The issue of traffic safety of patients with diabetes is rising on political as well as scientific levels. Driving by diabetic patients may be impaired by three factors: hyperglycemia, hypoglycemia, and diabetes complications. Management of diabetic patients is progressively aiming at near normoglycemia. Consequently, the rate of hypoglycemia and hypoglycemia unawareness has markedly increased. These factors could pose an increased threat to diabetic patients’ fitness to drive. Current legal restrictions regarding diabetes and driving privileges vary throughout the world, but laws are generally prompted by the impending danger of hypoglycemia during driving. To research the various aspects of diabetes and driving, several study methods have been applied. In consideration of dissenting opinions and laws, rules, and regulations, we will discuss in this article the currently available data on diabetes and driving, potential pitfalls in research, and give recommendations for future research. In modern traffic, the increasing age of drivers and their medical conditions can be risk factors for traffic incidents and accidents. The amounting prevalence of diabetes also leads to an increased number of diabetic drivers. Driving by diabetic patients may be impaired by three factors: hyperglycemia, hypoglycemia, and diabetes complications. In recent years, it has become apparent that acute hyperglycemia, and possibly also chronic hyperglycemia, may be associated with cognitive function loss. However, the cognitive dysfunction occurring during hypoglycemia is most striking. After the Diabetes Control and Complications Trial and the U.K. Prospective Diabetes Study, which showed that diabetes complications are reduced with tight glucose control, management of diabetic patients is progressively aiming at near normoglycemia. Consequently, the rate of hypoglycemia has increased. We now know that even a single episode of hypoglycemia leads to impaired hypoglycemia awareness. Hypoglycemia unawareness currently affects ~25% of patients with type 1 diabetes. The incidence of severe hypoglycemia in type 2 diabetes is lower but may approach the incidence in type 1 diabetes. Sequellae of diabetes complications (e.g., retinopathy, neuropathy) can impair driving capacity; retinopathy is associated with impaired vision, and its treatment with laser coagulation may reduce peripheral vision. Peripheral neuropathy may interfere with the operation of a vehicle. Eventually, the challenge will be to identify individual diabetic drivers who have an impaired fitness to drive. (Author/publisher)
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