Diabetes and driving

Abstract

A meeting of the Medical Advisory Panel on Driving and Diabetes in March, 2013, recommended that the UK’s Driver and Vehicle Licensing Agency (DVLA) modify its regulations. The panel concluded that previous strictures requiring patients treated with insulin to test their blood glucose 30 min before driving were unnecessarily exacting, and that 2 h was, in most circumstances, an acceptable time frame. The DVLA adjusted its standards accordingly. Studies of driving and diabetes are few; good quality ones fewer still. No statistics are available, at least in the UK, for the number of road accidents in which diabetes had a contributory role. Still, a slightly increased risk does seem likely (although much less so than for other, less scrutinised groups such as young men). The major concern is hypoglycaemia—an attack at the wheel can (and does) have catastrophic consequences. A history of severe hypoglycaemia, especially while driving, has a strong bearing on the risk of an accident. Impaired hypoglycaemia awareness is a potential risk factor, as is inadequate blood glucose monitoring before driving. The additional risk is concentrated in a small proportion of drivers, mainly in those with type 1 diabetes, of whom about a third have recurrent severe hypoglycaemia and about a quarter have impaired hypoglycaemia awareness. In the UK, which licences about 0·5 million drivers with diabetes, only those treated with insulin have to notify the DVLA of their illness. However, those treated with diet or tablets are required to make it known if they develop debilitating complications such as retinopathy or peripheral neuropathy. Drivers treated with insulin can be issued with group 1 (car and motorcycle) licences for up to 3 years, but were previously debarred from driving group 2 vehicles (buses and lorries). In the past few years important changes have taken place. A 2006 EU directive harmonised driving regulations across the Common Market. Member states are obliged to adopt the regulations, although enforcement inevitably varies from state to state. Historically, some European nations have been reluctant to expend resources on the expensive and time-consuming requirements of medical testing, making the UK’s six medical advisory panels, and centralised body for assessing fi tness to drive a European rarity.