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Type 1 Diabetics at Risk of Car Accidents

Fluctuating blood sugar levels to blame, study says

(HealthDay is the new name for HealthScoutNews.)

MONDAY, Aug. 4, 2003 (HealthDayNews) -- Drivers with type 1 diabetes may be more prone to car crashes than healthy folks.

That's the finding of one of the first studies using modern testing techniques to look at how this disease may affect the skills needed for safe driving.

In the study, doctors from the University of Virginia Health System also report that people with type 2 diabetes aren't accident prone, even if they're taking insulin.

"Type 1 diabetic drivers reported significantly more crashes, moving violations, episodes of hypoglycemic stupor [caused by extremely low blood sugar], and required assistance while driving compared to type 2 diabetics or spouse-control subjects," writes lead author Daniel J. Cox, a researcher with the University of Virginia Health System.

But experts caution that the study, which appears in the August issue of Diabetes Care, shouldn't be used to discriminate against diabetics.

Type 1 diabetes develops when the pancreas can no longer manufacture insulin, the hormone necessary to move sugar out of the blood and into tissues where it supplies energy. To compensate, those with type 1 diabetes must rely on an outside source of insulin, usually in the form of injections several times a day.

In type 2 diabetes, the body manufactures enough insulin, but is not able to efficiently utilize it. So, compensation involves medications that increase insulin sensitivity or, in some instances, supplemental insulin.

As the researchers explain, when insulin levels aren't well-controlled, there's the potential for blood sugar levels to either rise too high or drop too low. And they strongly infer that the drop in blood sugar more commonly seen in type 1 diabetes may precipitate the driving dangers.

"There's always the concern that patients who experience low blood sugar -- hypoglycemia -- may be at greater risk when driving or performing other tasks that require mental concentration and high performance," says Dr. Kenneth Hupart, chief of endocrinology, metabolism and diabetes at Nassau University Medical Center in East Meadow, N.Y.

"If you're driving during a period of hypoglycemia, for example, your reaction time and judgment might be impaired," Hupart explains.

Although people with type 2 diabetes are also prone to episodes of low blood sugar, Hupart says it happens far less frequently, and usually to a lesser degree -- one possible reason why this group did not appear to have any greater increase in driving risks.

The study involved 1,036 participants from seven diabetes specialty-care centers across the United States, as well as four centers in major European cities. At each center, people with either type 1 or type 2 diabetes, as well as their non-diabetic spouses, were asked to fill out an anonymous questionnaire concerning both their driving record and their diabetes history for the two years prior to the survey.

According to Cox, the questions included the number of automobile accidents and moving violations, the number of times driving assistance was required due to low blood sugar, and how often the patient drove while experiencing severe low blood sugar.

Also included were questions testing the patients knowledge of low blood sugar levels, and whether they routinely tested their blood sugar levels before getting behind the wheel.

The final analysis: When compared to drivers with type 2 diabetes, as well as non-diabetic drivers, people with type 1 diabetes were at what the researchers called "significant risk" for driving accidents.

Hupart says the study results could be instrumental in developing guidelines to reduce risks on the road.

"Hopefully it can offer a road map for improved patient counseling, wherein doctors can help those patients at highest risk of accidents alter their behaviors in such a way that this risk can decrease," Hupart says.

For example, he says, doctors could point out levels of blood glucose that would be considered dangerous or unsafe when driving, and then encourage patients who are at risk to pay attention to their own sugar levels before getting behind the wheel.

At the same time, however, he cautions against this or other similar studies being used to discriminate against those with diabetes.

"We don't want to promote unjustified discrimination against diabetics in our society, when it may not be appropriate, and when there may be a way of identifying the risk and lowering that risk," he says.

More information

For general information about diabetes, visit The American Diabetes Association (ADA). For more on low blood sugar, check the ADA's section on hypoglycemia.

SOURCES: Daniel J. Cox, researcher, University of Virginia Health System, Charlottesville; Kenneth Hupart, M.D., chief, endocrinology, metabolism and diabetes, Nassau University Medical Center, East Meadow, N.Y.; August 2003 Diabetes Care
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