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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hetta. G, Jane. M, Michelle. H, Anna. D, Reuben. R, Greg. K, Andre. JJ, Leslie L, Thomas. M, GF. TK. Impact of HIV on Cognitive Performance in Professional Drivers. J Acquir Immune Defic Syndr 2022; 89:527-536. [PMID: 34974470 PMCID: PMC9058184 DOI: 10.1097/qai.0000000000002899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The intellectually demanding modern workplace is often dependent on good cognitive health, yet there is little understanding of how neurocognitive dysfunction related to HIV presents in employed individuals working in high-risk vocations such as driving. HIV-associated neurocognitive impairment is also associated with poorer long-term cognitive, health, and employment outcomes. SETTING This study, set in Cape Town, South Africa, assessed the effects of HIV on neuropsychological test performance in employed male professional drivers. METHOD We administered a neuropsychological test battery spanning 7 cognitive domains and obtained behavioral data, anthropometry, and medical biomarkers from 3 groups of professional drivers (68 men with HIV, 55 men with cardiovascular risk factors, and 81 controls). We compared the drivers' cognitive profiles and used multiple regression modeling to investigate whether between-group differences persisted after considering potentially confounding sociodemographic and clinical variables (ie, income, home language, depression, and the Framingham risk score). RESULTS Relative to other study participants, professional drivers with HIV performed significantly more poorly on tests assessing processing speed (P < 0.003) and attention and working memory (P = 0.018). Group membership remained a predictor of cognitive performance after controlling for potential confounders. The cognitive deficits observed in men with HIV were, however, largely characterized as being mild or asymptomatic. Consistent with this characterization, their relatively poor performance on neuropsychological testing did not generalize to self-reported impairment on activities of daily living. CONCLUSION Drivers with HIV may be at risk of poorer long-term health and employment outcomes. Programs that monitor and support their long-term cognitive health are needed.
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Affiliation(s)
- Gouse Hetta.
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Masson Jane.
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Henry Michelle.
- Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - Dreyer Anna.
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Robbins Reuben.
- HIV Center for Clinical and Behavioral Science, New York State Psychiatric Institute and Columbia University, New York, USA
| | - Kew Greg.
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Joska John Andre.
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - London Leslie
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Marcotte Thomas.
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Thomas Kevin GF.
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
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Skyving M, Forsman Å, Dukic Willstrand T, Laflamme L, Möller J. Medical impairment and road traffic crashes among older drivers in Sweden - A national, population-based, case-control study. Accid Anal Prev 2021; 163:106434. [PMID: 34700248 DOI: 10.1016/j.aap.2021.106434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Several medical conditions are known to impair sensory, cognitive and motor functions and are associated with road traffic crashes (RTC). For the drivers of today, we lack updated knowledge on how driving-impairing conditions are associated with RTCs, across all driving-impairing conditions in a given population. We aim to determine this among older drivers in Sweden. METHODS A national, population register-based, matched case-control study comparing acknowledged driving-impairing health conditions among all older drivers (65 years or older) involved in an injurious RTC in the period 2011-2016 (n = 13,701) with those of controls: older drivers not involved in any RTC (n = 26,525) matched to the cases by age, sex and residential area. The medical conditions, extracted from the National Patient Register from 1997 up until date of RTC, were identified based on ICD-10 diagnosis codes and categorized into the 13 groups of medical conditions listed in the Swedish driver's license regulations. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals. RESULTS Unadjusted ORs for RTC were increased for all conditions. After taking the other 12 medical conditions into account, the ORs remained significant in 11 out of the 13. A strong association was found for the group "ADHD and autism spectrum disorders" (OR 2.79, CI 1.47-5.30), although with very low prevalence among cases (0.2%). Moderate associations were found for three conditions with a case prevalence between 1.3% and 8.5%: epilepsy and seizure disorders (OR 1.53, CI 1.25-1.89), substance abuse and dependence (OR 1.45, CI 1.29-1.63), psychological diseases and mental disorders (OR 1.28, CI 1.18-1.39) and for one condition with a case prevalence of 14.7%, diabetes (OR 1.28, CI 1.20-1.36). CONCLUSIONS In Sweden, in the current generation of older drivers, acknowledged driving-impairing medical conditions at the national and European levels remain a concern. After adjustment for one another, all but 2 of the conditions are associated with RTCs albeit to varying degrees and more pronounced in the age group 65-79 compared to 80 or older. To promote and sustain older people's mobility, addressing this issue will require a blend of interventions where, hopefully, technological and infrastructural innovations may help counteracting individual health-related shortcomings.
