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Abstract
Complications from diabetes mellitus can compromise a driver's ability to safely operate a motor vehicle, yet little is known about whether euglycemia predicts normal driving risks among adults with diabetes. We studied the association between glycosylated hemoglobin (HbA1c) and the risk of a motor vehicle crash using a population-based case control analysis. We identified consecutive drivers reported to vehicle licensing authorities between January 1, 2005 to January 1, 2007 who had a diagnosis of diabetes mellitus and a HbA1c documented. The risk of a crash was calculated taking into account potential confounders including blood glucose monitoring, complications, and treatments. A total of 57 patients were involved in a crash and 738 were not involved in a crash. The mean HbA1c was lower for those in a crash than controls (7.4% versus 7.9%, unpaired t-test, p = 0.019), equal to a 26% increase in the relative risk of a crash for each 1% reduction in HbA1c (odds ratio = 1.26, 95% confidence interval 1.03-1.54). The trend was evident across the range of HbA1c values and persisted after adjustment for measured confounders (odds ratio = 1.25, 95% confidence interval 1.02-1.55). The two other significant risk factors for a crash were a history of severe hypoglycemia requiring outside assistance (odds ratio = 4.07, 95% confidence interval 2.35-7.04) and later age at diabetes diagnosis (odds ratio per decade = 1.29, 95% confidence interval 1.07-1.57). In this selected population, tighter glycemic control, as measured by the HbA1c, is associated with an increased risk of a motor vehicle crash.
Highlights
Diabetic patients account for substantial amounts of driving
If diabetic drivers were identical to average American adults, the baseline risk of a serious crash would be about one in 20 per year [6]. This number would amount to about five diabetic drivers killed and another 50 incapacitated each day from motor vehicle crashes in the United States
Candidates were identified from mandatory annual reviews submitted by drivers who held commercial licenses or mandatory reports submitted in the aftermath of a documented motor vehicle crash
Summary
At a population disease prevalence of 5% to 7% for this diagnosis, general mobility statistics would suggest that diabetic patients drive about 250 million miles during the average day in the United States [1,2]. Such distances are extraordinary— greater than traveling from the earth to the sun and back [3]. Type 1 diabetes occurs when the body’s immune system prevents the production of insulin, the hormone that controls blood glucose It accounts for 5%–10% of diabetes cases in adults and the vast majority of cases in childhood. As obesity rates rise worldwide, it is expected that the prevalence of type 2 diabetes will increase
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