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The Decision not to Drive During Hypoglycemia in Patients with Type 1 and Type 2 Diabetes, According to Hypoglycemia Awareness

¹Department of Internal Medicine and Metabolic Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
²Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
³Department of Internal Medicine, Hospital Group Twente, location Twenteborg, Almelo, the Netherlands

adm.stork{at}hccnet.nl

ABSTRACT

Background:In recent years, there has been an ongoing discussion on the relationship between diabetes and driving. As driving performance will inevitably decline at lower levels of glycemia, patients' decision concerning driving or taking corrective action when hypoglycemia occurs immediately before or during driving, seems paramount.

Methods:Twenty-four type 1 diabetic patients with normal awareness of hypoglycemia (T1Norm), 21 type 1 patients with impaired awareness of hypoglycemia (T1Imp) and 20 type 2 patients with normal awareness of hypoglycemia were studied. They were asked whether they felt hypoglycemic and whether they would currently drive during experimental euglycaemia (5.0 mmol/l) and hypoglycemia (2.7 mmol/l).

Results:In the T1Norm-group 1 patient (4.2%) decided to drive during hypoglycemia. In the T1Imp-group 9 patients (42.9%) said they would drive in the hypoglycemic condition. In the T2-group 5 patients (25%) would drive. This was more frequently the case for patients on oral hypoglycemic agents (²=4.44; P=0.04). No effect of gender (²=0.78; P=0.38) or age (²=0.22; P=0.64) was noted.

Conclusions:Patients with type 1 diabetes and impaired awareness of hypoglycemia frequently decide to drive while hypoglycemic, while patients with type 1 diabetes and normal awareness of hypoglycemia appear to make safe decisions concerning hypoglycemia and driving. Strikingly, patients with type 2 diabetes and normal hypoglycemia awareness frequently take potentially dangerous decisions as well, particularly when using oral hypoglycemic agents. Therefore early, clear and consistent education is imperative.

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				For questions on Emerg. Med. J., October 1, 2008; 25(10): 705 - 705. [Full Text] [PDF]