Fenalti Salla Rafaela, de David Julia, Schneider Larissa, Tschiedel Balduino, Teló Gabriela H, Schaan Beatriz D
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.
Diabetes Res Clin Pract. 2021 Aug;178:108954. doi: 10.1016/j.diabres.2021.108954. Epub 2021 Jul 14.
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.
To assess local risk factors for traffic events in T1D adult Brazilian patients.
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.
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].
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.
1型糖尿病（T1D）患者遭遇汽车事故的风险较高，尤其是因为低血糖会损害生理和防御反应。
评估巴西成年T1D患者发生交通事件的局部危险因素。
这是一项前瞻性研究，对巴西一组T1D驾驶员（n = 168）进行为期12个月的随访，以评估交通事件的预测因素。参与者的纳入标准为巴西国籍、年龄≥18岁、T1D诊断超过一年、B、C或D类驾驶执照（四轮车辆）、每周驾驶三次或更多，以及每天检测血糖两次或更多。主要结局是通过一份关于过去30天的七项问题问卷评估的低血糖驾驶事故。次要结局包括与低血糖无关的驾驶事故。通过具有稳健方差估计的泊松回归模型进行统计分析，其中关联度量为相对风险。
共有109名参与者完成了12个月的随访。他们大多数为男性（66%），年龄为37±11岁，平均糖化血红蛋白（HbA1c）为8.2%（66 mmol/mol）。在随访中，交通事件的发生率很高（70.6%）；然而，报告事件中仅少数归因于低血糖（19.3%）。低血糖导致新交通事件的最佳预测因素是与驾驶特征相关的因素。其中最佳因素是驾驶时发生低血糖事件的病史[相对风险3.40（1.22 - 9.43）；p < 0.05]。
我们发现，既往驾驶时发生低血糖事件会显著增加发生新交通事件的风险，并且是其最佳预测因素。这突出了评估交通事故风险的必要性,尤其是对那些在驾驶时经历过低血糖事件的人。
