at road traffic accidents among patients with type 2 diabetes. METHODS A cohort study in Taiwan was conducted by following 989,495 patients with type 2 diabetes and the same number of matched controls recruited between 2010 and 2012 to the end of 2016. Collision events by motorcycle driver victims were identified from the Police-reported Traffic Accident Registry. Overall and sex-age-specific incidence rates of collision involving motorcycle driver victims were estimated under Poisson assumption. The Cox proportional hazard regression models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of collision in association with type 2 diabetes. RESULTS Over an up to 7 years of follow-up, patients with type 2 diabetes had a higher incidence rate of motorcycle collision than controls at 1.16 and 0.89 per 100 person-years, respectively, which represented a significantly elevated HR of 1.28 (95% CI 1.27-1.30) after adjusting for potential confounders including various diabetic complications. The elevated HR was similarly seen in both men and women patients, and was significantly decreasing with increasing age regardless of sex. Little evidence supported the dose-response relationship between duration of type 2 diabetes and motorcycle collision risk. CONCLUSIONS After adjustment for common diabetic complications and comorbidities that could impair driving performance, patients with type 2 diabetes still suffered from increased risk of motorcycle collisions, regardless of sex, but was more evident in younger than in older patients.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Hsuan Hou
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ke-Fei Wu
- Department of Accounting Information, Chihlee University of Technology, New Taipei, Taiwan
- Department of Business Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Hou WH, Chang YH, Hendrati LY, Isfandiari MA, Li CY, Hsu IL. Evaluation of motor vehicle crashes between scooter riders and car drivers after diagnosis of type 2 diabetes in Taiwan. Injury 2022; 53:3950-3955. [PMID: 36224056 DOI: 10.1016/j.injury.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the plausibility that diabetes may increase the risk of motor vehicle crashes (MVCs) due to various diabetes related complications and co-morbidity, findings from epidemiological studies on the relationship between diabetes and MVCs remained inclusive mainly due to heterogeneity in the study design and failure to complete consideration of potential confounders. This study re-visited this putative association with an improved study design. METHOD This study employed a controlled before-after study design and included 1,264,280 people aged 18-75 years with T2D newly diagnosed from 2009-2014 and an equal number of age-, sex-, and time-matched controls. The rate ratios (RRs) of vehicle type-specific incidence rates of MVCs in the 1 and 2 years before and after diabetes diagnosis (or the matched dates) were compared between the individuals with type 2 diabetes (T2D) and their matched controls. RESULTS The rate of MVCs increased slightly among people with T2D over 1 and 2 years following diabetes diagnosis, with RRs of 1.04 (95% confidence interval [CI]=1.02-1.07) and 1.11 (95% CI=1.09-1.13), respectively. These RRs were comparable to those obtained for controls (1.06 and 1.12, respectively). By contrast, the RRs of scooter crashes were significantly higher in the T2D group than in the control group during the 1 year (1.28 vs. 1.08, p < 0.001) and 2 years (1.32 vs. 1.08, p < 0.001) following diabetes diagnosis. CONCLUSION T2D diagnosis was associated with a moderate but significant increase in the risk of MVCs among scooter drivers, but not among car drivers.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lucia Yovita Hendrati
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Muhammad Atoillah Isfandiari
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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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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Hansen D, Kraenkel N, Kemps H, Wilhelm M, Abreu A, Pfeiffer AFH, Jordão A, Cornelissen V, Völler H. Management of patients with type 2 diabetes in cardiovascular rehabilitation. Eur J Prev Cardiol 2019; 26:133-144. [DOI: 10.1177/2047487319882820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The clinical benefits of rehabilitation in cardiovascular disease are well established. Among cardiovascular disease patients, however, patients with type 2 diabetes mellitus require a distinct approach. Specific challenges to clinicians and healthcare professionals in patients with type 2 diabetes include the prevalence of peripheral and autonomic neuropathy, retinopathy, nephropathy, but also the intake of glucose-lowering medication. In addition, the psychosocial wellbeing, driving ability and/or occupational status can be affected by type 2 diabetes. As a result, the target parameters of cardiovascular rehabilitation and the characteristics of the cardiovascular rehabilitation programme in patients with type 2 diabetes often require significant reconsideration and a multidisciplinary approach. This review explains how to deal with diabetes-associated comorbidities in the intake screening of patients with type 2 diabetes entering a cardiovascular rehabilitation programme. Furthermore, we discuss diabetes-specific target parameters and characteristics of cardiovascular rehabilitation programmes for patients with type 2 diabetes in a multidisciplinary context, including the implementation of guideline-directed medical therapy.
