New report on driving with type 2 diabetes

A new report published this week by the Transport Research Laboratory (TRL), funded by MSD, is calling on NICE to recommend that doctors ask their type 2 diabetes patients if driving is part of their work, in order to optimise medicines management to reduce the risk of hypoglycaemia events while driving. 

“The forgotten risk of driving with hypoglycaemia in type 2 diabetes” examines the social and economic impact of hypoglycaemia (low blood sugar) in drivers with type 2 diabetes and, specifically, how it affects safe driving. The report found that hypoglycaemia is a significant risk factor and highlights that direct costs of severe hypoglycaemia for those with type 2 diabetes amount to £16.4 million per year.

As part of the TRL report, new patient research has been commissioned amongst 1,500 people being treated for type 2 diabetes. The research showed that nearly two thirds (61%, n=60/99) of drivers on SUs with poor management of their diabetes experience more than three severe hypoglycaemic episodes per year; a severe hypoglycaemic episode is one which requires assistance from a third-party. By comparison, 35% (n=39/113) of those with average management of their diabetes experienced the same number of episodes per year. These figures are likely to be higher given the underreporting of such incidents. Just over a quarter (27%, n=89/332) of people with type 2 diabetes spoke to their doctor about hypoglycaemia and driving. While this figure increases for people taking SUs and glinides who drive as part of their profession, studies show that 37% (n=100/272) still do not talk to their doctors about hypoglycaemia and driving. 

Specific older diabetes medicines, such as SUs and glinides, may increase the risk of hypoglycaemia. 48% (n=47/99) of drivers that are on SUs and glinides and who have experienced a severe hypoglycaemic episode (or “hypo”) have had to take a day off sick from work. Despite this, awareness of hypos and their cause was found to be low with only 24% (n=58/243) of people with type 2 diabetes recognising the symptoms of a severe episode. Driving when experiencing symptoms of hypoglycaemia can cause serious consequences. According to police notifications received by Driving and Vehicle Licensing Agency (DVLA), there are around 45 serious events a month and five fatal crashes a year involving hypoglycaemia; however, this is believed to be a substantial underestimate of the true figure. Findings show that just 7% of drivers with type 2 diabetes stated that they had notified the DVLA of hypoglycaemic events, rising to just 10% of business and work drivers treated with an SU and glinides.

“Patients with type 2 diabetes who experience hypoglycaemic episodes are very hesitant about speaking with the doctor”, explains Dr Srikanth Bellary, “because they worry this will automatically lead to a review of their driving licence and a potential loss of livelihood. In actual fact, the risk of hypoglycaemia can be reduced taking simple precautions before driving or using alternative medicines available, allowing the patient to maintain good glucose control and continue to live their life. Until patients feel more confident however, it’s really up to the doctor to raise this issue proactively with their patients, so that a solution can be found quickly.”

The report is backed by Rob Flello, MP and Chair of the All-Party Parliamentary Group for Freight Transport, and also calls for the Driving and Vehicle Licensing Agency to provide clear guidance on how affected drivers can prevent hypoglycaemia through speaking with their doctor. Commenting on the report, Mr Flello stated, “This report highlights the potential dangers that drivers with type 2 diabetes may face if they do not seek medical advice to reduce their risk of hypoglycaemia, which I believe is a common side effect of many older diabetes medicines. Unfortunately, some people with type 2 diabetes are not telling their doctor if they experience a hypoglycaemic event behind the wheel, either because they are scared they will lose their driving licence or because of a lack of information on the condition. We really need doctors and patients to speak openly about the signs of hypoglycaemia, so the patient can receive the right advice to manage their diabetes effectively.”

As well as significant patient health benefits, tighter control of hypoglycaemia would benefit the wider health economy. Commenting on the report, lead author, Andrew Parkes, Chief Scientist at the Transport Research Laboratory said, “Better management of hypoglycaemia could have significant benefits for both patient care, and also use of finite NHS resources. It is estimated that the NHS spends £10 billion on diabetes each year, or £1 million per hour, 80% of this spending goes in to managing potentially preventable complications, including hypoglycaemia. Our report looks at ways that this burden can be reduced by encouraging healthcare professionals to help patients spot the signs of hypoglycaemia early and making the necessary changes to the patient’s treatment in order for them to maintain their driving licence and potential livelihood”.

The report calls for the following:

• For NICE to advise healthcare professionals to ask patient with type 2 diabetes if driving is part of their work and to consider this when prescribing medications
• For people with type 2 diabetes to be given appropriate education on the causes and risks of hypoglycaemia and the management of type 2 diabetes to empower them to speak with the HCP about medicines review
• For the Ambulance Service to collect data about hypoglycaemia in a consistent format so that the hidden risk of hypoglycaemia can be compared across regions and integrated into the patient pathway
• For the DVLA, as a trusted source of information, to provide clear and simple guidance on its website advising drivers of ways to prevent hypoglycaemia through speaking to their HCPs