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Background: Diabetes is the leading cause of end-stage renal disease (ESRD) worldwide. Also, diabetes is prevalent in kidney transplant recipients for nondiabetic reasons. Methodology: We used a mixed method methodology, including a case report, surveys of physicians’ opinions, and a review of the literature. Results: (A) A 58-year-old retired police officer was seen at the diabetes clinic in October 2015. His care was transferred from another physician who had relocated elsewhere. The patient’s medical history included type 2 diabetes for over 25 years, hyperlipidemia, hypertension, diabetic neuropathy, diabetic nephropathy, and diabetic retinopathy in addition to vitamin D deficiency and morbid obesity. He had received a renal transplant from a nonrelated live donor 7 years previously. His medications included sitagliptin 50 mg/day, gliclazide (modified release) 60–90 mg/day, metformin (extended release) 750 mg twice daily, and dapagliflozin 10 mg/day. We focus on the off-license use of dapagliflozin in a patient with a history of ESRD and renal transplantation. The lack of published experience with sodium-glucose cotransporter 2 (SGLT2) inhibitors in renal transplant recipients was discussed with him. “But I came to no harm,” was his reply. His records on renal function, hydration status, and glycemic control all seemed unaffected over the previous 2.5 years. He remains well till the time of this report. Serum electrolytes, creatinine, plasma albumin, hemoglobin, packed cell volume, and estimated glomerular filtration rate (eGFR) were not adversely affected. Glycated hemoglobin and fasting blood glucose were stable. Urine was consistently negative for ketones but loaded with glycosuria. It was agreed to continue with the same medication, observe the patient carefully, and seek for opinions of other physicians. (B) An online survey was conducted; the responses revealed that many physicians would use SGLT2 inhibitors in renal transplant recipients provided the renal function was satisfactory with an eGFR > 60. We have learned of an ongoing trial on SGLT2 inhibitors in renal transplant recipients. (C) A case series of 10 patients treated with canagliflozin showed reassuring findings. Conclusions: Despite the lack of formal trial evidence, the index case suggested the safe use of SGLT2 inhibitors by renal transplant recipients for a remarkably extended period of 2.5 years. Physicians seem willing to use SGLT2 inhibitors in this group of patients provided renal function is satisfactory.

Background: Ensuring medical fitness to drive is an important safety measure for people with diabetes and is a prerequisite for a driving licence in many countries. Objectives: To ascertain the current regulatory restrictions on drivers with diabetes currently being applied internationally. Methods: An electronic survey (in English) was sent to contacts of member organisations of the International Diabetes Federation and to selected specialists in diabetes. Questions addressed the regulations in place for insulin-treated drivers. Results: Information on licensing was obtained from 85 countries. No restrictions on drivers with insulin-treated diabetes existed in 59 countries (69.4%). Medical assessment of some type was required in 29 countries (34.5%). They were performed by different people and at different time intervals. Emphasis was placed on conditions causing potential risk to driving safety. When insulin is introduced to a licensed driver's treatment, in most countries the driver is permitted to continue driving without any change in licensing entitlement (n=68; 80%); in 16 countries (19%) a driver can retain their driving licence subject to special conditions and in one country the driver will have the driving licence revoked permanently. With respect to large goods vehicles and passenger-carrying vehicles, no restrictions or assessments are required for drivers with insulin-treated diabetes in most responding countries (n=56; 66%); licensing is permitted with some restriction in 23 countries (27%) and prohibited in six countries (7%). Conclusions: There is a wide variation between different countries and global regions in the statutory requirements and policies used to regulate and assess drivers with diabetes. The lack of regulation in many countries may adversely affect public safety.

Objectives To assess the perceptions of genetic and metabolic bone disorders with a focus on X-linked hypophosphatemia (XLH) in the Middle East and Africa. Methods An online survey of a convenience sample of physicians from relevant disciplines. The questions covered respondents' profiles, awareness of rare bone diseases, and XLH's burden, symptoms, and management. Results A total of 139 respondents were included in the analysis. Responses came from the Arabian Gulf (41.7%), Middle East (20.1%), North Africa (17.3%), and Sub-Saharan Africa (20.9%). The largest single specialty was endocrinology (41%). When asked, 16 (11.5%) could not know about any metabolic/genetic bone diseases, and 123 respondents (88.5%) stated that they could think/were aware of some metabolic/genetic bone diseases, 111 enumerated various genetic and metabolic disorders. When they were presented with a typical case scenario of XLH, 18.0% of the respondents admitted ignorance of any possibility. However, 82.0% indicated having some idea of the condition. Of the latter group, 109 provided suggestions for possible diagnosis; the top single diagnosis was XLH. A smaller proportion of adult physicians had patients with symptoms attributed to XLH. Around three-quarters of respondents were aware of conventional therapy for XLH with vitamin D and phosphate supplementation. However, 89.8% of respondents welcomed specific biological therapy. Conclusions Physicians are reasonably aware of XLH but have variable knowledge. They are unsatisfied with its conventional treatment. More in-depth knowledge of recognizing and modern management of bone metabolic and genetic conditions should be enhanced, particularly among adult physicians.

Background: Driving a motor vehicle is a highly coordinated process involving a series of learned reflexes and carefully made conscious decisions. The evaluation of an individual's ability to drive is a legal and safety necessity. Various factors such as age and illnesses can affect individual's ability to drive. Objectives: The aims of the current survey were to ascertain the level of awareness among medical professionals of fitness to drive and to evaluate their perception of some select medical aspects of fitness to drive and regulatory aspects of driving. Materials and Methods: This is a survey of 520 health care professionals addressing select clinical and regulatory issues regarding medical aspects of driving. A de novo questionnaire of four domains was developed based on the study objectives. The target population was identified from pooled lists of health care contacts. A widely used web-based commercial survey management service was utilized. Results: Out of the 520 respondents, males and females constituted 63.5% and 36.5% respectively. Country of residence of respondents include: UAE (55.2%), other Arabian Gulf countries (13.3%), rest of MENA region (14.8%), Western Europe and North America (12.3%) and other regions (1.9%). 47.4% of the respondents were hospital doctors while 16.4% were primary care physicians. 57.3% of the respondents thought the age threshold which requires medical assessment ranged between 60-70 years. There was a wide range of intervals of reissuing licenses (1-5 years) in countries where restrictions apply above a certain age. 92.5% identified a list of conditions as declarable to authorities. More than half of respondents considered the following conditions as relevant and declarable to the authorities in a descending order of frequency: epilepsy, visual impairment, alcoholism and drug dependency, blackouts and syncope, dementia, stroke with hemiplegia and insulin-treated Diabetes. The principal safety concerns for driving with diabetes were addressed by 94.6% of respondents. 79.3% identified hypoglycemia and 18.1% identified visual impairment (diabetic retinopathy) as major barriers to safe driving. 85.1% of respondents thought that the driving risks to be higher in insulin-treated (85.1%) than in sulphonylurea-treated (9.6%) diabetic patients. The majority of respondents believe that doctors have an obligation to alert their patients about diseases that risk their driving abilities and drivers have an obligation to provide all required details to their insurance companies. Confidentiality issues were addressed in the questionnaire and 316 (68.4%) thought that both physicians and diabetic patients need to report relevant information to regulatory driving authorities and insurance companies. Conclusion: This survey indicates that there is a considerable awareness among health care professionals regarding medical conditions that may affect an individual's ability to drive. Furthermore, it see...