Impaired Awareness of Hypoglycemia and Severe Hypoglycemia in Drivers With Diabetes: Insights From the Association of British Clinical Diabetologists Nationwide Audit

Deshmukh, Harshal; Wilmot, Emma G; Choudhary, Pratik; Narendran, Parth; Shah, Najeeb; Barnes, Dennis; Kamruddin, Shafie; Banatwalla, Rumaisa; Christian, Peter; Saunders, Simon; Lumb, Alistair; Herring, Roselle; Patmore, Jane; Walton, Chris; Ryder, Robert E.; Sathyapalan, Thozhukat

doi:10.2337/dc21-1181

Cited by 6 publications

(12 citation statements)

References 5 publications

(5 reference statements)

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“…And while insulin is most likely used by those with T1DM, many older adults with T2DM will eventually require treatment with the hormone, 48 further elevating their risk of hypoglycaemia. Symptoms of hypoglycaemia may manifest themselves with greater intensity and at lower blood glucose thresholds for older adults, 49 tying into the finding that older adults are more likely to experience impaired awareness of hypoglycaemia 50 possibly due to a shorter interval between initial autonomic symptoms (warnings such as seating or trembling) and ensuing (but possibly simultaneous or preceding) neuroglycopenic symptoms (such as confusion or loss of consciousness) 49 . Given these findings, it follows that older adults with diabetes may have special considerations when it comes to driving.…”

Section: Discussionmentioning

confidence: 99%

The association between diabetes and safe driving: A systematic search and review of the literature and cross‐reference with the current guidelines

Maxwell,

Dubois,

Cottrell‐Martin

et al. 2023

Diabet Med

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AimsWe conducted this review to characterize the quality of evidence about associations between diabetes and safe driving and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes.MethodsThe first stage entailed a systematic search and review of the literature. Evidence surrounding harms associated with diabetes and driving was identified, screened, extracted and appraised for quality utilizing the Newcastle Ottawa Scales (NOS). Next, relevant guidelines regarding driving and diabetes were sourced and summarized. Finally, the identified guidelines were cross‐referenced with the results of the systematic search and review.ResultsThe systematic search yielded 12,461 unique citations; 52 met the criteria for appraisal. Fourteen studies were rated as ‘high’, two as ‘medium’ and 36 as ‘low’. Studies with ratings of ‘high’ or ‘medium’ were extracted, revealing a body of inconsistent methods and findings. These results, cross‐referenced with the guidelines, suggest a lack of agreement and a limited evidence base to justify recommendations.ConclusionsThe results presented emphasize the need for a better understanding of the impacts of diabetes on safe driving to inform evidence‐based guidelines.

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Section: Discussionmentioning

confidence: 99%

The association between diabetes and safe driving: A systematic search and review of the literature and cross‐reference with the current guidelines

Maxwell,

Dubois,

Cottrell‐Martin

et al. 2023

Diabet Med

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“…Hypoglycaemia is a common occurrence in people living with diabetes, particularly those on insulin or long duration. 1,2 This results in a range of psychosocial and physical adverse effects alongside increased morbidity and mortality. 3 Increased frequency of hypoglycaemic episodes leads to disruption in the usual autonomic response to hypoglycaemia resulting in a lack of symptoms [impaired awareness of hypoglycaemia (IAH)].…”

Section: Introductionmentioning

confidence: 99%

“…Hypoglycaemia is a common occurrence in people living with diabetes, particularly those on insulin or long duration 1,2 . This results in a range of psychosocial and physical adverse effects alongside increased morbidity and mortality 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Population data on IAH and SH in drivers with diabetes and the subsequent effects on driving ability are limited both in the United Kingdom and worldwide 2 . We have recently shown that a large proportion of drivers with diabetes have IAH and SH; however, the effect of intermittently scanned continuous glucose monitoring (isCGM) on the prevalence of IAH and SH is not known.…”

Section: Introductionmentioning

confidence: 99%

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Intermittently scanned continuous glucose monitoring and hypoglycaemia awareness in drivers with diabetes: Insights from the Association of British Clinical Diabetologists Nationwide audit

Mark‐Wagstaff,

Deshmukh,

Wilmot

et al. 2023

Diabetes Obesity Metabolism

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AimFrequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third‐party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a complete loss of hypoglycaemia awareness or more than one SH event a year.MethodsThe FreeStyle Libre (FSL) Association of British Clinical Diabetologists (ABCD) Nationwide Audit consists of data collected by clinicians during routine clinical work, submitted into a secure web‐based tool held within the National Health Service (NHS) N3 network. Analysis of paired baseline and follow‐up data for people with type 1 diabetes who also held a driving licence was undertaken.ResultsThe study consisted of 6304 people who had data recorded about driving status from 102 UK specialist diabetes centres, of which 4218 held a driving licence: 4178 a group 1, standard licence, 33 a group 2, large lorries and buses, seven a taxi licence; 1819 did not drive. Paired baseline and follow‐up data were available for a sub‐cohort of 1606/4218. At a mean follow‐up of 6.9 months [95% CI (6.8, 7.1)], the Gold score had improved (2.3 ± 1.5 vs. 2.0 ± 1.3 p < .001), and the number of people who experienced an SH episode was also significantly lower (12.1% vs. 2.7%, p < .001).ConclusionThis study suggests that intermittently scanned continuous glucose monitoring may improve impaired awareness of hypoglycaemia and reduce the number of people with type 1 diabetes with a driving licence experiencing a severe hypoglycaemic episode.

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“…An ABCD audit of Libre outcomes has been running since 2017, reporting reduced HbA1c, improved hypoglycaemia awareness and reductions in hospital attendances for dysglycaemia. 8 This edition of the journal contains an examination of data from the ABCD Libre audit, asking whether prior structured education affects the outcomes with flash glucose monitoring. In particular, clinical outcomes were compared between those who had undergone Dose Adjustment for Normal Eating (DAFNE) structured education, other structured education or neither.…”

mentioning

confidence: 99%

benefits of flash glucose monitoring in the UK

Josipovic¹,

Evans²

2021

Br J Diabetes

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Impaired Awareness of Hypoglycemia and Severe Hypoglycemia in Drivers With Diabetes: Insights From the Association of British Clinical Diabetologists Nationwide Audit

Cited by 6 publications

References 5 publications

The association between diabetes and safe driving: A systematic search and review of the literature and cross‐reference with the current guidelines

The association between diabetes and safe driving: A systematic search and review of the literature and cross‐reference with the current guidelines

Intermittently scanned continuous glucose monitoring and hypoglycaemia awareness in drivers with diabetes: Insights from the Association of British Clinical Diabetologists Nationwide audit

benefits of flash glucose monitoring in the UK

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