Managing DME for the long haul

Take-Home

Vision loss caused by diabetic macular edema increases the health and financial burdens of managing diabetes, especially for long-haul truckers who rely on their eyesight to maintain employment.

Seattle-Managing diabetes is a substantial burden for long-haul truck drivers who may be susceptible to diabetic macular edema (DME).

Most problematic is that current commercial driver license (CDL) requirements prohibit use of insulin by drivers. Health-care providers are challenged by this issue when they develop programs to improve outcomes among patients with diabetes.

Dr. Patel

“For truck drivers, diabetes management is difficult because of the limited healthy-food choices on the road, limited opportunities to exercise, and the unwillingness to start insulin therapy due to regulations surrounding commercial vehicle operation and insulin use,” said Sunil S. Patel, MD, PhD, at the annual meeting of the Association for Research in Vision and Ophthalmology.

In addition, truck drivers’ ability to remain in their profession depends on good vision, he noted.

Focus groups and cost diaries

Dr. Patel and his colleagues hypothesized that DME creates a substantial economic burden for truck drivers and payers. To prove the hypothesis, they formed focus groups and used cost diaries to explore the related problem. Patients were recruited from the West Texas Retina Consultants, a private practice in Abilene, TX, where Dr. Patel practices. Patients who agreed to participate in the study were assigned to one of two focus groups (i.e., former truck drivers and current truck drivers).

The focus groups met for 90 minutes and an experienced moderator led the discussions. After the focus groups met, the participants completed a 90-day diary to record their out-of-pocket expenses related to diabetes. They also recorded the time they and their caregivers spent on activities related to diabetes or diabetes-related vision care, according to Dr. Patel.

Eight patients of 26 who were contacted agreed to participate in the study; four were current drivers and four were former drivers who could no longer driver because of decreases in visual acuity. Themes that were identified based on the focus group discussions were direct and indirect costs, vision and driving, diabetes and driving, mental health, and licensing.

Seven participants returned completed daily diary pages over the entire 90 days. The investigators found that the mean total annual out-of-pocket cost for diabetes and DME-related care was $4,743, with the greatest costs for vision aids ($2,801). Travel ($297), medications ($845), medical services ($634), and other services ($166) were the other considerations.

Direct medical costs were an additional expense for catastrophic diabetes-related events for two participants, one of whom underwent toe amputation with a systemic infection and the second, kidney failure. The mean annual time for diabetes- or vision-care-related activities was 36 hours for patients and 92 hours for caregivers.

Problems that drivers specifically mentioned were the higher costs of healthier foods, severe night-driving problems, the psychological impact of visual acuity loss, and the inability to have another job.

Representative comments were:

• “It is expensive to have diabetes, not just your medication and your testing supplies, but the kind of foods that you need to eat. You know, can’t buy a 50-cent pizza and put it in the oven, because 2 hours later, you’re back there with a blood sugar of 400.”
• “The night driving when you have this is much worse, because when you have . . . retinopathy, your vision is already compromised. But at night, when you’ve got those headlights coming at you . . . I caught myself several times heading toward . . . the vehicle that was coming at me.”

Summarizing the issues

“Diabetes and DME create significant economic burdens for truck drivers,” Dr. Patel concluded. “Current CDL requirements-such as those that prohibit insulin use-may deter patients from properly controlling blood sugar levels, which can result in expensive diabetes-related medical events.

“Health-care providers may want to consider these issues as they develop programs to improve outcomes among patients with diabetes,” he added.

Sunil S. Patel, MD, PhD

E: sunilpateltgo@gmail.com

Genentech sponsored both studies.

Measuring health-benefit costs, missed work

In another related study, Sunil S. Patel, MD, PhD, and colleagues conducted a retrospective analysis of the HCMS Group’s research reference database to compare annual health-benefit costs and absenteeism among commercial drivers and non-driver U.S. employees with diabetic macular edema (DME), diabetic retinopathy (DR), diabetes, or employees without diabetes.

The study found that health-benefit costs for drivers with DME were three times higher compared with employees who did not have DME, DR, or diabetes. In addition, drivers with DME missed 27 days of work annually compared with those without the condition, who only missed 8 days.

It is hoped by the researchers that the analysis will provide employers with the necessary information to assess the impact of DME and DR on employees, and provide insight into the importance of treatment for these conditions.

This study was presented during the American Diabetes Association’s 73rd Scientific Sessions in June.

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