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Affiliation(s)
- Marie Skyving
- Karolinska Institutet, Department of Global Public Health, Solnavägen 1E, SE-11365 Stockholm, Sweden; Swedish Transport Agency, Department of Road and Rail, Isafjordsgatan 1, SE-16440 Kista, Sweden.
| | - Åsa Forsman
- The Swedish National Road and Transport Research Institute (VTI), Olaus Magnus väg 37, SE-58195 Linköping, Sweden.
| | | | - Lucie Laflamme
- Karolinska Institutet, Department of Global Public Health, Tomtebodavägen 18 A, SE-17165 Stockholm, Sweden.
| | - Jette Möller
- Karolinska Institutet, Department of Global Public Health, Solnavägen 1E, SE-11365 Stockholm, Sweden.
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Haim A, Shalev Shamy R, Ridel D, Parmet Y, Loewenthal N, Liberty I, Tejman-Yarden S, Hershkovitz E, Borowsky A. Acute hyperglycaemia can impair driving skill in young type 1 diabetes mellitus patients. Diabetes Metab 2020; 47:101176. [PMID: 32735952 DOI: 10.1016/j.diabet.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
AIM Drivers with diabetes are at increased risk of being involved in road accidents. Therefore, this study aimed to evaluate the effects of acute hyperglycaemia (AH) compared with euglycaemia on driving ability in patients with type 1 diabetes mellitus (T1DM). METHODS Eighteen drivers with T1DM were asked to navigate twice through nine hazardous scenarios, using a driving simulator, during euglycaemia and then again during AH (mean blood glucose: 138 ± 34 mg/dL and 321 ± 29 mg/dL, respectively) in a counterbalanced crossover study. Driving performance was continually monitored for driving speed, steering wheel angle, acceleration, and location and velocity of other vehicles and obstacles, with drivers wearing a mobile head-mounted eye-tracking system. RESULTS The main findings were that, during AH, participants were less likely to identify a hazard [probability of identification (POI): 0.5725 ± 0.5], glanced fewer times at the hazard (3.24 ± 5.9), maintained shorter headway (between-vehicle) distance (mean: 40.87 ± 20.15 m) and had an increased number of braking events per km driven (6.69 ± 5.20) compared with driving during euglycaemia (POI: 0.733 ± 0.4; number of glances: 3.69 ± 6.99; headway distance: 50.46 ± 26.2 m; number of braking events per km driven: 4.31 ± 3.87; P < 0.05 for all parameters). CONCLUSION This study provides evidence that AH impairs driving performance in young T1DM patients by demonstrating the negative effects of AH on both hazard perception and speed management.
