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 “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.”
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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: http://bit.ly/2oJgxvQ Diabetes Care, online April 12, 2017.
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