Predicting and Reducing Driving Mishaps Among Drivers With Type 1 Diabetes

Abstract

OBJECTIVETwo aims of this study were to develop and validate A) a metric to identify drivers with type 1 diabetes at high risk of future driving mishaps and B) an online intervention to reduce mishaps among high-risk drivers.RESEARCH DESIGN AND METHODSTo achieve aim A, in study 1, 371 drivers with type 1 diabetes from three U.S. regions completed a series of established questionnaires about diabetes and driving. They recorded their driving mishaps over the next 12 months. Questionnaire items that uniquely discriminated drivers who did and did not have subsequent driving mishaps were assembled into the Risk Assessment of Diabetic Drivers (RADD) scale. In study 2, 1,737 drivers with type 1 diabetes from all 50 states completed the RADD online. Among these, 118 low-risk (LR) and 372 high-risk (HR) drivers qualified for and consented to participate in a 2-month treatment period followed by 12 monthly recordings of driving mishaps. To address aim B, HR participants were randomized to receive either routine care (RC) or the online intervention “DiabetesDriving.com” (DD.com). Half of the DD.com participants received a motivational interview (MI) at the beginning and end of the treatment period to boost participation and efficacy. All of the LR participants were assigned to RC. In both studies, the primary outcome variable was driving mishaps.RESULTSRelated to aim A, in study 1, the RADD demonstrated 61% sensitivity and 75% specificity. Participants in the upper third of the RADD distribution (HR), compared with those in the lower third (LR), reported 3.03 vs. 0.87 mishaps/driver/year, respectively (P < 0.001). In study 2, HR and LR participants receiving RC reported 4.3 and 1.6 mishaps/driver/year, respectively (P < 0.001). Related to aim B, in study 2, MIs did not enhance participation or efficacy, so the DD.com and DD.com + MI groups were combined. DD.com participants reported fewer hypoglycemia-related driving mishaps than HR participants receiving RC (P = 0.01), but more than LR participants receiving RC, reducing the difference between the HR and LR participants receiving RC by 63%. HR drivers differed from LR drivers at baseline across a variety of hypoglycemia and driving parameters.CONCLUSIONSThe RADD identified higher-risk drivers, and identification seemed relatively stable across time, samples, and procedures. This 11-item questionnaire could inform patients at higher risk, and their clinicians, that they should take preventive steps to reduce driving mishaps, which was accomplished in aim B using DD.com.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence

“…Studies have variably shown increased rates of driving accidents in drivers with type 1 diabetes, although this may be due to an overrepresentation of a particular subgroup of drivers with poorer glycemic awareness . Studies have also shown reductions in automobile accidents following specific hypoglycemia awareness training programs …”

“…120 Studies have also shown reductions in automobile accidents following specific hypoglycemia awareness training programs. 121 The young person who plans to obtain a driving license should be advised on the appropriate regulations and in particular:…”

Diabetes-Specific Questionnaires Validated in Brazilian Portuguese: A Systematic Review

“…The remaining concepts measured are also of great importance in the research and clinical follow-up of patients with diabetes: attitude towards diabetes, emotional distress, hope, perception of disease severity. However, some common barriers faced by patients with diabetes, such as beliefs, relationship with health care professionals, lifestyle changes (50), physical activity (51), and risk of driving (52) have not been evaluated in Brazilian diabetic populations and still require crosscultural adaptation and validation in order to be ready for using.…”

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

“…To assist this task, Cox and colleagues have developed an 11-item questionnaire to identify high-risk drivers and have shown that an online intervention reduced the incidence of driving mishaps over a 12-month period. 5 How are people with diabetes licensed to drive motor vehicles in different parts of the world?…”