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Affiliation(s)
- Alon Haim
- Pediatric Endocrinology & Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Rotem Shalev Shamy
- Pediatric Endocrinology & Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dana Ridel
- Department of Industrial Engineering & Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering & Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Neta Loewenthal
- Pediatric Endocrinology & Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Idit Liberty
- Department of Internal Medicine, Adult Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Shai Tejman-Yarden
- Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Eli Hershkovitz
- Pediatric Endocrinology & Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Avinoam Borowsky
- Department of Industrial Engineering & Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Gutiérrez-Abejón E, Criado-Espegel P, Herrera-Gómez F, Álvarez FJ. Population-Based Registry Analysis of Antidiabetics Dispensations: Trend Use in Spain between 2015 and 2018 with Reference to Driving. Pharmaceuticals (Basel) 2020; 13:E165. [PMID: 32722515 DOI: 10.3390/ph13080165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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. Accid Anal Prev 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ma S, Wu C, Zhang J, Zeng X, Zhao G, Sun X. Looking for an optimal pedal layout to improve the driving performance of patients with diabetic peripheral neuropathy. Appl Ergon 2019; 80:43-49. [PMID: 31280809 DOI: 10.1016/j.apergo.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
Diabetes can undermine people's ability to drive safely, but most previous studies have focused on its deterioration of the central nervous system. This study sought to investigate how diabetic peripheral neuropathy (DPN), a common complication of diabetes characterized by reduced sensitivity of the limbs, can influence people's braking behavior and other safety-related measures of driving. In addition, it also tested how such a deteriorating effect can be reduced by using certain pedal layout designs. In total, 29 healthy drivers and 31 drivers of type 2 diabetes matched in demographic variables were invited to participate in this study. The participants with type 2 diabetes (they are from here on out referred to as "patients")were then split into two subgroups based on the severity of DPN using the median of the Semmes-Weinstein monofilaments Examination (SWME) scores. All three groups of participants finished a series of vehicle-pedestrian conflict tasks in a driving simulator using nine different types of pedal layouts. These layouts varied in the lateral distance between the accelerator and the brake (45 mm, 60 mm, and 75 mm) and the width of brake pedals (50 mm, 70 mm, 90 mm). The results showed that patients with serious DPN had longer brake reaction times (BRT) and shorter minimum distance-to-collision (DTC) as compared to the other two groups. However, the effects of such a disadvantage varied across different pedal layouts. When the accelerator-brake distance was 45 mm, patients with serious DPN showed no compromised driving performance as compared to other two groups. In conclusion, we found the DPN could undermine driving performance of participants with type 2 diabetes, and a closer accelerator-brake lateral distance (45 mm) may be an optimal choice for them to counteract such a negative influence.
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Affiliation(s)
- Shu Ma
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, 100049, China; Department of Psychology, Zhejiang Sci-Tech University, 928 2nd Street, Xiasha Higher Education Park, Hangzhou, 310016, China
| | - Changxu Wu
- Department of Systems and Industrial Engineering, University of Arizona, United States
| | - Jingyu Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, 100049, China.
| | - Xianzhong Zeng
- Department of Endocrinology, Ganzhou People's Hospital, Ganzhou, China
| | - Guozhen Zhao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, 100049, China
| | - Xianghong Sun
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, 100049, China
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Merickel J, High R, Smith L, Wichman C, Frankel E, Smits K, Drincic A, Desouza C, Gunaratne P, Ebe K, Rizzo M. Driving Safety and Real-Time Glucose Monitoring in Insulin-Dependent Diabetes. ACTA ACUST UNITED AC 2019; 10:34-40. [PMID: 34306907 DOI: 10.20485/jsaeijae.10.1_34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our goal is to address the need for driver-state detection using wearable and in-vehicle sensor measurements of driver physiology and health. To address this goal, we deployed in-vehicle systems, wearable sensors, and procedures capable of quantifying real-world driving behavior and performance in at-risk drivers with insulin-dependent type 1 diabetes mellitus (DM). We applied these methodologies over 4 weeks of continuous observation to quantify differences in real-world driver behavior profiles associated with physiologic changes in drivers with DM (N=19) and without DM (N=14). Results showed that DM driver behavior changed as a function of glycemic state, particularly hypoglycemia. DM drivers often drive during at-risk physiologic states, possibly due to unawareness of impairment, which in turn may relate to blunted physiologic responses (measurable heart rate) to hypoglycemia after repeated episodes of hypoglycemia. We found that this DM driver cohort has an elevated risk of crashes and citations, which our results suggest is linked to the DM driver's own momentary physiology. Overall, our findings demonstrate a clear link between at-risk driver physiology and real-world driving. By discovering key relationships between naturalistic driving and parameters of contemporaneous physiologic changes, like glucose control, this study directly advances the goal of driver-state detection through wearable physiologic sensors as well as efforts to develop "gold standard" metrics of driver safety and an individualized approach to driver health and wellness.
