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Sunil Patel, Colleen Peters, Kristen Garcia, Angela Jaimes, Bryce Miller, Steven Kymes, Adam Turpcu; Truck Drivers Suffer Significant Economic Harm Due to Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2369.
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Truck drivers have been shown to be at increased risk of developing diabetes and may be particularly susceptible to diabetic macular edema (DME) as they have difficulty managing their diabetes due to their work lifestyle. Their profession is highly dependent on good vision to maintain employment. We hypothesize that DME creates substantial economic burden for truck drivers.
Participants were recruited from a large retina practice in west Texas. Inclusion criteria were a DME diagnosis and current or former employment as a long-haul truck driver. Ninety-minute focus groups were conducted by an experienced moderator and truck drivers were stratified by employment status. Proceedings were recorded and transcribed verbatim; coding of transcripts was performed by 3 reviewers. Following focus groups, study participants completed a 90-day diary detailing out-of-pocket (OOP) expenses and recorded time they and their caregivers spent on diabetes- or vision-care-related activities.
There were 8 participants total (4 current drivers and 4 former drivers who had stopped driving due to DME-associated vision loss). Noteworthy themes included the secretive elements of managing diabetes while conforming to commercial driver’s license requirements and degraded driving performance directly attributable to DME. Examples included manipulating testing to ensure diabetes-negative results, avoiding treatment to prevent detection, driving with monocular vision and the challenges of glare or poor lighting conditions with reduced vision. Mean total annualized OOP costs for diabetes- and DME-related care was $4743 (Figure 1). The greatest contributor to total OOP costs was the purchase of equipment (eg vision aides). Not included in these totals are direct medical costs for one catastrophic diabetes-related event for 2 separate participants: 1) a toe amputation with systemic infection and 2) kidney failure. Mean annualized time for diabetes- or vision-care-related activities was 36 hrs for patients and 92 hrs for caregivers.
Diabetes and DME create significant economic burden for truck drivers. Current commercial driver’s license requirements (eg those that prohibit insulin use) may encourage behaviors that can jeopardize the health of the patient and potentially lead to high-cost events. Healthcare providers may want to consider these issues as they develop programs to improve outcomes among diabetes patients.
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