Education paramount around fitness to drive in diabetes: expert

Healthcare professionals should routinely educate their patients with diabetes about safe driving, an expert has advised.

Professor Stephen Twigg, Head of Endocrinology at Royal Prince Alfred Hospital in Sydney, was speaking to delegates attending the ADS-ADEA Annual Scientific Meeting on the Gold Coast earlier this month.

“Driving is a privilege…legislative requirements are linked to safety, as poor health can be the main factor causing a motor vehicle crash,” he told delegates.

He said the main concern about diabetes and driving was in people who had experienced acute and severe episodes of hypoglycaemia.

“The prevention of hypoglycemia while driving is paramount…a hypo event during driving is already a failure in self-care,” said Professor Twigg who recently represented the Australian Diabetes Society on a working party on assessing fitness to drive.

Evidence shows a lack of awareness

Studies had shown people who had experienced an episode of severe hypoglycaemia in the past two years were up to four times more likely to have a motor vehicle crash compared to people with diabetes who had not experienced an episode.

There was also limited evidence that those with impaired awareness of hypoglycemia were at an increased risk of a motor vehicle accident.

However, international evidence indicated that people living with diabetes were often unaware of issues such as the importance of monitoring their blood glucose levels before getting behind the wheel, the need to be above 5mmol/L to drive and restriction periods for driving following an episode of severe hypoglycaemia.

The research also showed healthcare professionals’ lacked knowledge about how to apply assessing fitness to drive guidelines.

What to ask?

Professor Twigg advised healthcare professionals to ask a number of key questions during consultations.

These included asking whether the patient had experienced any episodes of severe hypoglycaemia over the past year, if they had reduced awareness of hypoglycemia and whether they checked their BGLs before driving and if so, why?

He said education for the person with diabetes at risk of hypos should also emphasise the need to:

  • Monitor their BGLs regularly
  • “Above 5 to drive”: Only drive when BGLs are above 5mmol/L
  • Re-check BGLs every 2 hours (for longer duration driving) and ensure they remain above 5mmol/L
  • Have their BG meter and a suitable hypo treatment in their car each time they drive

People who have had a recent episode of severe hypoglycaemia should be advised not to drive for 6 weeks and will require a reassessment and clearance from their medical practitioner to before they resume driving.

New guidelines and resources for patients

Updated guidelines for assessing fitness to drive have just been published and have a number of changes relevant to people living with diabetes.

In particular, the requirement to have an HbA1c under 9% has been removed, due to lack of evidence of a relationship between HbA1c and crash risk.

There is also inclusion of the Clarke hypoglycemia assessment questionnaire to help health professionals identify those at risk due to problematic hypoglycemia.

Professor Twigg also encouraged healthcare professionals to direct their patients to the free NDSS patient education leaflets on safe driving and diabetes:

NDSS Diabetes and Driving booklet.

NDSS Driving and recent severe hypoglycemia factsheet


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