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Affiliation(s)
- Jennifer Merickel
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
| | - Robin High
- University of Nebraska Medical Center, College of Public Health, Biostatistics 984355 Nebraska Medical Center, Omaha, NE, 68198
| | - Lynette Smith
- University of Nebraska Medical Center, College of Public Health, Biostatistics 984355 Nebraska Medical Center, Omaha, NE, 68198
| | - Christopher Wichman
- University of Nebraska Medical Center, College of Public Health, Biostatistics 984355 Nebraska Medical Center, Omaha, NE, 68198
| | - Emily Frankel
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
| | - Kaitlin Smits
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
| | - Andjela Drincic
- University of Nebraska Medical Center, Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism 984130 Nebraska Medical Center, Omaha, NE, 68198
| | - Cyrus Desouza
- University of Nebraska Medical Center, Department of Internal Medicine, Division of Diabetes, Endocrinology & Metabolism 984130 Nebraska Medical Center, Omaha, NE, 68198
| | - Pujitha Gunaratne
- Toyota Motor Engineering & Manufacturing North America Inc., Collaborative Safety Research Center 1555 Woodridge Avenue, Ann Arbor, MI, 48105
| | - Kazutoshi Ebe
- Toyota Motor Engineering & Manufacturing North America Inc., Collaborative Safety Research Center 1555 Woodridge Avenue, Ann Arbor, MI, 48105
| | - Matthew Rizzo
- University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 988440 Nebraska Medical Center, Omaha, NE, 68198
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Chitme HR, Al-Kashmiri A, Al-Thehli HM, Al-Qanoobi MJ, Al-Mushefri MM, Venuvgopal J. Impact of Medical Conditions and Medications on Road Traffic Safety. Oman Med J 2018; 33:316-321. [PMID: 30038731 DOI: 10.5001/omj.2018.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objectives Many medical conditions and medicines with therapeutic importance have been shown to impair driving skills, causing road traffic accidents, which leads to great human and economic suffering in Oman. The primary purpose of this study was to assess retrospectively the extent of medical conditions and medications influencing road traffic safety among drivers involved in road accidents. Methods We conducted a retrospective study among 951 injured or non-injured drivers who reported to Khoula and Nizwa hospitals. We used the Al-Shifa database to find the drivers and contacted randomly selected patients over phone. Results The majority of victims were male (72.0%), involving personal cars, and reported at Khoula Hospital. The results show that 7.6% of the victimized drivers had a history of medical conditions with diabetes and hypertension (36.1% each) the most common. About 4.0% of victims were on medications of which insulin was the most common (9.4%). Loss of control was contributed to 38.5% of cases followed by dizziness (25.6%), sleep amnesia (10.3%), and blurred vision (7.7%). Other effects blamed by victimized drivers include vertigo, phonophobia, photophobia, back pain, loss of sensation, and headache accounting for 17.9% of cases. Conclusion Medical conditions and medications influence road traffic safety to some extent in Oman.
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Almigbal TH, Alfaifi AA, Aleid MA, Billah B, Alramadan MJ, Sheshah E, AlMogbel TA, Aldekhayel GA, Batais MA. Safe driving practices and factors associated with motor-vehicle collisions among people with insulin-treated diabetes mellitus: Results from the Diabetes and Driving (DAD) study. J Safety Res 2018; 65:83-88. [PMID: 29776533 DOI: 10.1016/j.jsr.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 02/10/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The aim of this study was to assess the prevalence of people with insulin-treated diabetes mellitus (ITDM) who have discussed issues related to diabetes and driving with their health care providers (HCPs). We also sought to determine the safe driving practices that are currently employed by this group. Finally, we investigated the factors that might increase the risk of motor-vehicle collisions (MVCs) among this group in Saudi Arabia. METHOD This cross-sectional study surveyed a representative sample of 429 current male drivers with ITDM using a structured questionnaire in Saudi Arabia. RESULTS Most of the participants (76.5%) never discussed topics regarding diabetes and driving with their HCPs. The majority of the participants (61.8%) reported at least never doing one of the following: (a) carrying a blood glucose testing kit while driving, (b) testing their blood glucose level before driving or during a journey, or (c) having thought of a specific threshold of blood glucose level that would preclude driving. Three factors were associated with a higher risk of MVCs among participants with ITDM: (a) being on a basal/boluses regimen, (b) never having a discussion regarding diabetes and driving with their HCPs, and (c) having experienced hypoglycemia during driving. CONCLUSIONS The majority of people with ITDM had not had a discussion regarding diabetes and driving with their HCPs, which was reflected by a lack of safe driving practices. People with ITDM should be encouraged to take precautions while driving in order to prevent future MVCs. PRACTICAL APPLICATIONS This research highlights the importance of investing more effort in educating drivers who have diabetes about safe driving practices by their health care providers. Also, it will attracts the attention of policymakers for an urgent need to establish clear policies and procedures for dealing with drivers who have diabetes.
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Affiliation(s)
- Turky H Almigbal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | - Muath A Aleid
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mohammed J Alramadan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Eman Sheshah
- Diabetes Centre, King Salman Hospital, Riyadh, Saudi Arabia
| | - Turki A AlMogbel
- Buraydah Diabetes Centre, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
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Rudisill TM, Zhu M, Kelley GA, Pilkerton C, Rudisill BR. Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review. Accid Anal Prev 2016; 96:255-270. [PMID: 27569655 PMCID: PMC5045819 DOI: 10.1016/j.aap.2016.08.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/17/2016] [Accepted: 08/02/2016] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC). METHODS The a priori inclusion criteria were: (1) studies published from English-language sources on or after January 1, 1960, (2) licensed drivers 15 years of age and older, (3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, (4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies (5) outcome measure reported for at least one specific medication, (6) outcome measure reported as the odds or risk of a motor vehicle collision. Fourteen databases were examined along with hand-searching. Independent, dual selection of studies and data abstraction was performed. RESULTS Fifty-three medications were investigated by 27 studies included in the review. Fifteen (28.3%) were associated with an increased risk of MVC. These included Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone. CONCLUSIONS Several medications were associated with an increased risk of MVC and decreased driving ability. The associations between specific medication use and the increased risk of MVC and/or affected driving ability are complex. Future research opportunities are plentiful and worthy of such investigation.
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Affiliation(s)
- Toni M Rudisill
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Motao Zhu
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - George A Kelley
- Department of Biostatistics, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Courtney Pilkerton
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
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Abstract
AIMS The main objective of this study was to see whether diabetes is associated with an increased collision risk and to test the effect of age and gender on the overall collision risk for diabetes drivers. MATERIALS AND METHODS Twenty-eight studies were included in meta-analysis, using mean age, gender, continent and the prevalence of fatal road incidents as covariates. RESULTS The collision risk for diabetes drivers was small and not statistically significant - RR = 1.11 (1.01-1.23) with a prediction interval (PI) or 0.77-1.65. Age and gender were not associated with an increased overall risk. Insulin-dependent diabetes patients had a slightly increased effect size compared with the overall diabetes population, but the effect was not statistically significant. European diabetes drivers had a lower collision risk compared with their North American counterparts, the main cause being the difference of collision risk in the countries in which the studies were performed. CONCLUSIONS Overall, diabetes patients do not have a statistically significant increased risk for unfavourable traffic events. Old age and insulin-dependent patients tend to have a higher risk. Advances in diabetes care, associated with advances in road safety regulations, and automotive industry have not decreased significantly the collision risk in the last 50 years for drivers with diabetes.
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Affiliation(s)
- S Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University, Bucharest, Romania
- National Institute of Legal Medicine, Bucharest, Romania
| | - I Negoi
- Department of Surgery, Carol Davila University, Bucharest, Romania
| | - M Hostiuc
- Department of Internal Medicine and Gastroenterology, Carol Davila University, Bucharest, Romania
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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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Rudisill TM, Zhu M, Davidov D, Leann Long D, Sambamoorthi U, Abate M, Delagarza V. Medication use and the risk of motor vehicle collision in West Virginia drivers 65 years of age and older: a case-crossover study. BMC Res Notes 2016; 9:166. [PMID: 26979111 DOI: 10.1186/s13104-016-1974-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/03/2016] [Indexed: 02/06/2023] Open
Abstract
Background The current generation of older adults reports a higher lifetime prevalence of prescription, over-the-counter, and recreational drug use. The purpose of this analysis is to characterize the drug usage and determine the risk of motor vehicle collision associated with individual medications in a population of drivers ≥65 years. Methods A case-crossover study was conducted at West Virginia University Healthcare’s facilities using data obtained from the electronic health records (n = 611) of drivers ≥65 years admitted for medical treatment following a motor vehicle collision which occurred between Jan. 1, 2009 and June 30, 2014. Patients’ medication usage 14 days before collision were matched and compared to their medication usage during four control periods prior to collision. Odds ratios were then calculated for the most prevalent individual medications and pharmaceutical sub-classes using conditional logistic regression. Results Analgesic, cardiovascular and gastrointestinal medicines were common. Few drivers tested positive for either licit or illicit drugs. Of those testing positive for drugs, benzodiazepines and opiates were prevalent. Drivers consuming Tramadol (adjusted OR 11.41; 95 % CI 1.27, 102.15) were at a significantly increased risk of motor vehicle collision. Conclusions Older adult drivers who have a prescription for this medication may need to be aware of the potential risk. Further research is necessary in a larger, more nationally representative population.
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Houlden RL, Berard L, Cheng A, Kenshole AB, Silverberg J, Woo VC, Yale JF. Diabetes and driving: 2015 Canadian Diabetes Association updated recommendations for private and commercial drivers. Can J Diabetes 2015; 39:347-53. [PMID: 26443284 DOI: 10.1016/j.jcjd.2015.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Robyn L Houlden
- Division of Endocrinology and Metabolism, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Lori Berard
- Winnipeg Regional Health Authority, Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada
| | - Alice Cheng
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Mississauga, Ontario, Canada
| | - Anne B Kenshole
- Medicine and Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Jay Silverberg
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent C Woo
- Section of Endocrinology and Metabolism, John Buhler Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jean-François Yale
- McGill Nutrition and Food Science Centre, McGill University, Montréal, Quebec, Canada
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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
Abstract:Background:Seizures while driving are a well known occurrence in established epilepsy and have significant impact on driving privileges. There is no data available on patients who experience their first (diagnosed) seizure while driving (FSWD).Method:Out of 311 patients presenting to the Halifax First Seizure Clinic between 2008 and 2011, 158 patients met the criteria of a first seizure (FS) or drug-naïve, newly diagnosed epilepsy (NDE). A retrospective chart review was conducted. FSWD was evaluated for 1) prevalence, 2) clinical presentation, 3) coping strategies, and 4) length of time driving before seizure occurrence.Results:The prevalence of FSWD was 8.2%. All 13 patients experienced impaired consciousness. Eleven patients had generalized tonic-clonic seizures, one starting with a déjà-vu evolving to visual aura and a complex partial seizure; three directly from visual auras. Two patients had complex partial seizures, one starting with an autonomic seizure. In response to their seizure, patients reported they were i) able to actively stop the car (n=4, three had visual auras), ii) not able to stop the car resulting in accident (n=7), or iii) passenger was able to pull the car over (n=2). One accident was fatal to the other party. Twelve out of 13 patients had been driving for less than one hour.Discussion:FSWD is frequent and possibly underrecognized. FSWD often lead to accidents, which occur less if preceded by simple partial seizures. Pathophysiological mechanisms remain uncertain; it is still speculative if complex visuo-motor tasks required while driving play a role in this scenario.
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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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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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Papanas N, Trypsianis G, Tiaka EK, Manolakis AC, Katsavaki D, Birka S, Natsiopoulos K, Maltezos E, Papazoglou N. Increased Cardiovascular and Renal Disease but not Reduced Life Expectancy Among Diabetic Participants in the General Northern Greek Population. Angiology 2012; 63:443-447. [DOI: 10.1177/0003319711426423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
We compared life expectancy and causes of death based on death certificates of 269 diabetic participants (group A) and 5659 nondiabetic participants (group B) who died from January 1, 1991 to December 31, 2010, in 3 small towns of Northern Greece. Age at death was significantly ( P = .011) higher in group A (77.2 ± 8.7 years) than in group B (75.7 ± 18.9 years). Males with diabetes lived longer with a mean difference of 4.7 (2.8-6.6) years ( P < .001), whereas females without diabetes lived longer, with a mean difference of 2.3 (1.1-5.6) years ( P = .004). Diabetic participants died more frequently of myocardial infarction ( P = .001), chronic renal failure ( P < .001), followed by pneumonia ( P = .010) and hyperosmolar non-ketotic coma ( P < .001). Nondiabetic participants died more frequently of lung cancer ( P < .001), old age ( P < .001), and car accidents ( P = .004). In conclusion, the cardiovascular and renal disease burden among diabetic participants did not reduce life expectancy, especially in men.
