Motor vehicle driving among diabetics taking insulin and non-diabetics.

Abstract

parental blood pressure has been measured. It is interesting, however, that the relation between birth weight, maternal age, and birth rank and blood pressure were largely unaffected by adjustment for reported parental history of high blood pressure and seemed to be similar in children with and without a maternal history of hypertension. These findings suggest that the means by which familial influences on blood pressure are mediated are quite separate from those of the other factors discussed. Conclusions-Diabetic drivers treated with insulin and attending clinics have no more accidents than non-diabetic subjects and may be penalised unfairly by insurance companies. IntroductionDiabetes mellitus in drivers of motor vehicles is assumed to be a potential danger both to the driver and to other road users. This belief stems from both the immediate disabling effects of hypoglycaemia and the long term implications of the disease, particularly retinopathy. With these problems diabetics might be expected to have more road traffic accidents than the general population, but available evidence is conflicting. Early studies from the United States have consistently shown higher accident rates for diabetic BMJ VOLUME 299 2 SEPTEMBER 1989 591 motorists,'"3 but Ysander's work showed reduced rates among Swedish diabetic drivers.4 We could not find a comparable controlled study in the United Kingdom, but recent evidence has suggested that insulin dependent diabetic drivers have no excess of accidents.5 We compared rates of road traffic accidents among diabetic drivers taking insulin and non-diabetic drivers. We also assessed the motoring practices of diabetic drivers and the attitudes of insurance companies towards them. Subjects and methodsA complete census of insulin dependent and noninsulin dependent diabetic patients, aged 18-65 inclusive on 1 October 1986, who had been taking insulin for at least one year was carried out at two diabetic clinics in Belfast. During an initial period of four months individual patients were recruited when they attended their respective clinic. A further eight months' follow up was required to recruit subjects who did not attend in the initial four months. Patients gave informed oral consent before participating in the survey, which had been approved by the ethical committee of Queen's University, Belfast. Each volunteer completed a confidential questionnaire under supervision by one of us.The questionnaire was divided into three sections. In the first section personal and clinical details were recorded by the supervisor. The second and third sections contained multiple choice questions and questions requiring simple yes/no answers. Some questions also required subjects to give brief written details. The second section asked for information on home monitoring of blood glucose concentration, experience of hypoglycaemia, and alcohol consumption. In the third section the current driving state of patients was established. All patients who at the time of the survey drove motor vehicles on public road...

Diabetes and Motor Vehicle Crashes: A Systematic Evidence-Based Review and Meta-Analysis

“…As there is a reasonably large body of literature showing that hypoglycemia occurs more often among individuals treated with insulin than among those treated by pharmacotherapy or diet alone, one might reasonably expect to observe that individuals with insulin-treated diabetes are at higher risk for a motor vehicle crash when compared with individuals who control their diabetes by other means. Five of the 13 included studies provided separate crash risk data for drivers who were insulin-treated (Cox, 2003;Eadington & Frier, 1989;Laberge-Nadeau, 2000;Songer, 1988;Stevens, 1989) allowing us to estimate of the risk ratio associated with this subpopulation of drivers.…”

Diabetes and Driving

“…In many (retrospective) studies, information is obtained through questionnaires, filled out by the drivers themselves (45)(46)(47)(48)(49)(50)(51)70,72,83,84). This can cause a recall bias on the one hand and a bias of subjectivity on the other hand.…”

“…Interestingly, the mileage-adjusted accident rate for the whole group was 5.4 per million miles driven (men 4.9, women 6.3), which was considerably lower than the accident rate for the general population of 10.0 accidents per million miles. Stevens et al (49) found, among 354 insulintreated diabetic drivers in Belfast, a similar accident rate of 7.9 per million miles, which was 7.8 in a control group. Since these rates were only calculated for the 24% of case and control subjects who reported accidents, true accident rates must have been lower (49).…”

“…Stevens et al (49) found, among 354 insulintreated diabetic drivers in Belfast, a similar accident rate of 7.9 per million miles, which was 7.8 in a control group. Since these rates were only calculated for the 24% of case and control subjects who reported accidents, true accident rates must have been lower (49).…”

Impact of diabetes on crash risks of truck-permit holders and commercial drivers.

“…Existing studies on diabetes and crash risks show contradictory results. In some studies, diabetes increased the risk of passenger vehicle crashes (8)(9)(10)(11); in others, there was either no effect (12) or even decreased risk (13,14). The study by Songer et al (15) estimates an additional number of crashes as a result of severe hypoglycemia if drivers using insulin were allowed to drive commercial motor vehicles (CMVs) in interstate commerce.…”