title: The influence of new European Union driver's license legislation on reporting of severe hypoglycemia by patients with type 1 diabetes.
abstract: OBJECTIVE
  We test the hypotheses that the implementation in Denmark of new, stricter European Union (EU) legislation on driver's licensing, with the purpose to improve traffic safety in January 2012, has reduced the self-reported rate of severe hypoglycemia in a routine clinical setting and that anonymous reporting results in higher event rates.
  
  
  METHODS
  A cohort of 309 patients with type 1 diabetes was recruited in the outpatient clinic at Nordsjællands University Hospital Hillerød, Denmark. Yearly numbers of severe hypoglycemic events defined by need for treatment assistance from another person were retrieved from medical records in the years 2010 to 2012 and retrospectively reported in an anonymous questionnaire. Data from medical records in 2012 were compared with those from 2010 and 2011 and with data from the questionnaire.
  
  
  RESULTS
  Reported rates of severe hypoglycemia in the medical records were reduced by 55% in 2012 compared with the prior years (P = 0.034). The proportion of subjects reporting recurrent episodes was grossly reduced from 5.6 to 1.5% (P = 0.014). Compared with anonymous reporting in the questionnaire, the rate of severe hypoglycemia in 2012 was 70% lower (P < 0.001).
  
  
  CONCLUSIONS
  Reporting of severe hypoglycemia by patients with type 1 diabetes is significantly reduced following implementation of EU driver's licensing legislation that implies withdrawal of driver's licensing in case of recurrent episodes within 1 year. The resulting burden of concealed severe hypoglycemia may impair the safety of affected patients and unintentionally paradoxically reduce the general traffic safety.
authors.affiliation: Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ulpebj@noh.regionh.dk.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Pedersen-Bjergaard
authors.affiliation: Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Færch
authors.affiliation: Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Allingbjerg
authors.affiliation: Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Agesen
authors.affiliation: Department of Cardiology, Nephrology, and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Birger
authors.initials: B
authors.lastname: Thorsteinsson
mesh_terms: D000328:Adult; D000368:Aged; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D003430:Cross-Sectional Studies; D003718:Denmark; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D005062:European Union; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D008004:Licensure / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety / Q000331:legislation & jurisprudence; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents