How to Reduce Driving Mishaps in Patients with T1 Diabetes

Researchers have developed an identification tool and possible mishap prevention method for motor vehicle drivers with type 1 diabetes.

Because of the disruptive effects on cognitive-motor abilities when blood glucose levels are elevated, and because of chronic complications like retinopathy and neuropathy, which interfere with safe motor vehicle operations, drivers with type 1 diabetes are more likely to be involved in motor vehicle collisions and mishaps.

“Mishaps corresponded to the use of insulin pumps, a history of collisions, severe hypoglycemia, and hypoglycemia-related driving mishaps,” authors said, citing previous research.

In a recent study led by Daniel J. Cox, PhD, of the University of Virginia School of Medicine in Charlottesville, VA, researchers sought to A) identify drivers with type 1 diabetes at risk of future driving mishaps and B) to build an online intervention that could reduce mishaps among them.

In order to reach aim A, researchers recruited 1371 drivers from three regions in the United States who were diagnosed with type 1 diabetes and created a screening questionnaire in two phases — a development phase, which they called study 1, and a validation phase, called study 2.

Study 1 included questions about driving, and was followed by monthly check ins for a year to document any driving mishaps. A later analysis showed 11 items were predictive of which drivers were most likely to have mishaps. Those 11 items were used to create the Risk Assessment of Diabetic Drivers (RADD) — “a psychometrically sound instrument,” that identified about one third of the participants as having a higher risk of mishaps.

Study 2 was carried out between March 2012 and June 2013. A total of 493 people participated, and of those 240 were assigned to receive routine care, and were further divided by risk, with 122 being classified as high risk (HR) and 118 low risk (LR). Participants recorded driving mishaps for the next 12 months.

“In study 2, participants in the HR group reported that their passengers intervened 111 times because they perceived that the driver was impaired,” researchers wrote. However, passengers only intervened 27 times in the LR group.

To investigate aim B, the validation of RADD, the researchers randomized participants in the HR group to one of three groups: routine care, the internet intervention DiabetesDriving.com (DD.com), or DD.com combined with motivational interviewing (MI). “These participants were compared with the LR participants receiving RC in study 2, as they related to aim A,” authors wrote.

The internet intervention DD.com consisted of five units, as well as a “tool kit” which was mailed to the participants. The tool kit contained “1) a predriving checklist that focused on considering whether BG [blood glucose] is or may become low during the drive; 2) glucose sources, both fast-acting and long-acting; 3) a keychain with a stoplight logo to remind drivers of BG benchmarks; 4) stoplight logo stickers to place on the dashboard or near their car keys; 5) a BG meter to encourage self-monitoring of BG before and during long drives,” according to the authors.

The MI sessions were supposed to encourage the participants to complete all five units, and the assigned homework, of DD.com. They were conducted by phone, were semistructured and partially scripted.

“Participants from the LR and HR groups receiving RC, the DD.com group, and the DD.com + MI group completed 98%, 94%, 77%, and 78% of all monthly driving diaries, respectively,” researchers reported.

Participants in both the DD.com group and the RC group improved equally, and the researchers pointed out that “DD.com only affected hypoglycemia-related driving mishaps, not hyperglycemia- or non-diabetes-related mishaps.”

It is possible that simply participating in the study helped those in the RC group become more aware of risks related to driving and thereby lowered the number of mishaps.

The authors concluded by noting that this group of studies shows that it is possible to identify those drivers with type 1 diabetes at a higher risk of having driving mishaps, and to intervene and lower the number of mishaps using DD.com. The full study can be found in the journal Diabetes Care, which is published by the American Diabetes Association.

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