title: Motor vehicle crashes in diabetic patients with tight glycemic control: a population-based case control analysis.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  In this selected population, tighter glycemic control, as measured by the HbA1c, is associated with an increased risk of a motor vehicle crash.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada. dar@ices.on.ca
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
authors.forename: Anne B
authors.initials: AB
authors.lastname: Kenshole
authors.forename: Joel G
authors.initials: JG
authors.lastname: Ray
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000367:Age Factors; D000368:Aged; D001334:Automobile Driving; D001786:Blood Glucose; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin