Traffic hypoglycaemias and accidents in patients with diabetes mellitus treated with different antidiabetic regimens

Abstract

Abstract. Harsch IA, Stocker S, Radespiel-Tröger M, Hahn EG, Konturek PC, Ficker JH, Lohmann T (Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg, Erlangen; and Klinikum Fü rth, Fü rth, Germany). Traffic hypoglycaemias and accidents in patients with diabetes mellitus treated with different antidiabetic regimens. J Intern Med 2002; 252: 352-360.Objectives. Insulin-treated patients with diabetes are at a higher risk than the general population in causing traffic accidents due to hypoglycaemias. Preceeding investigations focused on insulin-treated patients and hypoglycaemia-induced accidents as Ôend-pointsÕ. We studied the incidence of symptomatic hypoglycaemia and hypoglycaemia-induced accidents during driving and put it in relation to the different treatment modes of insulin therapy (Conventional Insulin Treatment ¼ CT, Intensified Conventional Insulin Treatment ¼ ICT, Continuous Subcutaneous Insulin Infusion ¼ CSII) as well as to patients treated with oral hypoglycaemia-inducing agents and the two main types of diabetes mellitus. Design. Subjects and setting: We investigated 450 patients (122 treated with sulphonylureas, 151 with CT, 143 with ICT and 34 with CSII) by an anonymous questionnaire at different locations to avoid bias. A total of 176 persons had type 1 diabetes, 243 persons had type 2 diabetes, 31 subjects could not be classified.Results. Symptomatic hypoglycaemias during driving were rare events with an occurrence of 0.19-8.26 (minimal and maximal mean, depending on the mode of treatment), if given as hypoglycaemias per 100 000 km on one treatment regimen, or 0.02-0.63, if given as events per year driven. Their incidence increased significantly with the degree of ÔstrictnessÕ between the treatment groups, except between the patients treated with ICT and CSII. Hypoglycaemia-induced accidents are rare with 0.01-0.49, if given as events per 100 000 km and 0.007-0.01, if given as events per year driven. These differences were not significant. Significant confounders influencing the traffic safety of the patients were age, duration of diabetes and concomitant antihypertensive medication. Analysing the data in accordance with the type of diabetes revealed a significantly higher rate of hypoglycaemic events in patients with type 1 diabetes. The number of hypoglycaemia-induced accidents was considerably higher in this group, but failed slightly to reach statistical significance. Conclusions. Hypoglycaemias during driving are rare events, their occurrence is significantly influenced by the treatment regimen and type of diabetes. Hypoglycaemia-induced accidents are extremely rare, presumably as a positive effect of patient education in our group.

Impaired Awareness of Hypoglycemia and Driving Mishaps in Patients with Type 1 Diabetes Mellitus: A Multi-center Survey in Japan

“…5,6,7,9 The increased risk of accidents has been suggested to be associated with hypoglycemia in particular.…”

Carbohydrate Metabolism Disturbances among Public Transport Drivers — The Need for Regulations in Poland

“…Driving ability is controlled by specific regulations. The main potential danger of diabetes and driving is the possibility of hypoglycaemia [10]. Hypoglycaemia occurs from a relative excess of insulin in the blood and results in excessively low blood glucose level.…”

Diabetes mellitus and driving a motor vehicle

“…Так, например, в шотландском исследовании, опубликованном в 2004 г., было показано, что только 62% медицинских работников считают, что водители с СД, получающие инсулин, должны проверять уровень глюкозы крови перед началом движения; 13% опрошен-ных согласились с тем, что ездить с уровнем глюкозы крови менее 4 ммоль/л безопасно, а 8% не знали, что на-рушенная чувствительность к гипогликемии может быть противопоказанием к вождению [25]. В крупном меж-дународном исследовании почти половина водителей с СД1 и три четверти пациентов с СД2 никогда не обсуж-дали с лечащим врачом принципы безопасного вождения при диабете [26].…”