ADA has warned against blanket driving restrictions, instead recommending individual assessment….
The American Diabetes Association (ADA) says that diabetes needn’t prevent someone from driving, and only a doctor should decide if complications are severe enough to keep an individual off the road.
In a new position statement published in the January issue of Diabetes Care, the association advises against blanket bans or restrictions. Instead, it recommends that patients who have issues that might pose a driving risk be assessed by a physician who normally cares for people with diabetes.
“There have been inappropriate pushes to try to restrict driving licensure for people with diabetes, and we were concerned that these recommendations were coming from people who didn’t really know diabetes, and were unnecessarily restrictive,” explained Dr. Daniel Lorber, chair of the writing group that developed the position statement and director of endocrinology at New York Hospital Queens in New York City.
“The vast majority of people with diabetes drive safely,” said Lorber. Currently, states have different laws concerning driving and diabetes, and the ADA would prefer to see a standard questionnaire used to assess driving safety.
Nearly 19 million people in the United States have been diagnosed with diabetes, a disorder involving blood sugar levels. The biggest concern about drivers with diabetes stems from the risk of low blood sugar (hypoglycemia), which can cause confusion and disorientation. While an episode of hypoglycemia can affect driving ability, the ADA says such incidences are rare.
An analysis of 15 previous studies on people with diabetes and driving found that overall, people with diabetes have between a 12 percent and 19 percent increased risk of a motor vehicle accident compared to the general driving population.
But, society tolerates riskier driving situations all the time. A 16-year-old boy has a 42 times higher risk of getting into a car accident than a 35- to 45-year-old woman, according to the ADA. People with attention-deficit hyperactivity disorder (ADHD) have about four times the car accident risk of the general public, while those with sleep apnea are about 2.4 times more likely to crash.
“The challenges are to identify high-risk individuals and develop measures to assist them to lower their risk for driving mishaps,” wrote the ADA committee.
For example, people with diabetes who take insulin are most at risk of hypoglycemia. The ADA recommends that people who take insulin test their blood sugar before driving and retest at regular intervals if they’re driving for longer than one hour.
“Patients with type 1 diabetes are really normal these days. There’s no reason to restrict their driving ability,” said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City. “Patients are very smart today, and have more technology to help them manage their diabetes and avoid hypoglycemia.”
For those at risk of serious hypoglycemia, the ADA recommends not starting an extended drive with low normal blood sugar levels (between 70 and 90 milligrams per deciliter) without consuming some carbohydrates to prevent against a drop in blood sugar while driving. The ADA also recommends having a fast-acting source of carbohydrate (fruit juice, hard candy or dextrose tablets) to quickly raise blood sugar available in the car and keeping an extra snack, such as cheese crackers, handy, too.
Other factors related to diabetes that could affect driving include diabetic eye disease (retinopathy) and nerve disease (peripheral neuropathy). Retinopathy can affect vision and neuropathy can impair the ability to feel the gas and brake pedals. If these complications are severe, driving may become an issue.
The ADA recommends that people with diabetes who may pose a risk while driving be evaluated by a doctor familiar with diabetes. If the condition threatens the driver’s ability to drive safely, doctors can provide information to state licensing agencies. The ADA doesn’t recommend mandatory physician reporting, because it may keep people with diabetes from discussing these issues with their doctor.
The bottom line for people with diabetes, said Lorber, is to “know what your sugar is before you start to drive, and don’t drive if you’re below 70 mg/dL.”
Daniel Lorber, M.D., director, endocrinology, New York Hospital Queens, New York City, member, Professional Practices Committee, and chair, writing group for the position statement on driving and diabetes, American Diabetes Association; Joel Zonszein, M.D., director, clinical diabetes center, Montefiore Medical Center, New York City; January 2012 Diabetes Care