title: Diabetes and driving mishaps: frequency and correlations from a multinational survey.
abstract: OBJECTIVE
  The intensive treatment of diabetes to achieve strict glycemic control is a common clinical goal, but it is associated with an increased incidence of hypoglycemia. Becoming hypoglycemic while driving is a hazardous condition and may lead to a greater incidence of driving mishaps. This study investigated whether diabetes is associated with increased risk of driving mishaps and correlates of such a relationship.
  
  
  METHODS
  During routine visits to diabetes specialty clinics in seven U.S. and four European cities, consecutive adults with type 1 diabetes, type 2 diabetes, and nondiabetic spouse control subjects (n = 341, 332, and 363, respectively) completed an anonymous questionnaire concerning diabetes and driving.
  
  
  RESULTS
  Type 1 diabetic drivers reported significantly more crashes, moving violations, episodes of hypoglycemic stupor, required assistance, and mild hypoglycemia while driving as compared with type 2 diabetic drivers or spouse control subjects (P < 0.01-0.001). Type 2 diabetic drivers had driving mishap rates similar to nondiabetic spouses, and the use of insulin or oral agents for treatment had no effect on the occurrence of driving mishaps. Crashes among type 1 diabetic drivers were associated with more frequent episodes of hypoglycemic stupor while driving, less frequent blood glucose monitoring before driving, and the use of insulin injection therapy as compared with pump therapy. One-half of the type 1 diabetic drivers and three-quarters of the type 2 diabetic drivers had never discussed hypoglycemia and driving with their physicians.
  
  
  CONCLUSIONS
  Type 1 diabetic drivers are at increased risk for driving mishaps, but type 2 diabetic drivers, even on insulin, appear not to be at a higher risk than nondiabetic individuals. Clinical and treatment factors appear to increase risk, e.g., more frequent hypoglycemia while driving, method of insulin delivery, and infrequent self-testing before driving. Physicians are encouraged to talk to their type 1 diabetic patients about hypoglycemia and driving.
authors.affiliation: University of Virginia Health System, Charlottesville 22908, USA. djc4f@virginia.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cox
authors.forename: Jennifer Kim
authors.initials: JK
authors.lastname: Penberthy
authors.forename: John
authors.initials: J
authors.lastname: Zrebiec
authors.forename: Katie
authors.initials: K
authors.lastname: Weinger
authors.forename: James E
authors.initials: JE
authors.lastname: Aikens
authors.forename: Brian
authors.initials: B
authors.lastname: Frier
authors.forename: Barbara
authors.initials: B
authors.lastname: Stetson
authors.forename: Mary
authors.initials: M
authors.lastname: DeGroot
authors.forename: Paula
authors.initials: P
authors.lastname: Trief
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schaechinger
authors.forename: Norbert
authors.initials: N
authors.lastname: Hermanns
authors.forename: Linda
authors.initials: L
authors.lastname: Gonder-Frederick
authors.forename: William
authors.initials: W
authors.lastname: Clarke
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology