Driving and Diabetes: One Size Does Not Fit AllMonday, January 16, 2012
Determining whether someone`s diabetes poses a driving risk should be done on an individual basis and tied to concrete evidence of risk, rather than on a diagnosis of diabetes alone, according to a new position statement by the American Diabetes Association, published recently in a special supplement to the January issue of Diabetes Care (not affiliated with DiabetesCare.net).
The Standards of Medical Care in Diabetes, first published in 1989 and updated annually (see 2012 Standards of Medical Care here), are created to provide the best possible guidance to health care professionals for diagnosing and treating adults and children with all forms of diabetes. The Standards are based upon the most current scientific evidence, which is rigorously reviewed by the Association`s multi-disciplinary Professional Practice Committee. The
Committee addresses diabetes in a variety of settings, including schools, home, hospitals (for both inpatients and outpatients), prisons, workplaces and now our nation`s roadways.
This year, the Standards of Care include a section that specifically addresses driving and diabetes, which warns against "blanket restrictions" on driving for people with diabetes, and urges "individual assessment by a health care professional knowledgeable in diabetes" when considering restrictions for licensure. The Standards of Care refer to a separate document being issued simultaneously, the Association`s Position Statement on driving and diabetes, which notes that "[s]ometimes persons with a strong interest in road safety - including motor vehicle administrators, pedestrians, drivers and other road users, and employers - associate all diabetes with unsafe driving when, in fact, most people with diabetes safely operate motor vehicles without creating any meaningful risk of injury to themselves or others... The challenges are to identify high-risk individuals and develop measures to assist them to lower their risk for driving mishaps."
Accordingly, the Association calls for evaluating certain patients for "decreased awareness of hypoglycemia, hypoglycemia episodes while driving, or severe hypoglycemia. Patients with retinopathy or peripheral neuropathy require assessment to determine if those complications interfere with operation of a motor vehicle. Health care professionals should be cognizant of the potential risk of driving with diabetes and counsel their patients about detecting and avoiding hypoglycemia while driving."
The Position Statement also calls for institution of a standardized questionnaire that would help identify those individuals with diabetes who may require further evaluation for driving risks, rather than the current inconsistent system of state laws that range from no restrictions at all for people with diabetes to stringent restrictions on all people with diabetes.
"This country needs a far more consistent, fair and equitable means of determining driving risk when it comes to people with diabetes," said Daniel Lorber, MD, FACP, CDE, a member of the Professional Practice Committee and Chair of the writing group that developed the position statement on diabetes and driving. "The vast majority of people with diabetes have no problems driving safely whatsoever, and should not be held to restrictions that may interfere with their ability to work or live an otherwise normal life," said Lorber, Director of Endocrinology at New York Hospital of Queens in Flushing, NY. "It is important to remember that all people with diabetes do not have the same symptoms, or take the same measures to manage their disease. However, it is also important that we identify those who may pose a risk behind the wheel, and help to better educate people with diabetes about how to reduce those risks."
The Position Statement cites research comparing the risk for someone with diabetes of having a motor vehicle accident to that of the general population (12-19 percent increased risk overall), but as a means of perspective, also includes elevated risk levels for other populations not currently restricted from driving. "For example, 16-year old males experience 42 times more collisions than 35 to 45-year old females," it points out. "Drivers with attention deficit/hyperactivity disorder have a relative-risk ratio of approximately 4, while those with sleep apnea have a relative risk of about 2.4. If society tolerates these conditions, it would be unjustified to restrict the driving privileges of a whole class of individuals who are at much lower risk, such as drivers with diabetes."