The effect of epilepsy or diabetes mellitus on the risk of automobile accidents

Article Abstract:

While there is concern that some chronic diseases, particularly those affecting consciousness and body control, contribute to an unacceptable risk of automobile accidents, reliable data on this aspect of traffic safety have been difficult to obtain. A large portion of the difficulty in gathering satisfactory information results from problems in identifying a representative population of affected drivers. It is obvious that an epileptic patient who has become involved in an accident or mishap is more likely to come to the attention of officials than one who has not. To determine if patients with appropriately controlled epilepsy or diabetes mellitus have an increased risk of automobile accidents, a population based study of 30,420 licensed drivers was conducted. A total of 484 diabetic and 241 epileptic patients were identified among this cohort. Moving violations and accident records over a four-year period were tabulated, and revealed that patients with diabetes or epilepsy did, indeed, have a slightly increased risk of violations and mishaps. Although it was not more common than among other drivers, speeding was the most common moving violation among diabetics and epileptics. Careless driving was slightly more prevalent among drivers with epilepsy; it is speculated that this may be due to the effects of alcohol and drugs, which reduce the seizure threshold. Overall, the increased risk of motor vehicle accidents involving drivers with diabetes or epilepsy was less than that reported in previous studies, and is not regarded as sufficient to warrant further restrictions on driving privileges. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Epilepsy, Traffic accidents

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Improvement of gastric emptying in diabetic gastroparesis by erythromycin

Article Abstract:

Some persons who have had diabetes for many years develop gastroparesis, in which the stomach does not contract and empty normally. Food remains in the stomach, which can cause vomiting. Gastroparesis is particularly detrimental for diabetics, because erratic or delayed stomach emptying means that energy (calories) will not be absorbed into the bloodstream in a predictable fashion; as a result, blood sugar is even more difficult to control than in uncomplicated diabetes mellitus. The motility, or movements, of the stomach can be stimulated with the natural protein motilin, but unfortunately research on this substance has been limited by its high cost. The antibiotic erythromycin appears to be an effective substitute for motilin, and so it may be useful in treating gastrointestinal motility disorders. Ten subjects with diabetic gastroparesis were given erythromycin or an inert placebo intravenously, and the emptying of liquids and solids from the stomach was assessed. Ten normal controls were also studied. Erythromycin brought stomach emptying time to normal in the diabetics; two hours after eating, 63 percent of the food remained in the stomach with placebo but only 4 percent was retained with erythromycin. Controls had 9 percent of food remaining. The diabetics were then treated for four weeks with oral erythromycin, which increased stomach motility, but not as well as the intravenous therapy. From this preliminary study, it appears that erythromycin may be beneficial in treating diabetic gastroparesis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Abnormalities, Drug therapy, Erythromycin, Gastrointestinal system, Stomach, Diabetic neuropathies, Gastrointestinal motility

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Diabetic retinopathy: a synthesis of perspectives

Article Abstract:

A recent estimate places the number of patients in the United States who become blind as a result of sugar diabetes at 5,000, and 30,000 to 40,000 on a world-wide basis. Despite new methods of treatment, diabetes remains the leading cause of blindness in Europe, and North America. Although the pathologic and anatomic changes involved in the deterioration of the retina (the receptor area of the eye) or retinopathy of diabetes are well known, the fundamental underlying causes or etiology of the condition remain poorly defined. The initial pathologic changes of the retina involve changes to the small blood vessels and the tissues that directly surround them. As a result of these changes, small aneurysms (dilated areas of small vessel walls) and hemorrhages occur, and hard exudates (collections of material outside of the vessels) occur in many diabetics. A more aggressive condition, proliferative retinopathy, is marked by a new proliferation of vascular tissue that obliterates normal tissue and is also associated with bleeding and scarring within the eye. The causes of diabetic retinopathy is reviewed, as are associated pathologic changes to biochemical, blood vascular (hemodynamic), and endocrine, ductless gland factors (e.g., pancreas). In spite of the progress in understanding this disease entity and the development of new therapeutic approaches, the role of the physician remains unchanged: keep the patient's elevated sugar level (hyperglycemia) under control. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diabetic retinopathy

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