Harsch I A, Stocker S, Radespiel-Tröger M, Hahn E G, Konturek P C, Ficker J H, Lohmann T
Department of Medicine I, Division of Endocrinology and Metabolism, Friedrich-Alexander University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.
J Intern Med. 2002 Oct;252(4):352-60. doi: 10.1046/j.1365-2796.2002.01048.x.
Insulin-treated patients with diabetes are at a higher risk than the general population in causing traffic accidents due to hypoglycaemias. Preceding investigations focused on insulin-treated patients and hypoglycaemia-induced accidents as "end-points". We studied the incidence of symptomatic hypoglycaemia and hypoglycaemia-induced accidents during driving and put it in relation to the different treatment modes of insulin therapy (Conventional Insulin Treatment = CT, Intensified Conventional Insulin Treatment = ICT, Continuous Subcutaneous Insulin Infusion = CSII) as well as to patients treated with oral hypoglycaemia-inducing agents and the two main types of diabetes mellitus.
We investigated 450 patients (122 treated with sulphonylureas, 151 with CT, 143 with ICT and 34 with CSII) by an anonymous questionnaire at different locations to avoid bias. A total of 176 persons had type 1 diabetes, 243 persons had type 2 diabetes, 31 subjects could not be classified.
Symptomatic hypoglycaemias during driving were rare events with an occurrence of 0.19-8.26 (minimal and maximal mean, depending on the mode of treatment), if given as hypoglycaemias per 100 000 km on one treatment regimen, or 0.02-0.63, if given as events per year driven. Their incidence increased significantly with the degree of "strictness" between the treatment groups, except between the patients treated with ICT and CSII. Hypoglycaemia-induced accidents are rare with 0.01-0.49, if given as events per 100 000 km and 0.007-0.01, if given as events per year driven. These differences were not significant. Significant confounders influencing the traffic safety of the patients were age, duration of diabetes and concomitant antihypertensive medication. Analysing the data in accordance with the type of diabetes revealed a significantly higher rate of hypoglycaemic events in patients with type 1 diabetes. The number of hypoglycaemia-induced accidents was considerably higher in this group, but failed slightly to reach statistical significance.
Hypoglycaemias during driving are rare events, their occurrence is significantly influenced by the treatment regimen and type of diabetes. Hypoglycaemia-induced accidents are extremely rare, presumably as a positive effect of patient education in our group.
接受胰岛素治疗的糖尿病患者因低血糖导致交通事故的风险高于普通人群。先前的研究聚焦于接受胰岛素治疗的患者以及以低血糖诱发事故作为“终点”。我们研究了驾驶期间有症状低血糖及低血糖诱发事故的发生率，并将其与胰岛素治疗的不同模式（常规胰岛素治疗=CT、强化常规胰岛素治疗=ICT、持续皮下胰岛素输注=CSII）以及接受口服降糖药治疗的患者和两种主要类型的糖尿病相联系。
我们通过匿名问卷在不同地点调查了450名患者（122名接受磺脲类药物治疗、151名接受CT治疗、143名接受ICT治疗、34名接受CSII治疗），以避免偏差。共有176人患有1型糖尿病，243人患有2型糖尿病，31名受试者无法分类。
驾驶期间有症状低血糖是罕见事件，发生率为0.19 - 8.26（最小和最大均值，取决于治疗模式），以每100000公里一种治疗方案的低血糖次数计，或以每年驾驶的事件数计为0.02 - 0.63。除ICT和CSII治疗的患者之间外，其发生率随治疗组间“严格程度”的增加而显著上升。低血糖诱发事故罕见，以每100000公里的事件数计为0.01 - 0.49，以每年驾驶的事件数计为0.007 - 0.01。这些差异不显著。影响患者交通安全的显著混杂因素为年龄、糖尿病病程和同时使用的抗高血压药物。根据糖尿病类型分析数据显示，1型糖尿病患者低血糖事件发生率显著更高。该组低血糖诱发事故的数量相当高，但略未达到统计学显著性。
驾驶期间低血糖是罕见事件，其发生受治疗方案和糖尿病类型的显著影响。低血糖诱发事故极其罕见，推测这是我们组患者教育的积极效果。
