What drives patients? The effects and fear of hypoglycaemia on individuals, workplace, and patients continued eligibility to drive

Transcription

1 What drives patients? The effects and fear of hypoglycaemia on individuals, workplace, and patients continued eligibility to drive Bagger M 1, Dømgaard M 1, Rhee N 2, Burton CM 3, Thorsteinsson B 4 1: Danish Diabetes Association 2: Novo Nordisk Scandinavia 3: Point of Care 4: Nordsjællands Hospital

2 Method

3 Method Definitions: Mild hypoglycaemia: low blood glucose event requiring self-treatment Severe hypoglycaemia: low blood glucose event requiring 3 rd party assistance or resulting in loss of consciousness

4 Frequency Fear Impact Workplace Driver license

5 Total (3117) T1DM (1005) Insulin (556) T2DM (2112) Non-Insulin (1556) Age (years) mean±sd 57 ± ± ± ± 9 Male (%) 51.3% 43.4% 59.7% 53.3% Diabetes Duration (years) mean±sd 13 ± ± ± 8 7 ± 6 Treatment (%) Insulin 49.8% 99.8% 100.0% 0.0% Other injectable (GLP-1 analogues) 7.8% 0.1% 12.4% 11.1% Oral medication 53.7% 2.2% 60.8% 84.5% Diet only 5.3% 0.0% 0.0% 10.7% None 1.7% 0.0% 0.0% 3.3%

6 Total (3117) T1DM (1005) T2DM (2112) Insulin (556) Non-Insulin (1556) Mild hypoglycaemia Events per patient per week 0.8 ± ± ± ± 0.9 Proportion of patients 67.1% 98.5% 78.4% 42.7% Severe Hypoglycaemia Events per patient per year 1.2 ± ± ± ± 1.6 Proportion of patients 20.7% 49.8% 16.4% 3.5% Nocturnal Mild Hypoglycaemia Events per patient per week 0.2 ± ± ± ± 0.5 Proportion of patients 46.5% 89.8% 45.4% 15.4% Nocturnal Severe Hypoglycaemia Events per patient per year 0.3 ± ± ± ± 1.4 Proportion of patients 12.0% 31.3% 4.8% 0.5%

7 Total T1DM T2DM Insulin Non-Insulin Hypoglycaemia Fear Any Mild Hypoglycaemia 43.4% 45.3% 46.1% 38.7% Any Severe Hypoglycaemia 74.0% 75.4% 69.1% 68.0% Deliberately maintain high blood glucose during the day Deliberately maintain high blood glucose during the night Deliberately reduce the amount of physical exercise 29.9% 52.1% 21.0% 7.3% 39.0% 66.1% 29.9% 9.3% 15.7% 23.4% 11.4% 8.3%

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13 Total T1DM T2DM Insulin Non-Insulin Employment status (%) Employed 43.6% 56.2% 29.8% 36.1% Unemployed 5.1% 6.4% 4.1% 4.2% Pensioned 39.5% 18.8% 60.0% 52.7% Student 4.9% 10.8% 0.7% 0.1% Other 7.0% 7.7% 5.4% 6.9% Hypoglycaemia in the workplace (%) Mild hypoglycaemia Resulting in sick leave 10.9% 12.9% 9.7% 7.1% Resulting in difficulty working 19.3% 19.7% 23.1% 16.3% Severe hypoglycaemia Resulting in sick leave 19.1% 20.1% 13.6% 11.1% Resulting in difficulty working 22.0% 22.6% 22.7% 11.1%

14 Total T1DM T2DM Insulin Non-Insulin Aware of new EU legislation 66.5% 71.1% 66.5% 61.1% Perceived consequence on own license Driver license revoked 0.9% 0.7% 1.5% 0.7% No consequence 67.6% 64.9% 66.5% 71.6% Unsure 21.1% 23.9% 21.2% 17.8% Not Applicable (Not licensed) 10.4% 10.5% 10.8% 9.9% Driver license required for work 71.8% 71.5% 72.7% 71.9% Heavy goods vehicle license 14.9% 9.1% 21.1% 18.4% Proportion considering hypoglycaemia under-reporting in order to keep Driver license 22.6% 36.5% 14.1% 10.9% Heavy goods vehicle license 15.6% 30.9% 9.2% 10.8%

15 Conclusions A high proportion of patients with diabetes experience severe hypoglycaemia Fear of hypoglycaemia are associated to previous experience of hypoglycaemia and its severity rather than the type of diabetes or treatment Inappropriate self-care behaviours to avoid hypoglycaemia may negatively impact long-term treatment goals Few people take sick leave as a result of hypoglycaemia, but prolonged mental recovery of 4 hours or more may affect work productivity

16 Conclusions Compromising doctors roles as caregivers may ultimately lead to increased risk of hypoglycaemia, as patients may under-report severe hypoglycaemia thus preventing doctors from optimising diabetes therapy to avert hypoglycaemia More clear guidance and open dialogue on the issue of severe hypoglycaemia, and how this influences self-care behaviour and driving is required