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Ssemmondo E, Deshmukh H, Wilmot EG, Adeleke KA, Shah N, Walton C, Barnes D, Ryder REJ, Sathyapalan T. Effect of intermittently scanned continuous glucose monitoring in people with diabetes with a psychosocial indication for initiation. Diabetes Obes Metab 2024; 26:1340-1345. [PMID: 38228571 DOI: 10.1111/dom.15435] [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: 09/18/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
AIM To understand the effect of intermittently scanned continuous glucose monitoring (isCGM) in people with diabetes with a 'psychosocial' indication for access. METHODS The study utilized baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes in the UK. Diabetes-related distress (DRD) was assessed using the two-item diabetes-related distress scale (DDS). Participants were categorized into two groups: high DRD (DDS score ≥ 3) and lower DRD (DDS score < 3). The t-test was used to assess the difference in the pre- and post-isCGM continuous variables. RESULTS The study consisted of 17 036 people with diabetes, with 1314 (7%) using isCGM for 'psychosocial' reasons. Follow-up data were available for 327 participants, 322 (99%) of whom had type 1 diabetes with a median diabetes duration of 15 years; 75% (n = 241) had high levels of DRD. With the initiation of isCGM, after a mean follow-up period of 6.9 months, there was a significant reduction in DDS score; 4 at baseline versus 2.5 at follow-up (P < .001). The prevalence of high DRD reduced from 76% to 38% at follow-up (50% reduction in DRD, P < .001). There was also a significant reduction in HbA1c (78.5 mmol/mol [9.3%] at baseline vs. 66.5 mmol/mol [8.2%] at follow-up; P < .001). This group also experienced an 87% reduction in hospital admissions because of hyperglycaemia/diabetic ketoacidosis (P < .001). CONCLUSION People with diabetes who had isCGM initiated for a psychosocial indication had high levels of DRD and HbA1c, which improved with the use of isCGM.
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Affiliation(s)
- Emmanuel Ssemmondo
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Harshal Deshmukh
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby & Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kazeem A Adeleke
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Najeeb Shah
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Thozhukat Sathyapalan
- Allam Diabetes Centre, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
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Mark-Wagstaff C, Deshmukh H, Wilmot EG, Walker N, Barnes D, Parfitt V, Saunders S, Gregory R, Choudhary P, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Intermittently scanned continuous glucose monitoring and hypoglycaemia awareness in drivers with diabetes: Insights from the Association of British Clinical Diabetologists Nationwide audit. Diabetes Obes Metab 2024; 26:46-53. [PMID: 37718554 DOI: 10.1111/dom.15283] [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: 07/24/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
AIM Frequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third-party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a complete loss of hypoglycaemia awareness or more than one SH event a year. METHODS The FreeStyle Libre (FSL) Association of British Clinical Diabetologists (ABCD) Nationwide Audit consists of data collected by clinicians during routine clinical work, submitted into a secure web-based tool held within the National Health Service (NHS) N3 network. Analysis of paired baseline and follow-up data for people with type 1 diabetes who also held a driving licence was undertaken. RESULTS The study consisted of 6304 people who had data recorded about driving status from 102 UK specialist diabetes centres, of which 4218 held a driving licence: 4178 a group 1, standard licence, 33 a group 2, large lorries and buses, seven a taxi licence; 1819 did not drive. Paired baseline and follow-up data were available for a sub-cohort of 1606/4218. At a mean follow-up of 6.9 months [95% CI (6.8, 7.1)], the Gold score had improved (2.3 ± 1.5 vs. 2.0 ± 1.3 p < .001), and the number of people who experienced an SH episode was also significantly lower (12.1% vs. 2.7%, p < .001). CONCLUSION This study suggests that intermittently scanned continuous glucose monitoring may improve impaired awareness of hypoglycaemia and reduce the number of people with type 1 diabetes with a driving licence experiencing a severe hypoglycaemic episode.
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Affiliation(s)
| | - Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- University of Hull, Hull, UK
| | - Emma G Wilmot
- University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Neil Walker
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Dennis Barnes
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | | | | | - Rob Gregory
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Robert E J Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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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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