Nearly 19 million people in the United States have diagnosed diabetes, and many of these individuals will seek or presently hold a license to drive. Currently, states have different laws concerning driving and diabetes. “For people with diabetes, a driver’s license is essential for many reasons, including getting to and from work or school, caring for themselves and/ or family members, and many other daily life functions,” says Daniel Lorber, MD, FACP, CDE. “This is an important issue because there has been considerable debate on the role of diabetes and its relevancy on determining driver ability and eligibility for a license.” He adds that each state has its own laws on disclosure of diseases that may impact patients’ driving ability, further complicating the issue.
Research suggests most people with diabetes can and do drive safely, but in the past, there have been inappropriate attempts to restrict driving licensure for these patients. “The chief concern about driving with diabetes is hypoglycemia because these episodes can cause confusion and disorientation,” Dr. Lorber says. However, while hypoglycemic episodes can affect driving ability, the available data show that these incidents are uncommon. Other factors related to diabetes that could affect driving include retinopathy and peripheral neuropathy.
In the January 2012 issue of Diabetes Care, the American Diabetes Association released a position statement based on current scientific and medical evidence addressing the issue of driving in patients with diabetes. The statement advises against blanket restrictions and instead recommends that patients who have issues that could increase driving risks be assessed by physicians who normally care for people with diabetes. “Whenever there are legitimate concerns about the medical fitness of people with diabetes and their driving ability, it’s important to conduct an individual assessment of the person’s diabetes management before any restrictions are made,” says Dr. Lorber. “A particular emphasis should be placed on patients demonstrating the ability to detect and appropriately treat potential hypoglycemia should such episodes occur. A diagnosis of diabetes is insufficient for making any judgments about individual driver capacity.”
In the position statement, studies on people with diabetes and driving were analyzed. Overall, people with diabetes had between a 12% and 19% increased risk of motor vehicle accidents when compared with the general driving population. Despite these statistics, society has historically tolerated riskier driving situations in many other health-related populations. For example, ADHD sufferers are about four times as likely to get into car accidents as the general public. People with sleep apnea are about 2.4 times more likely to get into a crash.
Identify High-Risk Individuals
“An important challenge for clinicians managing patients with diabetes is to identify high-risk individuals,” Dr. Lorber says. “Once identified, we then need to take measures to help them lower their risk for driving mishaps.” The position statement provides healthcare providers with a list of questions to ask patients with diabetes who drive. It also provides assistance to clinicians who may be unsure about their responsibility in this health issue.
According to the American Diabetes Association, patients who are currently taking insulin are at the highest risk of hypoglycemia. Patients who are at risk for disruptive hypoglycemia should be counseled to always test their blood glucose before driving and carry blood glucose meters and appropriate snacks in their vehicles. The guideline recommendations also provide assistance for clinicians to help patients understand when they should not drive based on their glucose levels and how they should handle when symptoms and/ or glucose fluctuations occur (Table 1).
Physicians Play an Instrumental Role
Mandatory physician reporting to state licensing agencies about patient driving ability is not recommended because this may inhibit patients from discussing these issues with their healthcare providers. To overcome this, complete disclosure with patients is key. “Patient education is paramount to ensuring safe driving practices in people with diabetes,” says Dr. Lorber (Table 2). “At-risk individuals need to be evaluated and counseled on an individual basis. The great majority of people with diabetes do not have impaired driving skills. As healthcare providers, we need to ensure that patients understand that they must know their blood sugar levels before they start to drive and avoid driving if these levels are low. The signs and symptoms of diabetes and its complications must be understood so that patients are empowered to protect themselves and others on the road.”
American Diabetes Association. Diabetes and driving. Diabetes Care. 2012;35:S81-S86. Available at: http://care.diabetesjournals.org/content/35/Supplement_1/S81.full.
American Diabetes Association. Standards of Medical Care in Diabetes—2012. Diabetes Care. 2011;35:S11-S63. Available at: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.
Watson WA, Currie T, Lemon JS, Gold AE. Driving and insulin-treated diabetes: who knows the rules and recommendations? Pract Diabetes Int. 2004;24:201-206.
Cox DJ, Penberthy JK, Zrebiec J, et al. Diabetes and driving mishaps: frequency and correlations from a multinational survey. Diabetes Care. 2003;26:2329-2334.
Lonnen KF, Powell RJ, Taylor D, et al. Road traffic accidents and diabetes: insulin use does not determine risk. Diabet Med. 2008;25:578-584.
Redelmeier DA, Kenshole AB, Ray JG. Motor vehicle crashes in diabetic patients with tight glycemic control: a population-based case control analysis. PLoS Med. 2009;6:e1000192.
Cox DJ, Kovatchev BP, Anderson SM, et al. Type 1 diabetic drivers with and without a history of recurrent hypoglycemia-related driving mishaps: physiological and performance differences during euglycemia and the induction of hypoglycemia. Diabetes Care. 2010;33:2430-2435.