“Like pilots who have to go through a pre-flight checklist to ensure all systems are a go, drivers with diabetes should go through a check list, asking themselves whether they have had more physical activity, taken more insulin, eaten fewer carbohydrates than usual, feel any unusual symptoms and judge whether they are low or likely to go low during the drive,” said lead author Dr. Daniel Cox from the University of Virginia Health System and Virginia Driving Safety Laboratory in Charlottesville.

“If the answer is yes, then they should take appropriate steps to avoid hypoglycemia while driving,” Cox said by email.

Drivers with type 1 diabetes have a greater risk of collisions than their spouses without diabetes, and those mishaps correspond to the use of insulin pumps, a history of collisions, severe low blood sugar (hypoglycemia) and previous hypoglycemia-related driving mishaps, the study team writes in Diabetes Care.

The researchers developed an 11-item questionnaire to screen drivers with type 1 diabetes for a high risk of driving mishaps and developed an online intervention intended to help high-risk individuals avoid future mishaps.

Their Risk Assessment of Diabetic Drivers (RADD) scale included questions about past experiences while driving, like “have you had an automobile accident or received a moving vehicle violation in the last 2 years?” and diabetes-specific questions like, “have you had low blood glucose in the past 6 months?” and “was it a hassle trying to hide dizziness or other symptoms of low blood glucose?”

Based on answers to 11 questions, around 35 percent of individuals with type 1 diabetes could be classified as high-risk drivers whose mishap rate was nearly three times higher than that of people in the low-risk group.

High-risk drivers who went on to participate in the online intervention at DiabetesDriving.com had a driving mishap rate of about 2.5 per year in the following 12 months, compared with about 4.25 mishaps per year among high-risk drivers who did not participate in the intervention. Still, the mishap rate of high-risk drivers who did the intervention remained higher than that of low-risk drivers.

“Driving is a privilege, not a right,” Cox said. “Whether we have type 1 diabetes, sleep apnea, narcolepsy, slowed reaction times due to aging, or some other chronic or acute condition (e.g., excessive sleepiness or intoxication), we all have a responsibility to ourselves, our families, and others on the road to ensure we are a safe driver.”

People with diabetes should realize they should never drive when their blood glucose is below 70, because it is too easy to slip from mild hypoglycemia to moderate hypoglycemia that impairs judgment, information processing speed, and general reaction time, Cox added. “As soon as hypoglycemia is detected or suspected, the driver should immediately safely pull off the road, treat it, and not resume driving until the hypoglycemia resolves.”

“Diabetic patients have a tendency not to disclose their driving mishaps or near miss events due to fear of losing their driving licenses," said Dr. Thinzar Min from Swansea University in the UK, who was not involved in the study.

In the UK, drivers are allowed only one severe hypoglycemic episode in 12 months to retain Group 1 license (cars and motorcycles) and no severe hypoglycemic episodes for Group 2 licenses (trucks and busses), Min noted.

“I think the RADD scale would be more accurate if the patients can use it to assess themselves if they are high-risk or not,” she said. “Online interventions should be aimed at all diabetic patients who are taking insulin.”

Dr. Eitaro Nakashima from Chubu Rosai Hospitalin Nagoya, Japan, wrote recently about the pitfalls of tightening driving regulations for diabetic patients in Japan and Europe. "In my opinion, each patient should understand the degree of risk of driving mishaps and prepare sugar in their car. For general public, education and individual customized treatment are important for good outcome instead of tightening of driving regulations,” he told Reuters Health by email.

SOURCE: Diabetes Care, online April 12, 2017.

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