posted 11/01/02
While the risk of causing
traffic accidents through hypoglycemia is higher in insulin-treated diabetics
than in the general population, it is rare for such events to occur during
driving.
German researchers suggest the type of diabetes and treatment regimen have a
significant influence on such episodes. They add that the extreme rarity of
hypoglycemia-induced accidents could be related to the positive effect of
patient education.
In this study, 450 patients at different locations completed anonymous
questionnaires for investigators at Friedrich-Alexander University Erlangen-Nuremberg,
Erlangen and Department of Medicine I, Klinikum Furth, Furth, Germany.
Different treatment modes of insulin therapy were studied in relation to driving
and the incidence of symptomatic hypoglycemia and hypoglycemia-induced
accidents.
Of these subjects 122 were treated with sulphonylureas, 151 with conventional
insulin treatment (CT), 143 with intensified conventional insulin treatment (ICT)
and 34 with continuous subcutaneous insulin infusion (CSII). They included
patients treated with oral hypoglycemia-inducing agents and those with the two
main types of diabetes mellitus.
Type 1 diabetes was seen in 176 subjects, type 2 diabetes in 243 and no
classification was possible in the remaining 31.
Events of symptomatic hypoglycemias during driving were found to be rare.
If given as hypoglycemias per 100,000 km on one treatment regimen, the
occurrence was 0.19-8.26, minimal and maximal mean - depending on the mode of
treatment. If given as events per year driven the occurrence was 0.02-0.63.
Apart from patients treated with ICT and CSII, there was a significant increase
in the incidence according to the degree of 'strictness' between the treatment
groups. If given as events per 100 000 km, hypoglycemia-induced accidents were
rare at 0.01-0.49 and, as events per year driven, 0.007-0.01.
There was no significance in these differences.
Subjects age, duration of diabetes and concomitant antihypertensive medication,
however, were significant confounders influencing the traffic safety.
A significantly higher rate of hypoglycemic events was seen in those with type 1
diabetes by analyzing the data according to the type of diabetes.
Although the number of hypoglycemia-induced accidents in this group was
considerably higher it was not quite statistically significant, say the
researchers.
Source: Diabetes In Control Dot Com: J Intern Med 2002 Oct;252(4):352-360.
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