Diabetes and Driving

Abstract

The fitness of people with diabetes to drive should be assessed on an individual basis. • All drivers with diabetes should undergo a medical examination at least every 2 years to assess fitness to drive. Commercial drivers should undergo an assessment at the time of application for a commercial license and as per provincial requirements thereafter. • People with diabetes should play an active role in assessing their fitness to drive. • Health-care professionals should educate people with diabetes about strategies to reduce their risks for hypoglycemia while driving. They should also identify and inform individuals with diabetes at higher risk for motor vehicle accidents. KEY MESSAGES FOR PEOPLE WITH DIABETES • If you take insulin and/or an insulin secretagogue and intend to drive: • Immediately notify your health-care provider and your driving licensing body if you experience any episode of severe hypoglycemia while driving or you experience more than 1 episode of severe hypoglycemia while awake but not driving in the past 6 months if you are a private driver, or in the past 12 months if you are a commercial driver. Conflict of interest statements can be found on page S152. Can J Diabetes 42 (2018) S150-S153 Contents lists available at ScienceDirect Canadian Journal of Diabetes j o u r n a l h o m e p a g e : w w w. c a n a d i a n j o u r n a l o f d i a b e t e s. c o m

Population-Based Registry Analysis of Antidiabetics Dispensations: Trend Use in Spain between 2015 and 2018 with Reference to Driving

“…It seems that the real risk for car crashes is uncertain or slightly increased: rate ratios in insulin-treated diabetics of 0.54 to 1.8 [ 25 ], and standardized incidence ratios in oral antidiabetics-treated and insulin-treated diabetics of 1.2 to 1.4 [ 5 ] are found. Indeed, separately, oral antidiabetics and insulins should be associated to a lower risk [ 10 ] or no risk [ 13 , 32 ], which suggests that really an adequate monitoring of blood glucose levels of patients, to avoid hypoglycemia is of crucial importance [ 6 ]. Therefore, antidiabetics should be prescribed and consumed appropriately, even those not including the “medicines and driving” pictogram.…”

“…The prevention of hypoglycemia is of crucial importance, so that monitoring of patients with DM should be performed [ 40 ]. In this sense, healthcare professionals should educate patients with DM on symptoms and the predisposing conditions for this acute complication [ 14 ], and promoting adequate control of blood glucose [ 6 ]. Evidently, clinicians must particularly be sufficiently prepared and able to decide which people with DM have an unacceptable driving risk and must be excluded from driving [ 10 ].…”

“…Diabetes can affect fitness to drive [ 1 , 4 , 5 , 6 ]. Chronic complications, such as retinopathy or peripheral neuropathy, can impair sensory or motor function [ 6 , 7 ].…”

“…Diabetes can affect fitness to drive [ 1 , 4 , 5 , 6 ]. Chronic complications, such as retinopathy or peripheral neuropathy, can impair sensory or motor function [ 6 , 7 ]. On the other hand, acute complications, such as hypoglycemia or hyperglycemia, can affect perception, motor skills, cognition, and judgment, and may cause loss of consciousness during driving [ 7 , 8 ], which may result in road crashes [ 9 , 10 , 11 ].…”

Physiological Closed-Loop Control (PCLC) Systems: Review of a Modern Frontier in Automation

“…Small observational studies indicate that these results may follow from the rapid and pain-free nature of blood glucose selfmonitoring with these devices, which allows users to follow even stringent (¿10 times per day) testing guidelines without experiencing discomfort [33]. This research has also reported behavioral changes in patients, including better adherence to monitoring timelines, which may produce additional societal benefits, as unchecked low blood sugar is associated with otherwise avoidable injuries and a increased risk of car accidents [42]. Due to time lag and measurement inaccuracy -possibly exceeding 15% mean absolute relative difference (MARD) from matched reference measurements -users of these devices must still perform traditional SMBG tests when hypoglycemia is expected, measurements vary rapidly or do not corroborate symptoms, and when required by law [33].…”