Severe Hypoglycemic Episodes Infrequent in the Workplace

Although people with insulin-dependent diabetes are barred from certain occupations in Europe and North America, such individuals rarely experience episodes of severe hypoglycemia in the workplace, a 12-month prospective study has found. The researchers say employment restrictions for most type 1 diabetics "may be difficult to justify."

Dr. Alastair M. Leckie and colleagues note that people with insulin-treated diabetes may be restricted from working in certain occupations, due to the possibility of their developing a hypoglycemic episode.

To evaluate the actual frequency and severity of such episodes, Dr. Leckie, of the Institute of Occupational Medicine in Edinburgh, Scotland, and his team followed 243 employed individuals with insulin-treated diabetes for one year. Mild hypoglycemic episodes were defined as those that could be self-treated, while those that required the assistance of another person were considered severe.

On average, eight episodes of mild hypoglycemia occurred per person per year, the researchers found, with 30% of these episodes occurring in the workplace.

There were 238 severe episodes, of which 35 or 15% occurred in the workplace in a total of 27 people, for an overall incidence of severe workplace hypoglycemia of 0.14 episodes per person per year.

Adverse events occurred in 54, or 23%, of the severe hypoglycemic episodes, including 29 cases of loss of consciousness, 21 seizures, 4 head injuries, 5 cases of a person injuring someone else, and 2 instances of property damage.

The greatest workplace risk factor tied to the risk of having a severe hypoglycemic episode was working in isolation, the researchers found, while people whose job duties included driving were less likely to experience severe hypoglycemia.
Hypoglycemic episodes resulted in little work time lost, the researchers found, with the maximum time off required after a mild episode being 30 minutes, and a 1.5-day absence after a severe episode for one person.

The researchers conclude that while the risk of hypoglycemia cannot be eliminated among insulin-treated individuals, the findings show that individual and workplace risk can be gauged. Such "careful evaluation," they conclude, " may allow people with insulin treated diabetes to be employed in areas that have previously been restricted."
Diabetes Care 2005;28:1333-1338.

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EVIDENCE OF SUSTAINED BETA CELL FORMATION IN LONG-TERM TYPE I:
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