Graveling A J, Warren R E, Frier B M
Department of Diabetes, Royal Infirmary of Edinburgh, Scotland, UK.
Diabet Med. 2004 Sep;21(9):1014-9. doi: 10.1111/j.1464-5491.2004.01288.x.
Hypoglycaemia impairs driving performance, so drivers with insulin-treated diabetes should try to avoid hypoglycaemia when driving, and treat it effectively if it occurs. It is not known how many insulin-treated drivers are familiar with, or adhere to, recommended safe practice.
We surveyed a representative sample of 202 current drivers with insulin-treated diabetes (115 with Type 1 diabetes), using a structured questionnaire. Data were obtained on driving history, estimated frequency of hypoglycaemia, and measures taken to avoid and treat hypoglycaemia when driving.
The licensing authority (DVLA) and motor insurance company had been informed by almost all participants. Sixty-four participants (31.7%) had experienced hypoglycaemia while driving, and 27 (13.4%) reported that this had occurred within the preceding year. A minimum blood glucose level of 4.0 mmol/l or higher was considered necessary for driving by 151 drivers (74.8%), and 176 (87.1%) reported always keeping carbohydrate in their vehicle. However, 77 (38.1%) reported never carrying a glucose meter when driving, and 121 (59.9%) that they never test blood glucose before driving, or test only if symptomatic of hypoglycaemia. Most participants (89%) would stop driving to treat hypoglycaemia and would not resume driving immediately, although only 28 (13.9%) would wait longer than 30 min. Almost half of participants were failing to observe at least one essential aspect of safe driving.
Compliance with statutory requirements to inform the licensing authority and motor insurer is good, and drivers' perceptions of the minimum safe blood glucose level for driving are encouraging. However, most drivers rely on symptoms to detect hypoglycaemia while driving, and seldom test blood glucose before driving. Patient education should emphasize the role of blood glucose monitoring in relation to driving, and highlight the potential deterioration in driving performance when blood glucose falls below 4.0 mmol/l.
低血糖会损害驾驶能力，因此接受胰岛素治疗的糖尿病患者在驾驶时应尽量避免低血糖，一旦发生应有效处理。目前尚不清楚有多少接受胰岛素治疗的驾驶者熟悉或遵守推荐的安全驾驶规范。
我们使用结构化问卷对202名接受胰岛素治疗的糖尿病现职驾驶者（115名1型糖尿病患者）进行了具有代表性的抽样调查。收集了驾驶历史、低血糖估计发生频率以及驾驶时为避免和处理低血糖所采取措施的数据。
几乎所有参与者都已通知了驾照颁发机构（英国驾驶员与车辆牌照局）和汽车保险公司。64名参与者（31.7%）在驾驶时经历过低血糖，27名（13.4%）报告称在前一年发生过。151名驾驶者（74.8%）认为驾驶时血糖水平至少需要达到4.0 mmol/l或更高，176名（87.1%）报告称车内总是备有碳水化合物。然而，77名（38.1%）报告称驾驶时从不携带血糖仪，121名（59.9%）表示他们驾驶前从不测血糖，或者仅在出现低血糖症状时才检测。大多数参与者（89%）会停车处理低血糖，且不会立即恢复驾驶，不过只有28名（13.9%）会等待超过30分钟。几乎一半的参与者未能遵守安全驾驶的至少一个重要方面。
在遵守通知驾照颁发机构和汽车保险公司的法定要求方面情况良好，驾驶者对安全驾驶的最低血糖水平的认知令人鼓舞。然而，大多数驾驶者在驾驶时依赖症状来检测低血糖，且很少在驾驶前测血糖。患者教育应强调血糖监测在驾驶方面的作用，并突出血糖低于4.0 mmol/l时驾驶能力可能下降的情况。
