Hypoglycemia and driving a survey in United Arab Emirates

Abstract

Dear Editor, A meta-analysis from 15 studies demonstrated an increase in risk of road misshapes for patients with diabetes compared to the general population by about 12–19 % [1] A recent history of severe hypo is closely associated with road traffic accident in patients with diabetes [2]. In the UK, the driver and licensing agency (DVLA), by law, mandates drivers with diabetes to report their diabetes status if the fall in the category of high risk for hypo according to the following parameters; being treated with insulin therapy, having documented hypo unawareness, having one episode of severe hypo in the last year and having laser eye therapy and or sight problems [3]. At the moment, there is no clinical data on the incidence of hypoglycemia and driving among patients with diabetes on treatment in United Arab Emirates. I present here the results of a pilot study examining the behavior of individuals with diabetes while driving in UAE by implementing the hypoglycemia patient questionnaire survey of the American Diabetes association and Endocrine society 2013 workshop [4]. The survey included 82 small vehicle drivers, majority are middle-age type 2 diabetes (75 drivers) with median diabetes duration of 7.56 year (Table 1). Diabetes-related complications (as documented in patient file) are diabetes peripheral neuropathy 28.8 %, nephropathy (including microalbuminuria) 16.7 %, retinopathy 11.5 %, coronary artery diseases 9.6 %, and peripheral arterial disease 1 %. Among the drivers, equal numbers of them were on insulin and sulphonyl urea 28.6 % (average number of insulin injection is 2.48) and 28.6% on combination of insulin and sulphonyl urea. The results were alarming as they revealed that only 31.7 and 6.1 % of the 82 questionnaire responders were checking their blood glucose (BG) sometimes and always before going on the road, respectively. Interestingly, only 50 % of the insulin users (total number 39) are performing blood glucose testing before their journey and 44.4 and 5.6 % reported doing so sometimes and always, respectively. The self-reporting subjective hypoglycemia of at least one episode while driving in the last 1 year is 15 % among the drivers in the questionnaire. The frequency of hypo was variable and shown in Table 1. The knowledge among the drivers about the safe blood glucose level for driving to prevent hypoglycemia was only 44.1 % which signifies a lack of proper education to patients with diabetes on this vital issue. But when stratified to subgroups according to self-reported hypoglycemia (mainly subjective retrospective hypoglycemia) in the last 1 year, the drivers who had experienced hypoglycemia were more aware about the safe blood glucose reading before driving, 55.6 and 44.4 % knowing and not knowing the safe BG in the hypo subgroup compared to 35 and 64.7 % in no hypo subgroup (p = 0.012), respectively. The results of the present survey should alert professionals to look closely at the safety of their patients with diabetes behind the wheel. The process should focus on identifying high-risk diabetics and providing accessible education to them in relation to their potential risk of treatment-induced hypoglycemia. The main addressed points in the suggested educational materials are the following points: perform BG checking before driving for those at risk of hypo, always carry a simple and complex carbohydrate snack to ensure a rapid correction of hypo and BG stability, ensure taking a pre-drive carbohydrate when BG is the below the normal range (70– 90 mg/dl) if planning a long driving trip, and to pull over at * Rima Tahhan Dr.rimatahhan@gmail.com