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Affiliation(s)
- Dominique Hansen
- REVAL – Rehabilitation Research Center, Hasselt University, Belgium
- Jessa Hospital, Heart Center Hasselt, Belgium
- BIOMED – Biomedical Research Center, Hasselt University, Belgium
| | - Nicolle Kraenkel
- Department of Endocrinology, Diabetes and Nutrition, Charité – Universitätsmedizin Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, the Netherlands
| | | | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Portugal
| | - Andreas FH Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Charité – Universitätsmedizin Berlin, Germany
- DZD (German Centre for Diabetes Research), partner site Berlin/Nuthetal, Germany
| | - Alda Jordão
- Department of Internal Medicine, Hospital Pulido Valente, Portugal
| | | | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Germany
- Klinik am See, Rehabilitation Center for Internal Medicine, Germany
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Batais MA, Alamri AK, Alghammass MA, Alzamil OA, Almutairi BA, Al-Maflehi N, Almigbal TH. Diabetes and driving recommendations among healthcare providers in Saudi Arabia. A significant gap that requires action. Saudi Med J 2018; 39:386-394. [PMID: 29619491 PMCID: PMC5938653 DOI: 10.15537/smj.2018.4.22179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To assess healthcare providers’ knowledge and awareness of the recommendations for drivers with insulin-treated diabetes in Saudi Arabia. Methods: A cross-sectional study was conducted among healthcare providers working at 4 tertiary hospitals in Riyadh, Saudi Arabia between April 2016 and December 2016 using a self-administered questionnaire. Results: A total of 285 healthcare providers completed the survey (response rate 88.5%). Most (70.2%) were aware of the safe driving recommendations for patients with insulin-treated diabetes. However, the need to check blood glucose levels before driving was underestimated by almost one-third (30.2%). Only one-quarter (24.6%) identified the correct level of blood glucose level that is safe for a patient when driving, and 28.4% identified the recommended time for checking blood glucose before driving. Participants who were aware of the recommendations for safe driving had a significantly higher average knowledge score (68.8%) than those who were not aware (58.8%; p<0.001). There was a significant difference in the average knowledge score among medical specialties (p=0.002) and job levels (p<0.001). Conclusions: Most healthcare providers identified the importance of evaluating their patients for ability to drive safely, but we found some important areas of knowledge deficit. Professional intervention to improve healthcare providers’ awareness and knowledge regarding diabetes and driving is the first step in improving detection and reporting high-risk drivers with diabetes to prevent future driving mishaps.
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Affiliation(s)
- Mohammed A Batais
- Diabetes and Family Medicine, Family and Community Medicine Department, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Sundelin HEK, Chang Z, Larsson H, Lichtenstein P, Almqvist C, Tomson T, Ludvigsson JF. Epilepsy, antiepileptic drugs, and serious transport accidents: A nationwide cohort study. Neurology 2018; 90:e1111-e1118. [PMID: 29490912 DOI: 10.1212/wnl.0000000000005210] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the association between epilepsy and antiepileptic drugs and serious transport accidents requiring emergency care or resulting in death. METHODS We identified 29,220 individuals 18 years or older with epilepsy without cerebral palsy or intellectual disability and 267,637 matched controls using Swedish registers. This nationwide cohort was followed from 2006 to 2013 for serious transport accidents. We used Cox regression to analyze the risk of serious transport accidents between individuals with epilepsy and matched controls, and then stratified Cox regression to compare the risk during periods of medication with the risk during nonmedication period within the same individual with epilepsy. We adjusted for civil status, employment, education, living area, psychiatric disorders prior to the start of follow-up, and psychotropic medication. RESULTS Compared to matched controls, individuals with epilepsy were at increased risk of serious transport accidents (hazard ratio [HR] 1.37; 95% confidence interval [CI] 1.29-1.46). There were increased risks of pedestrian accidents (HR 2.24, 95% CI 1.69-2.97), bicycle accidents (HR 1.68, 95% CI 1.49-1.89) and car accidents (HR 1.31, 95% CI 1.19-1.44). However, among patients with a diagnosis of epilepsy, use of antiepileptic drugs did not influence the risk of serious transport accidents in population-level comparisons (HR 0.97; 95% CI 0.85-1.11) or within-individual comparisons (HR 0.99; 95% CI 0.69-1.42). CONCLUSION Serious transportation accidents were more common in individuals with epilepsy, but this risk was independent of use of antiepileptic drugs.
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Affiliation(s)
- Heléne E K Sundelin
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY.
| | - Zheng Chang
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Henrik Larsson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Paul Lichtenstein
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Catarina Almqvist
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Torbjörn Tomson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Jonas F Ludvigsson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
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