Fahreignung und Fahrfähigkeit bei Diabetes mellitus

Abstract

Chronic sequelae of diabetes that could potentially affect driving include the following: visual retinopathy with associated impaired visual acuity, loss of peripheral vision and poor dark adaptation; neuropathy that may affect lower limb functions needed for safe driving; and acute events, including transient cognitive dysfunction and loss of consciousness related to hypo- or hyperglycemia. Hyperglycemia does not suddenly incapacitate drivers, however its occurrence often leads to tiredness, blurred vision, decreased visual acuity and adjustment of treatment which may precipitate hypoglycaemia. The side effects of acute hypoglycemia are of particular concern, as they include slowing of both cognitive and motor functions. Hypoglycemia while driving ist the most important complication in persons treated with insulin, sulfonylureas or glinides. They can be prevented, however, by frequent measuring blood glucose before and every 60 to 90 minutes during driving, by keeping sugary snacks (carbohydrates) in the vehicle, and by taking carbohydrates in case of glucose levels below 5 mmol/l. For patients, who are treated with insulin and sulfonylureas/glinides, it is of utmost importance fort the treating physician to frequently talk about successful strategies for preventing hypoglycemias, and thus accidents, while driving. People with diabetes treated with insulin, sulfonylureas or glinides are nor allowed to drive a bus, taxi, or truck (commercial driving). Under special circumstances (evalution and treatment by a diabetologist/endocrinolgist, avoidance of hypoglycemias for three months, and frequent glucose measurements) an exception to this rule can be granted for truck and cab drivers (after a thorough licensing examination).