Driving and diabetes: are the changes in the European Union licensing regulations fit for purpose?

Alex J Graveling, Brian M Frier

Abstract


Driving is an important everyday activity for many people with diabetes, which is designated a prospective disability as it may impair driving performance as it progresses in severity. In effect, the principal threat to driving performance is hypoglycaemia associated with insulin therapy. Regular assessment of medical fitness to drive is undertaken to identify drivers with diabetes who are at greatest risk of experiencing motor vehicle accidents. Many countries do not restrict the licensing of drivers with insulin-treated diabetes and fail to review and/or restrict the driving of large goods vehicles or those carrying passengers. The European Union has formulated regulations for driving licensing for diabetes through successive directives, which have been implemented by individual countries including the UK. In response to submissions to relax licensing restrictions, some of these have been amended recently and were implemented in the UK in January 2018. Their rationale and potential value are discussed.

Keywords


driving, driving licensing, road traffic accidents, hypoglycaemia, type 1 diabetes, insulin therapy

Full Text:

HTML PDF

References


Graveling AJ, Frier BM. Driving and diabetes: problems, licensing restrictions and recommendations for safe driving. Clin Diabetes Endocrinol 2015;1:8. https://doi.org/10.1186/s40842-015-0007-3

Graveling AJ, Warren RE, Frier BM. Hypoglycaemia and driving in people with insulin-treated diabetes: adherence to recommendations for avoidance. Diabet Med 2004;21:1014–19. http://dx.doi.org/10.1111/j.1464-5491.2004.01288.x

Inkster B, Frier BM. Diabetes and driving. Diabetes Obes Metab 2013; 15:775–83. http://dx.doi.org/10.1111/dom.12071

Hostiuc S, Negoi I, Hostiuc M. Diabetes and collision risk. A meta-analysis and meta-regression. Int J Clin Pract 2016;70:554–68. http://dx.doi.org/10.1111/ijcp.12832.

Cox DJ, Gonder-Frederick LA, Singh H, et al. Predicting and reducing driving mishaps among drivers with type 1 diabetes. Diabetes Care 2017;40:742–50. http://dx.doi.org/10.2337/dc16-0995

American Diabetes Association. Diabetes and driving. Diabetes Care 2014;37(Suppl 1):S97–103. https://doi.org/10.2337/dc14-S097

DVLA. Assessing fitness to drive: guide for medical professionals. Swansea: Department for Transport, 2016.

Houlden RL, Berard L, Cheng A, et al. Diabetes and driving: 2015 Canadian Diabetes Association updated recommendations for private and commercial drivers. Can J Diabetes 2015;39:347–53. http://doi.org/10.1016/j.jcjd.2015.08.011

Beshyah SA, Beshyah AS, Yaghi S, Beshyah WS, Frier BM. A global survey of licensing restrictions for drivers with diabetes. Br J Diabetes 2017;17: 3–10. http://dx.doi.org/10.15277/bjd.2017.117

Hassoun AAK, Abdella N, Al Arouj M, et al. Driving and diabetes mellitus in the Gulf Cooperation Council countries: call for action. Diabetes Res Clin Pract 2015;110:91–4. http://dx.doi.org/10.1016/j.diabres.2015.08.002

World Health Organization. Global status report on road safety. Geneva: World Health Organization, 2015.

Pedersen-Bjergaard U, Faerch L, Allingbjerg ML, Agesen R, Thorsteinsson B. The influence of new European Union driver's license legislation on reporting of severe hypoglycemia by patients with type 1 diabetes. Diabetes Care 2015;38:29–33. http://dx.doi.org/10.2337/dc14-1417

Domgaard M, Bagger M, Rhee NA, Burton CM, Thorsteinsson B. Individual and societal consequences of hypoglycemia: a cross-sectional survey. Postgrad Med 2015;127:438–45. http://dx.doi.org/10.1080/00325481.2015.1045815

Broz J, Brabec M, Zdarska D, et al. Fear of driving license withdrawal in patients with insulin-treated diabetes mellitus negatively influences their decision to report severe hypoglycemic events to physicians. Patient Preferences and Adherence 2015;9:1367–70. https://doi.org/10.2147/PPA.S87393

Rees S, Browne A, Major H, Frier B. Renewal of driving licences and long duration insulin-treated diabetes: a comparison of medical assessment and self-reporting by drivers. Pract Diabetes 2012;29:117–19. http://dx.doi.org/10.1002/pdi.1671

European Commission. Commission Directive (EU) 2016/1106 amending Directive 2006/126/EC of the European Parliament and of the Council on driving licences. Off J Eur Union 2016;L183:59–63.

Geddes J, Wright RJ, Zammitt NN, Deary IJ, Frier BM. An evaluation of methods of assessing impaired awareness of hypoglycemia in type 1 diabetes. Diabetes Care 2007;30:1868–70. http://dx.doi.org/10.2337/dc06-2556

American Diabetes Association. Diabetes and driving. Diabetes Care 2012;35(Suppl 1):S81–6. http://dx.doi.org/10.2337/dc12-s081

Gubitosi-Klug RA, Braffett BH, White NH, et al. Risk of severe hypoglycemia in type 1 diabetes over 30 years of follow-up in the DCCT/EDIC study. Diabetes Care 2017;40:1010–16. http://dx.doi.org/10.2337/dc16-2723

Cox DJ, Ford D, Gonder-Frederick L, et al. Driving mishaps among individuals with type 1 diabetes: a prospective study. Diabetes Care 2009; 32:2177–80. http://dx.doi.org/10.2337/dc08-1510

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(12):e1000192. http://dx.doi.org/10.1371/journal.pmed.1000192

Donnelly LA, Morris AD, Frier BM, et al. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: a population-based study. Diabet Med 2005;22:749–55. http://dx.doi.org/10.1111/j.1464-5491.2005.01501.x

General Medical Council. Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA. 2017.

DCCT. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. Am J Med 1991;90:450–9. https://doi.org/10.1016/0002-9343(91)80085-Z

Graveling AJ, Frier BM. The risks of nocturnal hypoglycaemia in insulin-treated diabetes. Diabetes Res Clin Pract 2017;133:30–9. http://dx.doi.org/10.1016/j.diabres.2017.08.012

King P, Kong MF, Parkin H, Macdonald IA, Tattersall RB. Well-being, cerebral function, and physical fatigue after nocturnal hypoglycemia in IDDM. Diabetes Care 1998;21:341–5. https://doi.org/10.2337/diacare.21.3.341

Jauch-Chara K, Hallschmid M, Gais S, et al. Hypoglycemia during sleep impairs consolidation of declarative memory in type 1 diabetic and healthy humans. Diabetes Care 2007;30:2040–5. http://dx.doi.org/10.2337/dc07-0067

Brod M, Pohlman B, Wolden M, Christensen T. Non-severe nocturnal hypoglycemic events: experience and impacts on patient functioning and well-being. Qual Life Res 2013;22:997–1004. http://dx.doi.org/10.1007/s11136-012-0234-3

rod M, Christensen T, Bushnell DM. Impact of nocturnal hypoglycemic events on diabetes management, sleep quality, and next-day function: results from a four-country survey. J Med Econ 2012;15:77–86. http://dx.doi.org/10.3111/13696998.2011.624144

Geelhoed-Duijvestijn PH, Pedersen-Bjergaard U, Weitgasser R, Lahtela J, Jensen MM, Ostenson CG. Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries. J Med Econ 2013;16:1453–61. http://dx.doi.org/10.3111/13696998.2013.852098

Frier BM, Jensen MM, Chubb BD. Hypoglycaemia in adults with insulin-treated diabetes in the UK: self-reported frequency and effects. Diabet Med 2016;33:1125–32. http://dx.doi.org/10.1111/dme.12878

Feher MD, Langerman H, Evans M. Hypoglycemia, diabetes therapies and driving categories in type 2 diabetes. Curr Med Res Opin 2016;32:1005–12. http://dx.doi.org/10.1185/03007995.2016.1155981

Min T, Younis N. Driving and insulin-treated diabetes: are we aware of changes in the Third European Driving Licence Directive? Diabet Med 2016;33:553–4. http://dx.doi.org/10.1111/dme.12888

Watson WA, Currie T, Lemon JS, Gold AE. Driving and insulin-treated diabetes: who knows the rules and recommendations? Pract Diabetes 2007;24:201–6. http://dx.doi.org/10.1002/pdi.1097

Rayman G, Kroger J, Bolinder J. Could FreeStyle Libre sensor glucose data support decisions for safe driving? Diabet Med 2017 [Epub ahead of print 25 Sept 2017]. http://dx.doi.org/10.1111/dme.13515

Broz J, Donicova V, Brabec M, Janickova Zdarska D, Polak J. Could continuous glucose monitoring facilitate identifying diabetes patients with a higher risk of hypoglycemia during driving? J Diabetes Sci Technol 2013;7:1644–5. http://dx.doi.org/10.1177/193229681300700625




DOI: https://doi.org/10.15277/bjd.2018.170

Refbacks

  • There are currently no refbacks.


The Journal of the Association of British Clinical Diabetologists