Diabetes and driving. Performance, decision making and legal aspects

In this thesis, the current state regarding diabetes and driving is discussed, and recommendations for further research are made. Subsequently, studies are described, demonstrating that patients with type 1 diabetes with normal and with impaired hypoglycaemia awareness, as well as patients with type 2 diabetes with normal hypoglycaemia awareness, have normal driving performance during euglycaemia, as well as during moderate hypoglycaemia, although in type 2 diabetic patients more effort is required to do so. However, it is also shown that the decision not to drive during hypoglycaemia is not always adequately made in type 1 patients with impaired hypoglycaemia awareness and by type 2 diabetic patients, particularly when using oral hypoglycaemic agents. The importance of good and tailored patient education is stressed. For methodological purposes, a practical algorithm to establish and maintain euglycaemia is studied. Moreover, the HemoCue glucose analyser is studied, and it is shown that it can be used interchangeably with the frequently used standard glucose oxidase method. Finally, the Dutch law is discussed, and discrepancies between the law and its execution by the Central Vehicle Licensing Agency (CBR) are noted. Recommendations are made for legislators, licensing authorities and medical advisors in the Netherlands and throughout the world to evaluate their legislature, and amend it according to current and emerging insights.

[1]  M. Agarwal,et al.  Evaluation of a glucose meter against analytical quality specifications for hospital use. , 2004, Clinica chimica acta; international journal of clinical chemistry.

[2]  Michael J. Pencina,et al.  Trends in the Incidence of Type 2 Diabetes Mellitus From the 1970s to the 1990s: The Framingham Heart Study , 2006, Circulation.

[3]  G. Van den Berghe,et al.  Intensive insulin therapy in the medical ICU. , 2006, The New England journal of medicine.

[4]  Timothy W. Evans,et al.  Glucose Control and Mortality in Critically Ill Patients , 2003 .

[5]  Edwin A M Gale.  The rise of childhood type 1 diabetes in the 20th century. , 2002, Diabetes.

[6]  Bogdan Solnica,et al.  Analytical performance of glucometers used for routine glucose self-monitoring of diabetic patients. , 2003, Clinica chimica acta; international journal of clinical chemistry.

[7]  M Schetz,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[8]  W. Wosniok,et al.  Comparison of Several Point-of-Care Testing (POCT) Glucometers with an Established Laboratory Procedure for the Diagnosis of Type 2 Diabetes Using the Discordance Rate. A New Statistical Approach , 2003, Clinical chemistry and laboratory medicine.

[9]  D. Cox,et al.  Evaluating Clinical Accuracy of Systems for Self-Monitoring of Blood Glucose , 1987, Diabetes Care.

[10]  H. King,et al.  Global Burden of Diabetes, 1995–2025: Prevalence, numerical estimates, and projections , 1998, Diabetes Care.

[11]  Icek Ajzen,et al.  From Intentions to Actions: A Theory of Planned Behavior , 1985 .

[12]  R. Hawkins,et al.  Evaluation of Roche Accu-Chek Go and Medisense Optium blood glucose meters. , 2005, Clinica chimica acta; international journal of clinical chemistry.

[13]  E. Moberg,et al.  How accurate are home blood-glucose meters with special respect to the low glycemic range? , 1993, Diabetes research and clinical practice.

[14]  W. Tamborlane,et al.  Effect of Intensive Insulin Therapy on Glycemic Thresholds for Counterregulatory Hormone Release , 1988, Diabetes.

[15]  R. Holman,et al.  Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) , 1998, The Lancet.

[16]  B. Frier,et al.  Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. , 2005, Diabetes care.

[17]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[18]  D. Chan,et al.  Laboratory and bedside evaluation of portable glucose meters. , 1995, American journal of clinical pathology.

[19]  S. Haffner,et al.  Rapid rise in the incidence of type 2 diabetes from 1987 to 1996: results from the San Antonio Heart Study. , 1999, Archives of internal medicine.

[20]  P. Donnan,et al.  Frequency and predictors of hypoglycaemia in Type 1 and insulin‐treated Type 2 diabetes: a population‐based study , 2005, Diabetic medicine : a journal of the British Diabetic Association.

[21]  T. Koepsell,et al.  Increasing incidence of serious hypoglycemia in insulin users. , 2002, Journal of clinical epidemiology.

[22]  R. Weitgasser,et al.  Newer portable glucose meters--analytical improvement compared with previous generation devices? , 1999, Clinical chemistry.

[23]  A. Morris,et al.  Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. , 2003, Diabetes care.

[24]  J Herlitz,et al.  Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. , 1995, Journal of the American College of Cardiology.