A new study published in Diabetes Care
investigates ways to prevent driving incidents among patients with type 1 diabetes (T1D), who may be at higher risk of having such mishaps.
Prior research has shown that drivers with T1D tend to have a higher risk of accidents, particularly if they have greater insulin sensitivity and release less epinephrine during hypoglycemia. This correlation is thought to be due in part to the diminished cognitive and motor abilities that can result when the body experiences extreme blood glucose levels and the presence of diabetic complications like retinopathy and neuropathy that can make it more difficult to safely drive a car.
The American Diabetes Association (ADA) has issued a vague recommendation of screening and intervention to reduce the risk of driving mishaps, but has not provided guidance on how exactly clinicians can spot high-risk patients or what solutions to offer. The current study aimed to develop a questionnaire that would help identify patients with the factors that put them at risk of having an accident on the road, and created an internet-based intervention to educate individuals on how to prevent such accidents.
The questionnaires were developed through a prospective process in which participants with T1D completed questionnaires on several metrics that could affect driving safety, then reported any driving mishaps in the following 12 months. These driving mishaps were not limited to crashes, but also included losing control over the vehicle, committing a moving violation, or experiencing severe hypoglycemia at the wheel.
Researchers identified the factors that were most strongly linked with future driving mishaps, which were peripheral neuropathy, driving exposure in miles, general hypoglycemia problems, and a history of hypoglycemia-related driving mishaps. Using this data, they developed a brief 11-item questionnaire that scores patients’ answers and classifies their driving risk.
They then created an intervention program, DiabetesDriving.com, that focused on helping high-risk patients avoid or correct symptoms of hypoglycemia while driving. The intervention included web-based education modules and homework assignments as well as a mailed toolkit with resources like a pre-driving checklist, a blood glucose meter, and convenient sources of glucose. The subjects who participated in the intervention experienced fewer mishaps than the high-risk drivers receiving usual care, but more mishaps than the low-risk drivers receiving usual care.
According to the study, the ability of the questionnaire to identify high-risk drivers has prompted the ADA to feature it as a tool on its website. Clinicians can refer patients to the DiabetesDriving.com intervention, which was proven to help drivers with T1D to “better anticipate, prevent, detect, and treat hypoglycemia while driving.”
The researchers noted the possibility that receiving the toolkit and informational resources may have been sufficient on their own to reduce driving risk without needing to complete the additional 5-unit online educational program. Still, the intervention was effective and convenient, as the online delivery format made it possible for all patients to access without needing to visit a clinic.
The study demonstrated that it is possible to mitigate the probability of driving accidents in patients who are at risk of experiencing hypoglycemia symptoms that can interfere with driving. Future studies may assess the efficacy of similar questionnaires and interventions designed to reduce driving risks arising from hyperglycemia or other diabetes-related complications. Additionally, as this research only included adult patients, future interventions could be targeted at adolescents with diabetes, who are already at high risk of having accidents due to their limited experience both driving a car and managing their symptoms while driving.