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Affiliation(s)
- N. Papanas
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - G. Trypsianis
- Department of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - E. K. Tiaka
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - A. C. Manolakis
- Department of Internal Medicine and Gastroenterology, University of Thessaly, Larissa, Greece
| | | | | | | | - E. Maltezos
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - N. Papazoglou
- Diabetes Centre, General Hospital “Papageorgiou,” Thessaloniki, Greece
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Abstract
AIMS To investigate whether exposure to methadone affects the risk of motor vehicle accident with personal injury. DESIGN Cohort study linking three Norwegian administrative registries using unique person identifiers. SETTING Information was retrieved from the Norwegian Prescription Database on any prescriptions ever received by the individuals for methadone and all prescriptions for benzodiazepines. The Norwegian Road Accident Registry provided information about motor vehicle accidents involving personal injuries on Norwegian roads. The Central Population Registry provided demographic information on all residents in Norway. PARTICIPANTS All Norwegian adults aged 18-69 years were observed for 2.5 years. MEASUREMENTS Standardized incidence ratio (SIR) was calculated by comparing the incidence of traffic accidents with personal injuries in patients exposed to methadone with the incidence in those not exposed. FINDINGS During the 4626 person-years observed in patients exposed to methadone, there were 26 motor vehicle accidents. There were very few accidents among the females who received methadone and they had no increased risk of being involved in motor vehicle accidents (SIR 1.1; 95% CI 0.2-3.1). We observed an increased risk of involvement in accidents among males (SIR 2.4; 95% CI 1.5-3.6). This figure did not change significantly when exposure to benzodiazepines was excluded. CONCLUSIONS Men exposed to methadone appear to have an increased risk of being involved in motor vehicle accidents involving personal injuries. This increased risk could not be explained by exposure of benzodiazepines.
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Affiliation(s)
- Jørgen G Bramness
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
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Hegmann KT, Andersson GBJ, Greenberg MI, Phillips B, Rizzo M. FMCSA's Medical Review Board: Five Years of Progress in Commercial Driver Medical Examinations. J Occup Environ Med 2012; 54:424-30. [DOI: 10.1097/jom.0b013e3182480535] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Background The purpose of this research was to examine whether waterpipe smokers experience increased risk of motor vehicle crashes. Methods In a telephone survey, a random sample of Iranian drivers were asked to report their age, gender, vehicle age, whether their vehicles were equipped with anti-lock braking system (ABS), average daily drive time (DDT), whether they smoked cigarette or waterpipe, whether they had diabetes mellitus (DM), number of traffic crashes during the last calendar year and whether the crash involved a pedestrian or another vehicle. Results A total of 2070 motor vehicle owners with the mean age of 41.6 ± 11.45 were interviewed. The annual incidence of Road Traffic Crashes (RTC) was 14.9%; 14.0% involved a collision/s with other vehicles and 0.9% with pedestrians. There was an association between the RTC and male gender, DDT, being a cigarette smoker, being a waterpipe smoker and DM in univariable analysis. The association between RTC and being a waterpipe smoker and also cigarette smoker was significant in multivariable analysis after adjustment for DDT. Conclusions Being waterpipe and/or cigarette smoker and DDT were the independent predictors of the number of traffic crashes in Poisson regression model. If the increased risk of RTC among waterpipe or cigarette smokers is seen in other studies, it would be beneficial to promote tobacco cessation and control strategies through injury prevention initiatives.
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Affiliation(s)
- Soheil Saadat
- Sina Trauma Research Center, Tehran University of Medical Sciences, Tehran, Iran
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