Diabetes Management and Hyperglycemia in Safety Sensitive Jobs

The chronic and acute effects of hyperglycemia affecting cognition and work are as important as those of hypoglycemia. Its impact, considering that majority of diabetic patients fail to reach therapeutic targets, would be potentially significant. Self monitoring of blood glucose, recognition of body cues and management interventions should be geared not only towards avoidance of disabling hypoglycemia, but also towards unwanted hyperglycemia. Over the long term, chronic hyperglycemia is a risk for cognitive decline. Acute episodes of hyperglycemia, above 15 mmol/L have also been shown to affect cognitive motor tasks. Maintaining blood sugar to avoid hyperglycemia in diabetic workers will help promote safety at work.

Diabetes Management and Hypoglycemia in Safety Sensitive Jobs

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs.

The doctor in claims for work injuries and ill health--legal pitfalls

Occupational health work is currently undertaken by the specialist and the non-specialist physician alike. The work scope can vary from medical assessments of individual workers to health risk assessment at the workplace. The scope of the latter will include evaluation of exposures, hazards, risks and its management to control these risks. Much of the case law governing legal disputes over industrial safety and health have involved the employers. Over the years, the actions brought forth by workers have resulted in a formidable volume of case law based on statutes and on the common law of negligence in tort. Disputes over the assessment of workers' health or workplace health risks to the extent that it is a failure to discharge a reasonable standard of care, may result in the doctor being a defendant. Measures to prevent these legal pitfalls include communication with employers about the causative link of the illness suffered to workplace factors and the clarity of contractual obligations undertaken with regard to workplace health risk assessment.

Fitness to work: legal pitfalls

Medical examinations for fitness to work are undertaken by the specialist and the nonspecialist occupational physicians alike. An assessment done negligently in such a capacity will expose physicians to legal risks, even if they are not specialist occupational physicians. This is not unlike negligent care given in the traditional therapeutic care setting. Much of the case law governing legal disputes in medical fitness to work assessments depend on the kind of loss that is at stake, that is, whether it is one resulting in economic loss, as in loss of an employment opportunity, or one resulting in personal injury, such as when the doctor negligently fails to diagnose or to communicate a serious medical finding. In the latter, the courts are more likely to find for the injured claimants. One of the ways for doctors to reduce their risk in this area is to establish with prospective employers and employees the ground rules when conducting medical fitness to work examinations.

Bridging the gap between occupational medicine and family medicine

Family medicine and occupational medicine share close similarities in their focus on disease prevention and health promotion. The opportunities for mutual learning and collaboration in patient care abound, with far-reaching implications on the standard of patient care that can be offered. Unfortunately, a gap exists between family medicine and occupational medicine in dayto- day practice as well as in continuing medical education. It is important that we actively seek to bridge this gap. The workforce constitutes a significant part of the population and thus the patient load of a typical primary healthcare practice. Moreover, with an ageing population and rising retirement age, we can expect that there will be an increasing number of health issues to be addressed among older working people. Both occupational and non-occupational factors are important in determining an individual's health. Thus, family physicians need to adequately understand occupational medicine and vice versa.