Diabetes and driving

Abstract

The principal safety concern for driving for people treated with insulin or insulin secretagogues is hypoglycaemia, which impairs driving performance. Other complications, such as those causing visual impairment and peripheral neuropathy, are also relevant to medical fitness to drive. Case control studies have suggested that drivers with diabetes pose a modestly increased but acceptable and measurable risk of motor vehicle accidents compared to non-diabetic drivers, but many studies are limited and of poor quality. Factors which have been shown to increase driving risk include previous episodes of severe hypoglycaemia, previous hypoglycaemia while driving, strict glycaemic control (lower HbA1c) and absence of blood glucose monitoring before driving. Impaired awareness of hypoglycaemia may be counteracted by frequent blood glucose testing. The European Union Third directive on driving (2006) has necessitated changes in statutory regulations for driving licences for people with diabetes in all European States, including the UK. Stricter criteria have been introduced for Group 1 vehicle licences while those for Group 2 licences have been relaxed. Insulin-treated drivers can now apply to drive Group 2 vehicles, but in the UK must meet very strict criteria and be assessed by an independent specialist to be issued with a 1-year licence.

Driving and diabetes: problems, licensing restrictions and recommendations for safe driving

“…This has been reviewed previously in detail for drivers with insulin-treated diabetes [25]. Some studies have reported that RTA rates appear to be no higher in drivers with diabetes [26–28] whereas other studies have reported an increased risk [29, 30].…”

Blood glucose testing by drivers with diabetes: a survey of glucose meter users

“…In the European Union, blood glucose monitoring at times relevant to driving is now a requirement for professional drivers with insulin-treated diabetes who hold a Group 2 driving licence. 6 Failure to test blood glucose before driving could have legal consequences in the event of a hypoglycaemia-induced driving accident.…”

Driving and diabetes: are the changes in the European Union licensing regulations fit for purpose?

“…3 A more recent meta-analysis has concluded that the overall risk of RTAs for drivers with diabetes was not higher than for non-diabetic drivers; older drivers and those with insulin-treated diabetes exhibited a trend towards an increased risk, but this failed to reach statistical significance. 4 However, proving causation remains extremely difficult as the cause of many accidents is multifactorial and factors such as the age and gender of the driver, type of road, traffic conditions and time of day all influence the baseline risk of sustaining a RTA.…”