Lonnen K F, Powell R J, Taylor D, Shore A C, MacLeod K M
Diabetes and Vascular Research, Institute of Biomedical and Clinical Science, Peninsula Medical School, Exeter, UK.
Diabet Med. 2008 May;25(5):578-84. doi: 10.1111/j.1464-5491.2008.02409.x.
Progressive restrictions placed on insulin-treated patients with diabetes exclude them from driving group 2 and class C1 and D1 vehicles. This reflects an assumption that an increased risk of hypoglycaemia in these patients will cause road traffic accidents. These restrictions have been implemented without any consistent evidence that this is the case. The aim of the study was therefore to investigate whether the rate of road traffic collisions in insulin-treated patients was higher than that of the non-diabetic population using a population register-based study.
A historical cohort study combined information from the Devon and Cornwall Constabulary database on road traffic collisions with the district wide retinal screening database, to provide an anonymized matched database of road traffic collisions in the diabetic population. Accident rates were calculated in the diabetic population and compared to rates in the non-diabetic population using relative risks.
The estimated overall annual accident rate for the non-diabetic population was 1469 per 100,000 vs. 856 per 100,000 for the diabetic population as a whole (Chi-squared, P < 0.001). On stratification of the groups by age, within the insulin-treated group there was no significant difference in the accident rate compared to the non-diabetic population, with relative risks between 0.51 [confidence interval (CI) 0.25-1.05] and 1.13 (CI 0.88-1.46).
Our findings suggest that insulin-treated patients as a group do not pose an increased risk to road safety. They reiterate the need for an individualized risk-based assessment when considering driving restrictions.
对接受胰岛素治疗的糖尿病患者实施的渐进性限制措施，使其无法驾驶2类以及C1和D1级车辆。这反映出一种假设，即这些患者低血糖风险增加会导致道路交通事故。这些限制措施在实施时并未有任何一致的证据表明情况确实如此。因此，本研究的目的是通过一项基于人群登记的研究，调查接受胰岛素治疗的患者的道路交通事故发生率是否高于非糖尿病人群。
一项历史性队列研究将德文郡和康沃尔郡警察局数据库中关于道路交通事故的信息与全区视网膜筛查数据库相结合，以提供一个匿名的糖尿病患者道路交通事故匹配数据库。计算糖尿病患者人群的事故发生率，并使用相对风险将其与非糖尿病患者人群的发生率进行比较。
非糖尿病患者人群的估计年事故发生率为每10万人1469起，而整个糖尿病患者人群为每10万人856起（卡方检验，P<0.001）。按年龄对各组进行分层后，在接受胰岛素治疗的组中，与非糖尿病患者人群相比，事故发生率没有显著差异，相对风险在0.51[置信区间（CI）0.25 - 1.05]和1.13（CI 0.88 - 1.46）之间。
我们的研究结果表明，作为一个群体，接受胰岛素治疗的患者对道路安全并不构成更高的风险。这些结果重申了在考虑驾驶限制时进行基于个体风险评估的必要性。
